AGREEMENT FOR JUDGMENTAND FOR PAYMENT ORDERDOCKET NUMBERTrial Court of MassachusettsSmall Claims SessionPLAINTIFF(S) WHO ARE PARTIES TO THIS AGREEMENT VS.COURT DIVISIONDEFENDANT(S) WHO ARE PARTIES TO THIS AGREEMENTG Check here if defendant has moved and write new address above or on back of court copyREQUESTED DATE OF PAYMENT REVIEWG No payment review requestedGJUDGMENT FOR PLAINTIFF(S). It is hereby agreed that in this small claim the Court may enter a judgment for the plaintiff(s) named above and against the defendant(s) named above for:$ DAMAGES$ COSTS$ ATTORNEY FEES(if authorized by contract or statute)GPlus PREJUDGMENT INTEREST from (date)at the 12% statutory rate or the % contractual rateGPrejudgment interest is waived by the plaintiff.GPostjudgment interest is waived by the plaintiff.PAYMENT ORDER. It is also agreed that the Court may enter a payment order that requires the defendant(s):Gto pay the plaintiff(s) the total amount of the judgment on or before (date).Gto pay the plaintiff(s) $ each G week G month beginning on (date)until the total amount of the judgment is paid in full.This payment order will not be satisfied with any exempt income listed on pg. 2 of this form.GREVISED PAYMENT ORDER. In this small claim the Court has already entered a judgment and it is hereby agreed that the Courtmay revise that payment order as follows:This payment order will not be satisfied with any exempt income listed on pg. 2 of this form.GSATISFIED IN FULL. It is also agreed that this claim or judgment has already been satisfied in full.(By court rule plaintiff(s) must file an acknowledgment of satisfaction with the court when the judgment has been paid in full.)GJUDGMENT FOR DEFENDANT(S). It is hereby agreed that in this small claim the Court may enter a judgment for the defendant(s) named above, and the plaintiff(s) shall take nothing on this claim.GDISMISSAL. It is hereby agreed that the Court may enter a judgment dismissing this small claim.GJUDGMENT ON COUNTERCLAIM. It is also agreed that the Court may enter the following judgment on the counterclaim brought by the above-named defendant(s) against the above-named plaintiff(s):OTHER PROVISIONS OR COMMENTSUpon acceptance by the Court, a judgment and payment order will be entered in accordance with the above terms and will be enforceable as an order of the Court. X SIGNATURE OF PLAINTIFF(S) OR ATTORNEY FOR PLAINTIFF(S)PRINT NAMEDATE X SIGNATURE OF DEFENDANT(S) OR ATTORNEY FOR DEFENDANT(S)PRINT NAMEDATERECORD OF COURT REVIEW (For optional use by magistrate)G To be entered as court222s judgment and/or payment order. G Agreement was submitted in open court and Rule 7(a) inquiry made of defendant(s) as to any payment order. X CLERK-MAGISTRATE / ASST. CLERK DC-SC-8 () www.mass.gov/courts/districtcourt American LegalNet, Inc. www.FormsWorkFlow.com Rev. 11/18 INCOME AND PROPERTY THAT ARE EXEMPT FROM PAYMENT ORDERS (This list of exempt income and property is not comprehensive. It is provided to assist the court in avoiding the issuance of orders that would require payment from exempt sources. When requesting a payment order, the creditor bears the burden of proving that the debtor has sufficient non-exempt income or property with which to satisfy the judgment. See G.L. c. 224, 247 16.) 1.INCOME FROM THE FOLLOWING SOURCES is exempt by law from payment orders:267Unemployment Benefits (G.L. c. 151A, 247 36)267Workers Compensation Benefits (G.L. c. 152, 247 47)267Social Security Benefits (42 U.S.C. 247 401)267Federal Old-Age, Survivors & Disability Insurance Benefits (42 U.S.C. 247 407)267Supplementary Security Income (SSI) for Aged, Blind & Disabled (42 U.S.C. 247 1383[d][1])267Other Disability Insurance Benefits up to $400 weekly (G.L. c. 175, 247 110A)267Emergency Aid for Elderly & Disabled (G.L. c. 117A)267Veterans Benefits267Federal Veterans Benefits (38 U.S.C. 247 5301[a])267Special Benefits for Certain WW II Veterans (42 U.S.C. 247 1001)267Medal of Honor Veterans Benefits (38 U.S.C. 247 1562)267State Veterans Benefits (G.L. c. 115, 247 5)267Transitional Aid to Families with Dependent Children (AFDC) Benefits (G.L. c. 118, 247 10)267Maternal Child Health Services Block Grant Benefits (42 U.S.C. 247 701)267Other public assistance benefits (G.L. c. 235, 247 34, cl. fifteenth)267Payouts from certain Massachusetts employee pension plans (G.L. c. 32, 247 19)2.Certain PERSONAL AND REAL PROPERTY is also exempt from payment orders, including:267$2,500 in cash or savings or other deposits in a banking or investment institution (G.L. c. 235, 247 34, cl.fifteenth)267Automobile or vehicle up to exemption limit (G.L. c. 235, 247 34, cl. sixteenth)267Other specific types of personal property are exempt under other clauses of G.L. c. 235, 247 34267Real estate subject to automatic or declared homestead exemption (G.L. c. 188) and, in lieu thereof, theamount of money necessary for rent, up to $2,500 per month (G.L. c. 235, 247 34, cl. fourteenth)267There are also exemptions for 223aggregate224 amounts, up to maximum limits, of certain unused exemptions(G.L. c. 235, 247 34, cl. seventeenth)3.In addition, A PORTION OF WAGES AND CONTRIBUTIONS TO EMPLOYMENT-BASEDRETIREMENT PLANS is exempt by law from payment orders.Massachusetts law exempts the greater of 85% of the debtor222s gross earnings or 50 times the greater of the Federal minimum wage ($7.25 as of 7/24/09) or the Massachusetts minimum wage ($11/hr. until 12/31/18 per G.L. c. 151, 247 1; $12/hr. as of 1/1/19; $12.75/hr. as of 1/1/20; $13.50/hr. as of 1/1/21; $14.25/hr. as of 1/1/22; and $15/hr. as of 1/1/23) for each week or portion thereof (G.L. c. 224, 247 16 & c. 235, 247 34, cl. fifteenth). The amount exempt under federal law (15 U.S.C. 2472471671-1677) may exceed the Massachusetts exemption. If so, the federal exemption applies. See Worksheet for Computing Amount of Wages Exempt From Attachment, Execution and Payment Orders. https://www.mass.gov/media/910531/download/ American LegalNet, Inc. www.FormsWorkFlow.com