Nebraska State Court Form REQUIRED CC 3:11 Rev. 7/18 Neb. Rev. Stat. 247 25-1516 EXECUTION NOTICE OF EXEMPTIONS Page 1 of 3 Notice of Exemptions CC 3:11 Rev. 07/18 IN THE COURT OF COUNTY, NEBRASKA Case No. Plaintiff vs. EXECUTION NOTICE OF EXEMPTIONS Defendant COURT MAILING ADDRESS: NOTICE TO THE DEBTOR YOU ARE HEREBY NOTIFIED THAT THIS COURT ISSUED A WRIT OF EXECUTION IN THIS CASE DIRECTING THAT SOME OF YOUR PROPERTY BE SOLD ACCORDING TO LAW AND THE PROCEEDS OF THE SALE BE DELIVERED TO THE CLERK OF THIS COURT TO BE USED TO SATISFY A PART OR ALL OF YOUR DEBT TO THE CREDITOR. THE LAW OF NEBRASKA AND THE LAW OF THE UNITED STATES PROVIDES THAT CERTAIN PROPERTY CANNOT BE TAKEN FROM YOU AND SOLD TO PAY A DEBT. THE KINDS OF PROPERTY THAT CANNOT BE TAKEN FROM YOU AND THE PROCEDURE FOR CLAIMING THE EXEMPTION ARE SET FORTH BELOW. THE LAW EXEMPTS FROM EXECUTION YOUR INTEREST IN OR RIGHT TO PROPERTY SET OUT IN LAW AS FOLLOWS: (1) Eachnatural person residing in this state shall have exempt from forced sale on execution the sum of five thousand dollarsin personal property, except wages. (If you claim exemptions under this section you shall file a list of the whole of theproperty owned and an indication of the items of property claimed to be exempt, along with a value for each itemlisted.) (See Neb. Rev. Stat. 247 25-1552).(a) The immediate personal possessions of the debtor and his or her family; (b) all necessary wearing apparel ofthe debtor and his or her family; (c) the debtor's interest, not to exceed an aggregate fair market value of threethousand, in household furnishings, household goods, household computers, household appliances, books, ormusical instruments which are held primarily for personal, family, or household use of such debtor or the dependentsof such debtor; (d) the debtor's interest, not to exceed an aggregate fair market value of five thousand, in implements,tools, or professional books or supplies, other than a motor vehicle, held for use in the principal trade or business ofsuch debtor or his or her family; (e) the debtor's interest, not to exceed five thousand dollars, in a motor vehicle; andthe debtor's interest in any professionally prescribed health aids for such debtor or the dependents of such debtor.(See Neb. Rev. Stat. 247 25-1556). Continued American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Notice of Exemptions CC 3:11 Rev. 07/18 To every resident of Nebraska, who became disabled in the service of the United States as a soldier, sailor ormarine, all pension money hereafter received and all property hereafter purchased and improved exclusivelytherewith, not exceeding two thousand dollars in value, of and belonging to such soldier, sailor or marine. (SeeNeb. Rev. Stat. 247 25-1559). Under specific circumstances, and to the extent reasonably necessary for the support of the debtor and anydependent of the debtor, an interest held under a stock bonus, pension, profit-sharing, or similar plan or contractpayable on account of illness, disability, death, age, or length of service. (See Neb. Rev. Stat. 247 25-1563.01).All proceeds and benefits accruing under any structured settlement providing periodic payments for personal injuries.(See Neb. Rev. Stat. 247 25-1563.02).A homestead not exceeding sixty thousand dollars in value shall consist of the dwelling house in which the claimantresides, its appurtenances, and the land on which the same is situated, not exceeding one hundred and sixty acres ofland, to be selected by the owner, and not in any incorporated city or village, or, at the option of the claimant, aquantity of contiguous land not exceeding two lots within any incorporated city or village. (See Neb. Rev. Stat. 247 40-101).Under specific circumstances, all proceeds, cash values, and benefits accruing under any annuity contract, underany policy or certificate of life insurance payable upon the death of the insured to a beneficiary other than the estateof the insured, or under any accident or health insurance policy. (See Neb. Rev. Stat. 247 44-371).(1) A noninsurance benefit, charity, relief, or aid to be paid, provided, or rendered by any society; and (2) allproceeds, cash values, and benefits accruing under any annuity contract, under any policy or certificate of lifeinsurance payable upon the death of the insured to a beneficiary other than the estate of the insured, or under anyaccident or health insurance policy. (See Neb. Rev. Stat. 247 44-1089). IF YOU BELIEVE THAT SOME OF YOUR PROPERTY IS EXEMPT FROM EXECUTION YOU MAY REQUEST A HEARING BY CHECKING THE BOX ON THIS FORM AND MAILING OR DELIVERING THIS FORM TO THE OFFICE OF THE CLERK OF THIS COURT SET FORTH ABOVE. IF YOU CLAIM AN EXEMPTION UNDER 247 25-1552, YOU WILL HAVE TO PROVIDE A LIST OF YOUR PROPERTY AND THE VALUE OF YOUR PROPERTY AT THE TIME YOU MAIL OR DELIVER YOUR REQUEST FOR HEARING. (See paragraph 1 above and Inventory below) FAILURE TO CLAIM THE EXEMPTION WITHIN TWENTY DAYS OF THE DATE YOU RECEIVE THIS NOTICE MAY MEAN THAT THE PROPERTY SEIZED WILL BE SOLD AND THE PROCEEDS APPLIED TO YOUR DEBT. IF YOU REQUEST A HEARING, THE HEARING WILL BE CONDUCTED NO LATER THAN TEN DAYS AFTER THE COURT RECEIVES YOUR REQUEST, UNLESS YOU REQUEST AN EARLIER HEARING DATE DUE TO AN EMERGENCY, IN WHICH CASE THE COURT SHALL SCHEDULE THE HEARING AS SOON AS PRACTICABLE. IF YOU WANT LEGAL REPRESENTATION YOU SHOULD CONTACT YOUR LAWYER IMMEDIATELY. IF YOU NEED THE NAME OF A LAWYER, CONTACT THE LOCAL BAR ASSOCIATION OR YOUR LOCAL LEGAL AID OR LEGAL SERVICES OFFICE. REQUEST FOR HEARING I believe that some of my seized property may be exempt from execution in this matter and request that a hearing be held no later than 10 days after the delivery of this request to the court. Date Signature Name (Judgment Debtor) Street Address/P.O. Box Bar Number and Firm Name (attorneys only) City/State/ZIP Code Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Notice of Exemptions CC 3:11 Rev. 07/18 INVENTORY: If you are claiming an exemption under Neb. Rev. Stat. 247 25-1552, you must file a list of the whole of the property you own and the value of each item listed. In addition, you must indicate which items you claim to be exempt. List the property below. (See paragraph 1.) (Attach additional pages if necessary.) ITEM OF PROPERTY FAIR MARKET VALUE CHECK IF CLAIMED AS EXEMPT American LegalNet, Inc. www.FormsWorkFlow.com