IN THE JUSTICE OF THE PEACE COURT OF THE STATE OF DELAWARE, IN AND FOR _________ COUNTY COURT NO. _____ COURT ADDRESS: ________________________________ CIVIL ACTION NO.________________________ ________________________________ PLAINTIFF(S): VS. DEFENDANT(S): Name___________________________ Name________________________________ FREEHOLDERS SCHEDULE To be completed by Defendant: The Defendant requests that the following items be exempted under 10 Del.C. 4902 and 4903 from levy and sale: _________________________________________________________ ____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ___________________________________ Defendant To be completed by freeholders: (attach additional sheets if necessary) Defendants Exempt Property under 10 Del.C. 4903: _______________________________________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ Defendants Non-exempt Property: ________________________________________ ________________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ ________________________________________________________________________ _____________ We certify that the items specified above are appraised at their true va lue in money and were designatedand set apart by the Defendant and claimed as exempt from execution or a ttachment process. __________________________________________ Freeholder for Defendant __________________________________________ Freeholder for Plaintiff __________________________________________ Freeholder Named by Constable/Court Official SWORN TO this _______ day of _________________, 20___. _________________________________________ J.P. Constable/Court Official American LegalNet, Inc. www.USCourtForms.comJ.P. Civ. Form No. 48 (Rev. 6/15/00)