IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) Plaintiff(s), vs. CASE NO. CREDITOR'S AFFIDAVIT AND REQUEST Defendant(s). AFFIDAVIT I, the undersigned, upon oath or affirmation and under penalty of perjury, state as follows: 1. I am: the judgment creditor the attorney for the judgment creditor 2. 3. The judgment creditor obtained a judgment against in the total amount of $ . (judgment debtor) I have reason to believe that the judgment debtor has property of a kind listed in AS 09.38.020 that is not exempt. I understand that AS 09.38.020 allows the judgment debtor the following exemptions: a. b. c. d. e. Up to $4,050 worth of household goods, wearing apparel, books, musical instruments, family portraits and heirlooms; Up to $1,350 worth of jewelry; Up to $3,780 worth of professional books and tools of trade; Up to $1,350 for pets; and Up to $4,050 for one motor vehicle, if the full value of the vehicle does not exceed $27,000. 4. Following is a description of the property I wish to seize to satisfy the judgment, and my reasons for believing the property is not exempt: Description of Property Reasons Property Is Not Exempt Page 1 of 2 CIV-535 (11/12)(st.3) CREDITOR'S AFFIDAVIT AND REQUEST AS 09.38.075; AS 09.38.020; 8 AAC 95.030; Civil R. 69 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Description of Property Reasons Property Is Not Exempt REQUEST I request an order by the court notifying the judgment debtor of my claim to levy on the property listed above and of judgment debtor's right to contest my claim by filing a Claim of Exemptions form with the court within 15 days after the court's order is issued. If the judgment debtor fails to respond within the time allowed, the court may then order the judgment debtor to appear and disclose the description, location and value of his or her property. Failure to appear may result in waiver by the judgment debtor of any objection to my levy. I also request that the court order the judgment debtor to refrain from removing, encumbering, damaging or disposing of any of the property listed in my affidavit for 30 days after the debtor receives the court's order. Date Signature of Judgment Creditor or Attorney Printed Name and Title Mailing Address Subscribed and sworn to or affirmed before me at Alaska, on . (date) (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires City State ZIP , Distribution: 1. original to court 2. copy for creditor (to be sent to debtor as part of "Order to Debtor" packet if court issues CIV-536 Order to Debtor) 3. creditor's copy Page 2 of 2 CIV-535 (11/12)(st.3) CREDITOR'S AFFIDAVIT AND REQUEST AS 09.38.075; AS 09.38.020; 8 AAC 95.030; Civil R. 69 American LegalNet, Inc. www.FormsWorkFlow.com