FINANCIAL INSTITUTION EXECUTION PROCEEDINGS - JUDGMENT DEBTOR WHO IS NOT A NATURAL PERSON, APPLICATION AND EXECUTION STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov (See page 2 for instructions to financial institution) * Instructions - Judgment Creditor or Attorney 1. Type or print legibly. 2. Complete the application section; prepare original and 2 copies. 3. Present original and all copies to clerk of court. P F E A B A * * JD-CV-24N Rev. 10-09 C.G.S. 52-367a A E X I S S U E * Instructions - Clerk 1. Check the file to ensure that the information provided on the application is correct. 2. Sign original execution. 3. Return original and 1 copy to applicant, retain a copy for file. Address of court Geographical area number Judicial District Housing Session Docket number Fold Application Name and mailing address of Judgment Creditor or Attorney (To be completed by Judgment Creditor) Name(s) and address(es) of Judgment Creditor(s) Name(s) and address(es) of Judgment Debtor(s) Date of judgment (Include, where applicable, prejudgment interest and attorney's fees) 5. Total amount unpaid (Subtract 4 from 3) 1. Amount of judgment 4. Total amount paid (If any) 2. Amount of costs 3. Amount of judgment, costs and fees (Add 1 and 2) 6. Application fee for financial institution execution (If not waived by the court) 7. Other court ordered postjudgment costs and fees 8. Total of items 5, 6 and 7 Check if applicable Signed (Judgment Creditor or Attorney) Date signed Telephone number Post judgment interest was ordered by the court Financial Institution Execution To Any Proper Officer, Whereas on said Date of Judgment the above-named Judgment Creditor(s) recovered judgment against the above-named Judgment Debtor(s) before the above-named court for the amount of judgment, costs and fees stated above, as appears of record, whereof execution remains to be done. These are, therefore, by authority of the State of Connecticut to command you: Make demand upon the main office of any financial institution having its main office within your county, or if such main office is not within your county and such financial institution has one or more branch offices within your county, upon an employee of such a branch office, such employee and such branch office having been designated by the financial institution in accordance with regulations adopted by the commissioner of banking, for payment to you of any debt due said Judgment Debtor(s), which sum shall not exceed the total unpaid judgment, costs and fees as stated above, plus post judgment interest as ordered by the court, if applicable, plus the application fee and other court ordered postjudgment costs and fees, and your own fees. Said sum shall be received by you and applied on this execution. After having made such demand you are directed to serve a true and attested copy hereof, with your doings thereon endorsed, with the financial institution officer upon whom such demand was made. You shall not serve more than one financial institution execution per judgment debtor at a time, including copies thereof. After service of an execution on one financial institution, you shall not serve the same execution or a copy thereof upon another financial institution until receiving confirmation from the preceding financial institution that the judgment debtor had insufficient funds at the preceding financial institution available for collection to satisfy the execution. If you do not receive within twenty-five days of the service of the demand a response from the financial institution that was served indicating whether or not the judgment debtor has funds at the financial institution available for collection, you may assume that sufficient funds are not available for collection and you may proceed to serve For Court Use Only another financial institution in accordance with section 52-367a of the General Statutes. Hereof fail not, and make due return of this writ with your doings thereon, according to law. Signed (Assistant Clerk) Date signed Page 1 of 2 FINANCIAL INSTITUTION EXECUTION PROCEEDINGS American LegalNet, Inc. www.FormsWorkFlow.com Note: The provisions of section 52-367a, as amended from time to time, take precedence over these instructions. Instructions To Financial Institution Upon Receipt Of A Financial Institution Execution When Judgment Debtor is Not A Natural Person 1. You must remove from the judgment debtor's account the amount of any debts due from you to the judgment debtor not exceeding the Total Amount Unpaid as appears on page 1 of this form, plus interest and the Application Fee for Financial Institution Execution and court ordered postjudgment costs or fees and the serving officer's fee. 2. Except as provided in #4 below, you must immediately pay to the serving officer the amount removed from the judgment debtor's account. Nothing herein shall be construed to affect any other rights or obligations of the financial institution with regard to the funds in the judgment debtor's account. 3. You must act on this execution according to section 42a-4-303 of the general statutes, before your midnight deadline. 4. If the deposit account is subject to a security interest of a secured party, other than you, pursuant to a control agreement between you and such secured party under article 9 of title 42a, and if any funds removed from the judgment debtor's account pursuant to subsection (c) of section 52-367a of the general statutes you shall forthwith mail a copy of the execution when received from the serving officer, postage prepaid, to the judgment debtor and to such other secured party at the last known address of such parties with respect to the affected accounts on your records. You shall hold the amount removed from the judgment debtor's account for twenty days from the date of the mailing to the judgment debtor and such other secured party, and during such period you shall not pay the serving officer. Such other secured party shall give notice of its prior perfected security interest in such deposit account, by delivering to the clerk of the court that issued the execution a written claim for determination of interests in property pursuant to section 52-365c and by delivering a copy of such claim to the financial institution upon which such execution is served. 5. If a written claim for determination of interests in property is made pursuant to subsection (e) of section 52-367a of the general statutes, you shall continue to hold the amount removed from the judgment debtor's account until a court order is received regarding disposition of the funds. If no written claim for determination of interests in property is made you shall, upon demand, forthwith pay the serving officer the amount removed from the judgment debtor's account, and the serving officer shall thereupon pay such sum, less such serving officer's fees, to the judgment creditor, except to the extent otherwise ordered by a court. JD-CV-24N (back/page 2) Rev. 10-09 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com