American LegalNet, Inc. www.FormsWorkFlow.com Civil Rule 69 AS 09.38.035-.080 Do not use this form for AS 09.38.020 property. IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) Plaintiff(s), ) vs. ) ) ) ) CASE NO. Defendant(s). ) ) CLAIM OF EXEMPTIONS 1. I do not wish to claim exemptions for the money or property listed in the Credito Affidavit. 2. I do wish to claim exemption(s) for the following property: a.Money in the amount of $ seized on from an account at (name of bank) . This money belongs to . I believe this money is exempt because it comes from Social Security Other b.Money in the amount of $ seized on from an account at (name of bank) . This money belongs to . I believe this money is exempt because it comes from Social Security Other IMPORTANT NOTE: If you attach copies of bank statements or the seizure notice from your bank to prove where the money in the account(s) came from, be sure to black out all account numbers. These documents will be stored in a public file. A copy of this document with all attachments will be sent to the creditor. c.Other property valued at $. Description: Reason it is exempt: (Attach additional pages if necessary. Do not write on the back of this form.) Date Signature of Debtor Mailing Address City State Zip E-mail AddressDaytime Telephone I certify that on , a copy of this claim and form CIV-516 were sent to: Debtor Creditor/Atty: By Clerk: CIV-515 (12/12)()CLAIM OF EXEMPTIONS