District Court County Court ___________________________County, Colorado Court Address: Plaintiff(s): v. Defendant(s): COURT USE ONLY Case Number: Division: Courtroom: NOTICE OF LEVY TO THE JUDGMENT DEBTOR(S): You are hereby notified that pursuant to and under the authority of a WRIT OF GARNISHMENT IN AID OF WRIT OF ATTACHMENT issued by the Clerk of the Court, certain personal property, owned by you, or owed to you, is being held or taken to pay the claim of the above Plaintiff(s). The personal property being held or taken is: _________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ You have legal rights that may prevent all or part of your money or property from being taken. That part of the money or property that 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. Not withstanding your right to claim the property as "exempt", no exemption other than the exemptions set forth in Section 13-54-104(3), C.R.S., may be claimed for a Writ which is the result of a judgment taken for arrearages for child support or for child support debt. The purpose of this Notice of Levy is to tell you about these rights. If the money or property which is being withheld from you includes any "exempt property", you must file within 14days of receiving this Notice of Levy a written claim of exemption with the Clerk of the Court, describing what money or property you think is "exempt property" and the reason that it is exempt. You must act quickly to protect your rights. Remember, you only have 14days after receiving this Notice of Levy to file your claim of exemption with the Clerk of Court. Your failure to file a claim of exemption with 14days is a waiver of your right to file. Dated: _______________________________ ______________________________________ Clerk of Court/Deputy Clerk PARTIAL LIST OF EXEMPT PROPERTY (Numbered statutory references are subject to change) 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, certain items used in your occupation, bicycles, motor vehicles (greater for disabled persons), life insurance, income tax refunds, money received because of loss of property or for personal injury, equipment that you need because of your health, or money received because you were a victim of a crime. 2. All or part of your earnings under Section 13-54-104, C.R.S. FORM 34 R10-12 NOTICE OF LEVY © 2012 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 22. 23. Workers' compensation benefits under Section 8-42-124, C.R.S. Unemployment compensation benefits under Section 8-80-103, C.R.S. Group life insurance benefits under Section 10-7-205, C.R.S. Health insurance benefits under Section 10-16-212, C.R.S. Fraternal society benefits under Section 10-14-403, C.R.S. Family allowances under Section 15-11-404, C.R.S. Teachers' retirement fund benefits under Section 22-64-120, C.R.S. Public employees' retirement benefits (PERA) under Sections 24-51-212 and 24-54-111, C.R.S. Social security benefits (OASDI, SSI) under 42 U.S.C. §407. Railroad employee retirement benefits under 45 U.S.C. §23. Public assistance benefits (OAP, AFDC, TANF, AND, AB, LEAP) under Section 26-2-131, C.R.S. Policemen's and firemen's pension fund payments under Sections 31-30-117, 31-30.5-208 and 31-31-203, C.R.S. Utility and security deposits under Section 13-54-102(1)(r), C.R.S. Proceeds of the sale of homestead property under Section 38-41-207, C.R.S. Veteran's Administration benefits under 38 U.S.C. §5301. Civil service benefits under 5 U.S.C. §8346. Mobile homes and trailers under Section 38-41-201.6, C.R.S. Certain retirement and pension funds and benefits under Section 13-54-102(2)(s), C.R.S. A Court-ordered child support and maintenance obligation or payment under Section 13-54-102(1)(u), C.R.S. Public or private disability benefits under Section 13-54-102(1)(v), C.R.S. REMEMBER THAT THIS IS ONLY A PARTIAL LIST OF "EXEMPT PROPERTY"; you may wish to consult with a lawyer who can advise you of your rights. If you cannot afford one, there are listings of legal assistance and legal aid offices in the yellow pages of the telephone book. RETURN OF SERVICE Judgment Debtor's Name ___________________________________ Case Number: ___________________ I declare under oath that I am 18 years or older and not a party to the action and have served this Notice of Levy in this case on ____________________________ (name of party) in ____________________ (County) ___________________ (State) on ___________________ (date) __________ (time) at the following location: __________________________________________________________________________________________ By (Check one): By handing it to a person identified to me as ________________________________ (name of judgment debtor). By leaving it with _________________________________________ (Type or write name legibly), who is designated to receive service because of a legal relationship with _______________________ (name of judgment debtor) as provided for in C.R.C.P. 4(e). I attempted to serve _________________________________ (name of judgment debtor) on _______ occasions but have not been able to locate him/her/it. Return to the Judgment Creditor is made on ______________________ (date). I attempted to leave it with __________________________ (name of person) who refused service. ___________________________________ Signature of Process Server Private process server Sheriff, _________________________County Fee $ ____________ Mileage $ ________ ___________________________________ Name (Print or type) Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______. Note: Not required for service by a sheriff or deputy. My Commission Expires: __