Claim Of Exemption And Request For Hearing

Joseph E. Smith Clerk of the Circuit Court St. Lucie County, Florida County Civil division 250 N.W. Country Club Drive Port Saint Lucie, Florida 34986 (772) 785-5880 In the County Court, Nineteenth Judicial Circuit, in and for County of St. Lucie, State of Florida ­ Civil Division Case No. ___________________________________________ PLAINTIFF VS ____________________________________________ DEFENDANT. CLAIM OF EXEMPTION AND REQUEST FOR HEARING I claim exemption from garnishment under the following categories as checked: ______ 1. Head of family wages. (Check either a. or b. below, if applicable) ______ a. I provide more than one-half of the support for a child or other dependent and have net earnings of $750. or less per week. ______ b. I provide more than one-half of the support for a child or other dependent, have net earnings or more than $750. per week, but have not agreed in writing to have my wages garnished. ______ 2. Social Security benefits ______ 3. Supplemental Security Income benefits ______ 4. Public assistance (welfare) ______ 5. Workers' Compensation ______ 6. Reemployment assistance or unemployment compensation ______ 7. Veterans' benefits ______ 8. Retirement or profit-sharing benefits or pension money ______ 9. Life insurance benefits or cash surrender value of a life insurance policy or proceeds of annuity contract ______ 10. Disability income benefits ______ 11. Prepaid College Trust Fund or Medical Savings Account ______ 12. Other exemptions as provided by law (Explain):________________________________________________________________________ I request a hearing to decide the validity of my claim. Notice of hearing should be given to me at: Address:________________________________________________________________________________________ Telephone number: _____________________________________________________________________________ I CERTIFY UNDER OATH AND PENALTY OF PERJURY that a copy of this CLAIM OF EXEMPTION AND REQUEST FOR HEARING has been furnished by (circle one) United States mail or hand delivery on __________________, 20_____, to: (insert names and addresses of Plaintiff or Plaintiff's attorney and of Garnishee or Garnishee's attorney to whom this document was furnished) ____________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ I FURTHER CERTIFY UNDER OATH AND PENALTY OF PERJURY that the statements made in this request are true to the best of my knowledge and belief. _________________________________________ DEFENDANT'S SIGNATURE __________________________________ DATE STATE OF FLORIDA COUNTY OF ________________ Sworn and subscribed to before me this _______ day of ___________________________________, 20_____. _________________________________________ Notary Public / Deputy Clerk Personally know ____ or produced identification ____ Type of Identification produced ________________ Updated 07/01/2013 American LegalNet, Inc. www.FormsWorkFlow.com By:_______________________________________