FORM 29 SC R 8 / 1 8 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 1 of 3 County Court District Court County, Colorado Court Address: Plaintiff(s)/Petitioner(s): v. Defendant(s)/Respondent(s): COURT USE ONLY Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY The Judgment credi tor is (check one): a licensed collection agency pursuant to 24712 - 14 - 101, et. seq., C.R.S. ; represented by an a ttorney ; or not represented by an attorney and is not a licensed collection agency pursuant to 247 12 - 14 - 101, et. seq., C.R. S. ress, other identifying information: 1. Original Amount of Judgment Entered (date) $ 2. Plus any Interest Due on Judgment ( currently % per annum) + $ 3. Taxa ble Costs (including estimated cost of service of this Writ) + $ 4. Less any Amount Paid - $ 5. Principal Balance/Total Amount Due and Owing = $ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form . VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct and I am authorized to act for the Judgment Creditor . Printed name of Judgment Creditor Address City State Zip Code Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country Printed name of Authorized Party Signat ure of Authorized Party (Title,and Phone No.) Address City State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com FORM 29 SC R 8 / 1 8 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 2 of 3 W RIT 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 pa rty 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 foll owing 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. T his Writ with Notice applies to all personal pr operty (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 o f this Writ unless the personal property is incapable of being divided. c. After you file your answers to the following questions , and after receiving a separate notice or order from the court , MAKE CHECKS PAYABLE AND MAIL TO: the J udgment Creditor named above ( May select only if the Judgment Creditor is a licensed collection agency pursuant to 12 - 14 - 101, et. seq., C.R.S.); the J applicable); or to the C lerk of the County Court or District Cou rt in (city), Colorado ( Must select if the Judgment Creditor is not represented by an attorney AND is not a licensed collection agency pursuant to 12 - 14 - 101, et. seq., C.R.S.) at the address below: Name: Address: PLEASE PUT THE CASE NUMBER (above) ON THE FRONT OF THE CHECK. CLERK OF THE COURT By Deput y Clerk: Date: QUESTIONS TO BE ANSWERED BY GARNISHEE : Case Number: T he 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. I f you answered YES to question c, describe the nature and amount of the setoff claimed: (Attach additional pages if necessary): VERIFIC ATION I declare under penalty of perjury under the law of Colorado that I am authorized to act for the Garnishee and the foregoing is true and correct. Name of Garnishee (Print) Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country (Printed name of Person Answering) Signature of Person Answering American LegalNet, Inc. www.FormsWorkFlow.com FORM 29 SC R 8 / 1 8 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 3 of 3 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 t he money o 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 th ese right s. 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 a llowances, stock - in - trade and certain items used in your occupation, bicycles, motor vehicles (greater for disabled persons), life insurance, income tax refunds, attributed to an earned income tax credit or child tax credit, 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. 3. - 42 - 124, C.R.S. 4. Unemployment compensation benefits under Section 8 - 80 - 103, C.R.S. 5. Group life insurance benefits under Section 10 - 7 - 205, C.R.S. 6. Health insurance benefits under Section 10 - 16 - 212, C.R.S. 7. Fraternal society benefits under Section 10 - 14 - 403, C.R.S. 8. Famil y allowances under Section 15 - 11 - 404, C.R.S. 9. - 64 - 120, C.R.S. 10. - 51 - 212 and 24 - 54 - 111, C.R.S. 11. Social security benefits (OASDI, SSI) under 42 U.S.C . 247407. 12. Railroad employee retirement benefits under 45 U.S.C. 247231m. 13. Public assistance benefits (OAP, AFDC, TANF, AND, AB, LEAP) under Section 26 - 2 - 131, C.R.S. 14. - 30 - 1117 & 31 - 30.5 - 208 and 31 - 31 - 203, C.R.S. 15. Utility and security deposits under Section 13 - 54 - 102(1)(r), C.R.S. 16. Proceeds of the sale of homestead property under Section 38 - 41 - 207, C.R.S. 17. 18. Civil service retirement benefits under 5 U.S.C. 2478346. 19. Mobile homes and trailers under Section 38 - 41 - 201.6, C.R.S. 20. Certain retirement and pension funds and benefits under Section 13 - 54 - 102(1)(s), C.R.S. 21. A C ourt - ordered child support or maintenance obligation or payment under Section 13 - 54 - 102(1)(u), C.R.S. 22. Public or private disability benefits under Section 13 - 54 - 102(1)(v), C.R.S. , 14 days of receiving this notice a written Clai n you file the claim, you must immediately deliver, by certified mail, return receipt requested, a copy of your claim to the Ga rnishee dress 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 arr earages for child support or for child support debt. Once you have properly filed you r claim, the court will schedule a hearing within 14 days. The Clerk of the Cour