Free AFFIDAVIT RE - Connecticut


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AFFIDAVIT RE: EXEMPT FUNDS
JD-CV-73 New 2-02 C.G.S 52-367b, P.A. 01-196

CONNECTICUT JUDICIAL BRANCH

COURT USE ONLY

SUPERIOR COURT
www.jud.ct.gov

AFFEXE

INSTRUCTIONS Complete and present to the clerk of court where the action is pending.
DOCKET NO. NAME OF CASE (FIRST-NAMED PLAINTIFF V. FIRST-NAMED DEFENDANT)

Judicial District at:
ADDRESS OF COURT

Small Claims Area at:

Housing Session at:

G.A. at:

AFFIDAVIT RE: EXEMPT STATUS OF FUNDS The undersigned duly deposes and says that he/she is the in the

1. I am over the age of eighteen and believe in the obligation of an oath. 2. I believe that the judgment debtor's account contains funds which are not exempt from execution because: (Explain the facts on which you base your belief.)

3. The amount that I believe is not exempt is: $

.

I request a hearing on this matter. I hereby certify that the foregoing statements are true to the best of my knowledge and belief.
SIGNED (Affiant)

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SIGNED (Clerk, Commissioner of Superior Court, Notary Public)

Subscribed and sworn to before me on:

DATE

COURT ORDER (For Court Use Only) Having reviewed this affidavit, I find that: The judgment creditor HAS demonstrated a reasonable belief that the judgment debtor's account contains funds which are not exempt from execution. The judgment creditor IS authorized to submit a written application to the clerk for a hearing on the exempt status of funds. The judgment creditor HAS NOT demonstrated a reasonable belief that the judgment debtor's account contains funds which are not exempt from execution. The judgment creditor IS NOT authorized to submit a written application to the clerk for a hearing on the exempt status of funds.
BY (Judge of the Superior Court) DATE FOR COURT USE ONLY

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