EXEMPTION CLAIM AND REQUEST FOR HEARING (SEND THIS PART TO THE COURT IF REQUESTING) TO: SUPERIOR COURT NO. 5 OF HAMILTON COUNTY HAMILTON COUNTY GOVERNMENT AND JUDICIAL CENTER ONE HAMILTON COUNTY SQUARE, SUITE 297 NOBLESVILLE, IN 46060 CAUSE NO. 29D05- I believe that all or part of the money in my account(s) that may have been frozen cannot be frozen since the account(s) contain exempt funds. I would like a hearing at the earliest time. Date: SIGNATURE PRINTED NAME STREET ADDRESS CITY, STATE, ZIP PHONE DURING BUSINESS HOURS CHECK ONE: I am the Judgment Debtor. I maintain a joint account with the Judgment Debtor. American LegalNet, Inc. www.FormsWorkFlow.com