FORM 28 SC R 3 /1 8 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS County Court District Court County, Colorado Court address: Plaintiff(s): v. Defendant(s): COURT USE ONLY (Name and Address): Phone Number: E - mail: FAX Number: Atty.Reg. #: Case Number: Division Courtroom OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS Instructions to Judgment Debtor: Use this form to object to the calculations of your exempt earnings. Name : Phone Number: Street Address : Mailing Address, i f different: City: State: Zip Code: EXEMPTION CHART or federal minimum wage, whichever is greater.) PAY PERIOD Weekly Bi - Weekly Semi - monthly Monthly AMOUNT EXEMPT IS THE GREATER OF: 30 x Minimum Hourly Wage or 75% of Disposable Earnings 60 x Minimum Hourly Wage or 75% of Disposable Earnings 65 x Minimum Hourly Wage or 75% of Disposable Earnings 130 x Minimum Hourly Wage or 75% of Disposable Earnings 1. because I believe that the correct calculation is : Gross Earnings for My Pay Period from thru $ Less Deductions Required by Law (For Example, Withholding Taxes, FICA) - $ Disposable Earnings (Gross Earnings Less Deductions) = $ Less Statutory Exemption (Use Exemption Chart on Writ) - $ Net Amount Subject to Garnishment = $ Less Wage/Income Assignment(s) Dur ing Pay Period (If Any) - $ Amount which should be withheld = $ OR 2. The earnings garnished are pension or retirement benefits/deferred compensation/health, accident or disability insurance a nd they are totally exempt because : I understand that I must make a good faith effort to resolve my dispute with the Garnishee. I have have not attempted to resolve this dispute with the Garnishee. Name of Person I Talked to: Position: Phone Number: American LegalNet, Inc. www.FormsWorkFlow.com FORM 28 SC R 3 /1 8 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS : Even though I am filing this Objection, you are directed to send my none xempt earnings Garnishment. The Court will hold my nonexempt earnings in its registry until my Objection is resolved. I certify that the ab ove is correct to the best of my knowledge and belief and that I sent a copy of this document by certified mail ( return receipt requested ) to both the Garnishee and to the Judgment Creditor, or if the Judgment Creditor is represented by Counsel, E - Service By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledgin g that I have made a change to the original content of this form . Garnishee J udgment Creditor or Attorney Address: Address: Signature of Judgment Debtor or American LegalNet, Inc. www.FormsWorkFlow.com