JUSTICE COURT, HENDERSON TOWNSHIP CLARK COUNTY, NEVADA Plaintiff, - vs - Defendant. ) ) ) ) ) ) ) ) ) ) CASE NO. DEPT. NO. AFFIDAVIT CLAIMING EXEMPTION FROM EXECUTION I, That the Wages _____ , under penalty of perjury, depose and state: Bank Account _____ Other Personal Property ______ taken by ____________________________________________________________________, Judgment Creditor, is exempt from execution for the following reasons: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ It is requested that these Wages _____ Bank Account _____ Other Personal Property ______ be returned or released to me within five (5) days upon receipt of this Affidavit. DECLARATION PURSUANT TO NRS 53.045: I declare under Penalty of Perjury under the law of the State of Nevada that the foregoing is true and correct. Executed on ____________________________ (Date) Plaintiff's Signature (Signed under Penalty of Perjury) JC Henderson American LegalNet, Inc. www.FormsWorkFlow.com