FINANCIAL INSTITUTION EXECUTION PROCEEDINGS - JUDGMENT DEBTOR WHO IS A NATURAL PERSON, APPLICATION AND EXECUTION JD-CV-24 Rev. 2-15 C.G.S. §§ 52-356b, 52-367b P.A. 14-7, 14-9 STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov (See page 2 for instructions to financial institution and ADA Notice) Instructions - Clerk *APFEABA* *APFEABA* *EXISSUE* *EXISSUE* Instructions - Judgment Creditor Or Attorney 1. Type or print legibly. 2. Complete the application section; prepare original and 2 copies. 3. Complete section 1 of the Exemption Claim Form, JD-CV-24a and attach to this form. 4. Present original and 1 copy to clerk of court. Retain a copy. Address of court Judicial district 1. Check the file to ensure that the information provided on the application is correct. 2. Sign original execution. 3. Return original to applicant, retain a copy for file. Docket number Geographic area Housing session number Name and mailing address of Judgment Creditor or Attorney (To be completed by Judgment Creditor) Name(s) and address(es) of Judgment Creditor(s) Fold Application Name(s) and address(es) of Judgment Debtor(s) Date of judgment 1. Amount of judgment 4. Total amount paid (If any) 3. Amount of judgment, costs and fees (Add 1 and 2) (Include, where applicable, 2. Amount of costs prejudgment interest and attorney's fees) 5.Total amount unpaid (Subtract 4 from 3) 6. Application fee for financial institution execution (If not waived by the court) 9.Total of items 5, 6, 7 and 8 7. Application fees paid for prior executions on this judgment 8. Other court ordered postjudgment costs and fees Is this judgment arising out of services rendered at a hospital? No Yes Check if applicable postjudgment interest was ordered by the court If this is a judgment arising out of services rendered at a hospital, has a stay of a financial institution execution been entered pursuant to an installment payment order? No Yes If a stay of a financial institution execution has been entered, has the Judgment Debtor defaulted on an installment payment order? No Yes (Specify): Date signed Telephone number Signed (Judgment Creditor or Attorney) Financial Institution Execution To any proper officer, Whereas on said Date of Judgment the above-named Judgment Creditor(s) recovered judgment against the above-named Judgment Debtor(s) before the abovenamed court for the amount of judgment, costs and fees stated above, as appears of record, whereof execution remains to be done. These are, therefore, by authority of the state of Connecticut to command you: Within seven days from your receipt of this execution, make demand upon the main office of any financial institution having its main office within your county, or if such main office is not within your county and such financial institution has one or more branch offices within your county, upon an employee of such a branch office, such employee and such branch office having been designated by the financial institution in accordance with regulations adopted by the commissioner of banking, for payment to you pursuant to section 52-367b(b) of the General Statutes of any nonexempt debt due said Judgment Debtor(s), which sum shall not exceed the total unpaid judgment, costs and fees as stated above, plus postjudgment interest as ordered by the court, if applicable, plus the application fee and other court ordered postjudgment costs and fees and your own fee. After having made such demand you are directed to serve a true and attested copy of this execution, together with the attached affidavit and exemption claim form, with your doings endorsed thereon, with the financial institution officer upon whom such demand was made. Said sum shall be received by you and applied on this execution in accordance with the provisions of section 52-367b of the General Statutes. You shall not serve more than one financial institution execution per judgment debtor at a time, including copies thereof. After service of an execution on one For Court Use Only financial institution, you shall not serve the same execution or a copy thereof upon another financial institution until receiving confirmation from the preceding financial institution that the judgment debtor had insufficient funds at the preceding financial institution available for collection to satisfy the execution, provided any such additional service is made not later than forty-five days from the receipt by you of such execution. After service of an execution, you shall not serve the same execution or a copy thereof upon such financial institution if an electronic direct deposit from a readily identifiable source described in section 52 -376b (c) of the General Statutes was made to the judgment debtor's account within the look-back period described in section 52 -376b (c) of the General Statues (sixty days or, with regard to federal benefits, such greater period as required by federal law). If no such deposit was made, you may subsequently serve the same execution or a copy thereof upon such institution, provided the execution has not expired or otherwise become unenforceable. Hereof fail not, and make due return of this writ with your doings thereon, according to law. Signed (Assistant Clerk) Date signed Page 1 of 2 FINANCIAL INSTITUTION EXECUTION PROCEEDINGS American LegalNet, Inc. www.FormsWorkFlow.com NOTE: The provisions of section 52-367b, as amended from time to time, take precedence over these instructions. Instructions To Financial Institution Upon Receipt Of A Financial Institution Execution When Judgment Debtor Is A Natural Person 1. If any funds are removed from the judgment debtor's account pursuant to subsection (c) of section 52-367b of the General Statutes, complete section II of the accompanying Exemption Claim Form (JD-CV-24a) and (1) send, forthwith, 2 copies of both this form and the Exemption Claim Form to the judgment debtor and to any secured party that is a party to a control agreement between you and such secured party under article 9 of title 42a of the General Statutes, postage pre-paid, at the last known address of the judgment debtor and of any such secured party with respect to the affected accounts on the records of your institution and (2) mail notice to the judgment debtor as required by 31CFR212.6 and 212.7. 2. Remove from the judgment debtor's account the amount of any debts due from you to the judgment debtor not exceeding the Total Amount Unpaid as appears on page 1 of this form plus interest and the Applicat