IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA. DIVISION CASE NUMBER CLAIM OF EXEMPTION CIVIL AND REQUEST FOR HEARING OTHER (AFEG) PLAINTIFF(S) VS. DEFENDANT(S) CLOCK IN I CLAIM EXEMPTIONS from garnishment under the following categories as checked: 1. Head of family wages. (Check either a or b below, if applicable.) a. I provide more than one-half of the support for a child or other dependant and have net earnings of $750.00 or less per week. b. I provide more than one-half of the support for a child or other dependant, have net earnings of more than $750.00 a week, but have not agreed in writing to have my wages garnished. 2.003 Social Security benefits. 3.003 Supplemental Security Income benefits. 4.003 Public assistance (welfare). 5.003 Workers222 Compensation. 6.003 Reemployment assistance or unemployment compensation. 7.003 Veteran222s benefits. 8.003 Retirement or profit-sharing benefits or pension money. 9.003 Life Insurance benefits or cash surrender value of a life insurance policy or proceeds of annuity contract. 10.003 Disability income benefits. 11.003 Prepaid College Trust Fund or Medical Savings Account. 12.003 Other exemptions as provided by law. (explain) I request a hearing to decide the validity of my claim. Notice of the hearing should be given to me at: Address: . Telephone Number: . The statements made in this request are true to the best of my knowledge and belief. Defendant222s Signature003 Date The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced as identification and did / did not take an oath. SWORN TO AND SUBSRCIBED BEFORE ME this day of , 20. NOTARY PUBLIC, STAMP HARVEY RUVIN CLERK OF COURTS BY: (COURT SEAL) DEPUTY CLERK / NOTARY PUBLIC Important -See Reverse CLK/CT 862 Rev. 10/18003 Clerk222s web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com NOTICE TO DEFENDANT OF RIGHT AGAINST GARNISHMENT OF WAGES, MONEY , AND OTHER PROPERTY The Writ of Garnishment delivered to you with this Notice means that wages, money, and other property belonging to you have been garnished to pay a court judgment against you. HOWEVER, YOU MAY BE ABLE TO KEEP OR RECOVER YOUR WAGES, MONEY, OR PROPERTY. READ THIS NOTICE CAREFULLY. State and federal laws provide that certain wages, money, and property, even if deposited in a bank, savings and loan, or credit union, may not be taken to pay certain types of court judgments. Such wages, money, and property are exempt from garnishment. The major exemptions are listed below on the form for Claim of Exemption and Request for Hearing. This list does not include all possible exemptions. You should consult a lawyer for specific advice. IF AN EXEMPTION FROM GARNISHMENT APPLIES TO YOU AND YOU WANT TO KEEP YOUR WAGES, MONEY, AND OTHER PROPERTY FROM BEING GARNISHED, OR TO RECOVER ANYTHING ALREADY TAKEN, YOU MUST COMPLETE A FORM FOR CLAIM OF EXEMPTION AND REQUEST FOR HEARING AS SET FORTH BELOW AND HAVE THE FORM NOTARIZED. IF YOU HAVE A VALID EXEMPTION, YOU MUST FILE THE FORM WITH THE CLERK222S OFFICE WITHIN 20 DAYS AFTER THE DATE YOU RECEIVE THIS NOTICE OR YOU MAY LOSE IMPORTANT RIGHTS. YOU MUST ALSO MAIL OR DELIVER A COPY OF THIS FORM TO THE PLAINTIFF OR THE PLAINTIFF222S ATTORNEY AND THE GARNISHEE OR THE GARNISHEE222S ATTORNEY AT THE ADDRESSES LISTED ON THE WRIT OF GARNISHMENT. NOTE THAT THE FORM REQUIRES YOU TO COMPLETE A CERTIFICATION THAT YOU MAILED OR HAND DELIVERED COPIES TO THE PLAINTIFF OR THE PLAINTIFF222S ATTORNEY AND THE GARNISHEE OR THE GARNISHEE222S ATTORNEY. If you request a hearing, it will be held as soon as possible after your request is received by the court. The plaintiff or the plaintiff222s attorney must file any objection within 8 business days if you hand delivered to the plaintiff or the plaintiff222s attorney a copy of the form for Claim of Exemption and Request for Hearing or, alternatively, 14 business days if you mailed a copy of the form for claim and request to the plaintiff or the plaintiff222s attorney. If the plaintiff or the plaintiff222s attorney files an objection to your Claim of Exemption and Request for Hearing, the clerk will notify you and the other parties of the time and date of the hearing. You may attend the hearing with or without an attorney. If the plaintiff or the plaintiff222s attorney fails to file an objection, no hearing is required, the writ of garnishment will be dissolved and your wages, money, or property will be released. IF YOU HAVE A VALID EXEMPTION, YOU SHOULD FILE THE FORM FOR CLAIM OF EXEMPTION IMMEDIATELY TO KEEP YOUR WAGES, MONEY, OR PROPERTY FROM BEING APPLIED TO THE COURT JUDGMENT. THE CLERK CANNOT GIVE YOU LEGAL ADVICE. IF YOU NEED LEGAL ASSISTANCE YOU SHOULD SEE A LAWYER. IF YOU CANNOT AFFORD A PRIVATE LAWYER, LEGAL SERVICES MAY BE AVAILABLE. CONTACT YOUR LOCAL BAR ASSOCIATION OR ASK THE CLERK222S OFFICE ABOUT ANY LEGAL SERVICES PROGRAM IN YOUR AREA. AMERICANS WITH DISABILITIES ACT OF 1990 ADA NOTICE 223 If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact the Eleventh Judicial Circuit Court222s ADA Coordinator, Lawson E. Thomas Courthouse Center, 175 NW 1st Avenue, Suite 2400, Miami, FL 33128; Telephone (305) 349-7175; TDD (305) 349-7174, Email ADA@jud11.flcourts.org; or via Fax at (305) 349-7355, at least seven (7) days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than seven (7) days; if you are hearing or voice impaired, call 711. 224 Note: The form 223Affidavit of Service by Defendant Pursuant to F.S. 77.041 (3) and Request for Clerk to Dissolve 223Writ224 can be obtained from the Clerk222s Office Important -See Reverse CLK/CT 862 Rev. 10/18 Clerk222s web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com