Office of the Sheriff
St. Louis County 7900 Carondelet Avenue Clayton, MO 63105
JUDGMENT DEBTOR'S CLAIM FOR EXEMPTION
IN THE CIRCUIT COURT OF ST. LOUIS COUNTY, MISSOURI
Jim Buckles, Sheriff
Date: ________________ Cause Number: ________________
Garnishment Number: ________________
_______________________________________________
Plaintiff/Petitioner
vs. _______________________________________________
Judgment Debtor I, _____________________________________, hereby notify the Sheriff of St. Louis County, Missouri, that I am claiming my exemption of the below named items in accordance with the exemption laws of the State of Missouri, found in Chapter 513 of the Revised Statutes of Missouri.
Head of Household (Section 513.440 RSMo) $1,250.00 Number of dependent children under the age of (18) ______ @ $350.00/child $___________ Section 513.430 RSMo, ALL FUNDS or $_____________ per month as follows:
Social Security Disability
Child Support Unemployment
SSI
Retirement/Pension
Other _____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________ ________________________________
Judgment Debtor's Signature
NOTE TO JUDGMENT DEBTOR: The plaintiff (or plaintiff's attorney) has ten (10) days in which to notify the Sheriff of any objection to the exemptions claimed above. Subscribed and sworn to before me this _________day of _______________________, 20______. ___________________________________ Notary Public
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My Commission Expires: _______________
(314) 615-4724
FACSIMILE: (314) 615-2548
TTY: (314) 615-4567