STATE OF INDIANA COUNTY OF HAMILTON ) )SS: ) IN THE SUPERIOR COURT NO. 6 OF HAMILTON COUNTY CAUSE No. 29D06-______________________________ and _______________________________________ (Garnishee Defendant) _______________________________________ (Street address) _______________________________________ (City, State, Zip) ___________________________________ Judgment Creditor vs. ___________________________________ Judgment Debtor ___________________________________ (Street address) ___________________________________ (City, State, Zip) You are hereby notified to put a hold on any account which you now have for ___________________________ pursuant to I.C. 28-9-3-4. Judgment debtor's SSN: XXX-XX-______________ (last four digits only) Judgment Amount: $_________________ Court Costs $______________________ ORDER TO ANSWER INTERROGATORIES To the above-named execution debtor, you are hereby ordered to answer the following interrogatories, as propounded by the judgment debtor or his attorney, in the above-entitled cause of action, for proceedings supplemental to execution: 1. 2. 3. 4. Does your bank have an account in the name of ______________________________________________? Answer: ______________________________________________________________________________ Is it a savings and/or checking account and what is the number? Answer: ___________________________ ______________________________________________________________________________________ What is the current balance: Answer: ________________________________________________________ State any other property which your bank holds for the judgment-debtor. Answer: ____________________ ______________________________________________________________________________________ These interrogatories must be certified as true by you, the copy retained by you, and the original returned by first-class mail to the Court, as required by law, on or before the _____ day of _______________, 20___. "Such Court shall have full power to enforce answers thereto." Date: _____________________________ ________________________________ Gail Bardach, Judge Hamilton Superior Court No. 6 To the above-named Judge of the Superior Court No. 6 of Hamilton County: I hereby certify that the above answers are true, without equivocation or evasion. Dated: ____________________________ Rev. 2/07 Order to Answer Interrogatories ________________________________ Proper Official American LegalNet, Inc. www.FormsWorkFlow.com EXEMPTION CLAIM AND REQUEST FOR HEARING (Send this part to the Court) TO: SUPERIOR COURT NO. 6 OF HAMILTON COUNTY HAMILTON COUNTY GOVERNMENT AND JUDICIAL CENTER ONE HAMILTON COUNTY SQUARE, SUITE 215 NOBLESVILLE, IN 46060 Cause No. 29D06-___________________________________ 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 ____________________________________ Address ____________________________________ 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 NOTICE OF CERTAIN EXEMPTIONS AND YOUR RIGHT TO A PROMPT HEARING It may be that the judgment creditor has or will give notice to your bank or any other persons holding property or assets for you of the intent to put a hold on certain accounts held by you, either individually or jointly with another person, including, but not limited to bank, share, and credit union accounts. Under Indiana law, this Notice may already have resulted in the placing of a hold on those accounts. UNDER FEDERAL AND STATE LAW, CERTAIN FUNDS ARE EXEMPT FROM GARNISHMENT. THIS MEANS THAT THESE FUNDS MAY NOT BE TAKEN BY CREDITORS EVEN IF THEY HAVE BEEN DEPOSITED INTO YOUR ACCOUNTS. SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, VETERANS BENEFITS, CERTAIN DISABILITY PENSION BENEFITS AND BENEFITS UNDER ANY PENSION PAID FROM A TRUST QUALIFIED UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 CANNOT BE TAKEN. THERE MAY BE OTHER EXEMPTIONS UNDER STATE OR FEDERAL LAW. IF YOU OR ANOTHER PERSON WHO MAINTAINS A JOINT ACCOUNT WITH YOU BELIEVE THAT ALL OR SOME OF THE FUNDS IN THSES ACCOUNTS ARE EXEMPT, YOU OR YOUR JOINT DEPOSITOR ARE ENTITLED TO A PROMPT HEARING IN THIS COURT TO PRESENT EVIDENCE TO ESTABLISH EXEMPTIONS AND TO SEEK REMOVAL OF THE HOLD. To obtain such a hearing, fill in the form marked "Exemption claim and Request for Hearing" attached hereto and return it to this Court either by mail or by personally bringing it to the Court. A copy of that form should also be sent to judgment creditor's attorney or to the judgment creditor if the judgment creditor is not represented by counsel. A prompt hearing will be scheduled by the Court as soon as possible, but generally no later than 5 days (excluding Saturdays, Sundays, and legal holidays) after the completed form is received by the Court. Please call the court (317-770-4450) to find out when the hearing is scheduled. When calling the Court, please have the cause number handy. The cause number is located on the reverse side of this document under the Court's address. After the hearing, the Court will decide whether all or part of the funds in each account on which a hold has been placed or other accounts in which you have an interest may be taken by the judgment debtor. If a joint depositor or you do not request an early hearing, there will be a hearing at the time when you are ordered to appear. At that hearing, you and a joint depositor are entitled to assert any exemptions. However, if a joint depositor or you do not request an early hearing, each account on which a hold has been placed may not be released until the time you are ordered to appear. American LegalNet, Inc. www.FormsWorkFlow.com