ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, and Phone): ATTORNEY FOR (Name): UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER PLAINTIFF(S) v. CLAIM OF EXEMPTION AND FINANCIAL DECLARATION (Wage Garnishment - F.R.C.P. RULE 64) DEFENDANT(S). READ THE EMPLOYEE INSTRUCTIONS BEFORE COMPLETING THIS FORM. Copy the information required above from the Earnings Withholding Order. The top left space is for your or your attorney's name and address. 1. I need the following earnings to support myself or my family (check a. or b.): a. 2. G All earnings. b. G$ each pay period. Please send all paper to: at the address: G me G my attorney G shown above G following (specify): 3. I am willing for the following amount to be withheld from my earnings during the withholding period. I understand that the judgment creditor can accept this offer by not opposing the Claim of Exemption, which will result in the following sum being withheld each pay period: a. G None. b. G Withhold $ each pay period. 4. My pay period is: a. G daily G twice a month My gross pay is $ G weekly G monthly G every two weeks G other (specify): per pay period. per pay period. b. c. d. My take-home pay is $ List payroll deductions (item and amount): 5. The following person(s) depend(s), in whole or in part, on me for support. Name If minor(s), use only initials Age Relationship Monthly Income and Its Source CV-88G (07/05) CLAIM OF EXEMPTION AND FINANCIAL DECLARATION (Wage Garnishment - F.R.C.P. RULE 64) Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 6. The earnings of others listed in item 5 are now subject to wage assignments and Earnings Withholding Orders as follows: 7. My monthly expense are as follows: a. Rent or house payment and maintenance c. e. g. i. k. Utilities and telephone Laundry and cleaning Insurance (life, health, accident, etc.) Child, spousal support (prior marriage) Transportation and auto expenses (insurance, gas, repair) $ $ $ $ $ $ $ b. d. f. h. j. l. Food and household supplies Clothing Medical and dental payments School, childcare Entertainment and incidentals Installment payments (insert total and list below in item 8) $ $ $ $ $ $ $ m. Other (specify): 8. List payments on installment and other debts. Creditor's Name Total Monthly Expenses (add a through m) G Continued on Attachment 8. For $ $ $ Monthly Payment $ $ $ Balance 9. What do you own? (State value.) a. Cash $ c. Cars, other vehicles, and boat equity (list make, year): 1. 2. 3. d. Real estate equity (addresses): 1. 2. 3. $ $ $ $ $ $ b. Checking, savings, credit union, etc. (list institutions): 1. $ 2. 3. 4. $ $ $ e. Other personal property: jewelry, furniture, furs stocks, bond, etc. (list separately): 1. 2. $ $ Total for item e: $ 10. An Order Assigning Salary and Wages (for support) is now in effect as to my earnings. The amount payable under that order is: monthly. $ 11. Other facts that support this Claim of Exemption are (describe unusual medical needs, school tuition, expenses for recent family emergencies, or other unusual expenses to help the judge understand your budget): 12. I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed on (date) at (place) , California. (Type or print name) (Signature of judgement debtor) Deliver the original and one copy of this form to the levying officer at the address shown on the Earnings Withholding Order. If you are signing this in California, it does not have to be notarized. CV-88G (07/05) CLAIM OF EXEMPTION AND FINANCIAL DECLARATION (Wage Garnishment - F.R.C.P. RULE 64) Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com