United States Bankruptcy Court, District of Colorado U.S. Custom House, 721 � 19th Street Denver, Colorado 80202-2508 Plaintiff(s)/Petitioner(s): v. Defendant(s)/Respondent(s): Judgment Creditor's Attorney or Judgment Creditor (Name and Address): COURT USE ONLY Case Number: Phone Number: FAX Number: E-mail: Atty. Reg. #: Division Courtroom WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Judgment Debtor's name, last known address, other identifying information: _______________________________________ ____________________________________________________________________________________________________ 1. 2. 3. 4. 5. Original Amount of Judgment Entered ___________________________(date) Plus any Interest Due on Judgment (________________% per annum) Taxable Costs (including estimated cost of service of this Writ) Less any Amount Paid Principal Balance/Total Amount Due and Owing $ ___________________ + $____________________ + $____________________ - $____________________ = $____________________ I affirm that I am authorized to act for the Judgment Creditor and this is a correct statement as of _________________ (date). Subscribed under oath before me on __________________ ___________________________________________ Notary Public or Deputy Clerk My Commission Expires: ___________________________ By: ___________________________________________ Signature (Type Name, Title, Address and Phone No.) ___________________________________________ Print Judgment Creditor's Name Address: __________________________________________ ___________________________________________ WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY THE PEOPLE OF THE STATE OF COLORADO to the Sheriff of any Colorado County, or to any person 18 years or older and who is not a party to this action: You are directed to serve a copy of this Writ of Garnishment upon ______________________________________, Garnishee, with proper return of service to be made to the Court. TO THE GARNISHEE: YOU ARE HEREBY SUMMONED AS GARNISHEE IN THIS ACTION AND ORDERED: a. To answer the following questions under oath and file your answers with the Clerk of the Court (AND to mail a completed copy with your answers to the Judgment Creditor or attorney when a stamped envelope is attached) within 14 days following service of this Writ upon you. YOUR FAILURE TO ANSWER THIS WRIT WITH NOTICE MAY RESULT IN THE ENTRY OF A DEFAULT AGAINST YOU. b. To hold pending court order the personal property of any kind (other than earnings of a natural person) in your possession or control, including the debts, credits, choses in action or money owed to the Judgment Debtor whether they are due at the time of the service of the writ or are to become due thereafter. YOU ARE NOTIFIED: a. This Writ with Notice applies to all personal property (other than earnings) owed to or owned by the Judgment Debtor and in your possession or control as of the date and time this Writ was served upon you. b. In no case may you withhold any personal property greater than the amount on Line 5 on the front of this Writ unless the personal property is incapable of being divided. c. * IF you are ordered to pay funds to the Court, tender your check for the amount ordered PAYABLE TO THE CLERK OF THE ________________________________, COURT AT 721 19th St., Denver, CO 80202-2508. CLERK OF THE COURT Kenneth S. Gardner By Deputy Clerk: ___________________________________________ DATE: ___________________________________________ FORM 29 R7-12 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 1 of 3 � 2012 Colorado Judicial Department for use in the Courts of Colorado American LegalNet, Inc. www.FormsWorkFlow.com QUESTIONS TO BE ANSWERED BY GARNISHEE Judgment Debtor's Name: ___________________________________ Case Number: ___________________ The following questions MUST be answered by you under oath: a. On the date and time this Writ was served upon you, did you possess or control any personal property of the Judgment Debtor or did you owe any rents, payments, obligations, debts or moneys other than earnings to the Judgment Debtor? YES NO b. If YES, list all items of personal property and their location(s) and/or describe the nature and amount of the debt or obligation: (Attach additional pages if necessary): _________________________________________________________ _______________________________________________________________________________________________ c. Do you claim any setoff against any property, debt or obligation listed above? YES NO d. If you answered YES to question c, describe the nature and amount of the setoff claimed: (Attach additional pages if necessary): _______________________________________________________________ ______________________________________________________________________________________________ I affirm that I am authorized to act for the Garnishee and the above answers are true and correct. Name of Garnishee (Print) ________________________________________ Subscribed under oath before me on _____________ (date) Address: ___________________________________________________ ____________________________________________________ Phone Number _____________________________________________ Notary Public/Deputy Clerk My Commission Expires: ____________________________ Name of Person Answering (Print) ______________________________ Signature of Person Answering _________________________________ NOTICE TO JUDGMENT DEBTOR OF EXEMPTION AND PENDING LEVY This Writ with Notice is a Court order which may cause your property or money to be held and taken to pay a judgment entered against you. You have legal rights which may prevent all or part of your money or property from being taken. That part of the money or property which may not be taken is called "exempt property". A partial list of "exempt property" is shown below, along with the law which may make all or part of your money or property exempt. The purpose of this notice is to tell you about these rights. PARTIAL LIST OF EXEMPT PROPERTY 1. All or part of your property listed in Sections 13-54-101 and 102, C.R.S., including clothing, jewelry, books, burial sites, household goods, food and fuel, farm animals, seed, tools, equipment and implements, military allowances, stock-in-trade and certain items used in your occupation, bicycles, motor vehicles (greater for disabled persons), life insurance, income tax refunds, including a refund attributed to an earned income tax credit or chi