4-803[For use with district, magistrate and metropolitan court rules of civil procedure 1-065.1, 2-801, 3-801]STATE OF NEW MEXICOCOUNTY OF [ JUDICIAL DISTRICT COURT][ COURT], Plaintiffv.No. , DefendantCLAIM OF EXEMPTIONS ON EXECUTIONA JUDGMENT HAS BEEN ENTERED AGAINST YOU. ALL OF THEPROPERTY YOU POSSESS MAY BE SEIZED AND SOLD TO PAY THISJUDGMENT. YOU MUST COMPLETE AND RETURN THIS FORM WITHINTEN (10) DAYS TO CLAIM ANY STATUTORY EXEMPTION FROM THISSEIZURE AND SALE.(check only applicable boxes)Part I.Homestead exemption(This part is for use only in the district court)[ ]Judgment debtor owns, leases or is purchasing a dwelling house which judgmentdebtor occupies and is entitled to hold exempt a homestead in the amount of sixtythousand dollars ($60,000) under Section 42-10-9 NMSA 1978.Part II.Exemption in lieu of homestead exemption(Parts II and III are for use in the districtcourt, magistrate court and metropolitan court)[ ]Judgment debtor is a resident of this state who does not claim a homesteadexemption, but claims an exemption of real or personal property in the amount offive thousand dollars ($5,000) under Section 42-10-10 NMSA 1978. Theproperty claimed to be exempt is as follows: LIST PROPERTY STATED VALUE American LegalNet, Inc. www.FormsWorkFlow.com $ $(Attach additional page if necessary)Part III.Personal property exemptionsUnless the judgment debtor files a written waiver of exemption, the sheriff may not seizethe judgment debtor's personal clothing, furniture or books.In addition to the property claimed or listed as exempt above, the judgment debtor herebyclaims the following exemptions:(check only applicable boxes)[ ]personal property worth up to $500 LIST ITEMS STATED VALUE $(Attach additional page if necessary)[ ]tools of the trade worth up to $1,500.Occupation of judgment debtor: LIST ITEMS STATED VALUE $(Attach additional page if necessary)[ ]one motor vehicle worth up to $4,000 or that amount of equity in a more valuablevehicleMAKE, MODEL AND YEAR OF VEHICLEFAIR MARKET VALUE $Amount of any lien on vehicle: $.[ ]jewelry worth up to $2,500LIST JEWELRY ITEMSSTATED VALUE $(Attach additional page if necessary)[ ]medical-health equipment being used for the health of the claimant or a memberof the household of the claimant and not in a profession; (Attach separate sheet American LegalNet, Inc. www.FormsWorkFlow.com setting forth items claimed and the name of the household member and themedical condition of the member.)[ ]pensions or retirement funds;[ ]not more than $5,000 in benefits from a benevolent association of which thejudgment debtor is a member;[ ]building materials not financed by the judgment creditor in this action as providedby Section 48-2-15 NMSA 1978;[ ]a partner's interest in specific partnership property subject to the limitations ofSection 54-1-25 NMSA 1978;[ ]worker's compensation benefits subject to the limitations of Section 52-1-52;[ ]occupational health benefits as provided by Section 52-3-37 NMSA 1978;[ ]unemployment compensation benefits subject to the limitations of Section51-1-37 NMSA 1978 for necessities furnished while the debtor was unemployedand child support;[ ]public assistance and welfare benefits;[ ] cash surrender values and benefits of life insurance contracts;[ ]payment from life, accident and health insurance policies or annuity contracts;[ ]crime victims' reparation fund payments;[ ]fraternal benefit society benefits;[ ]the minimum amount of shares necessary for certain cooperative associationssubject to the limitations provided by Section 53-4-28 NMSA 1978;[ ]the debtor's membership interest in the property of a club or association pursuantto Section 53-10-2 NMSA 1978;[ ]oil and gas equipment not financed by the judgment creditor to be used forpurposes for which it was purchased as provided by Section 70-4-12 NMSA1978;[ ]allowances to surviving spouse and children from estate of a deceased estatesubject to the limitations of Sections 45-2-401 and 45-2-402 NMSA 1978;THIS LIST MAY NOT BE COMPLETE. YOU MAY CLAIM ANYOTHER EXEMPTION PERMITTED BY LAW BY COMPLETING THEFOLLOWING:[ ]other exemption (specify) .I am aware of my exemption rights:[ ]I desire to claim my exemption rights[ ]I waive my right to claim my exemption rights to the following propertyLIST ITEMSSTATED VALUE $(Attach additional page if necessary)I understand that by waiving my statutory right to exempt property, this American LegalNet, Inc. www.FormsWorkFlow.com property may be seized and sold.YOU MUST RETURN A COMPLETED AND SIGNED COPY OF THIS FORMTO THE CLERK OF THE COURT WHOSE ADDRESS IS SHOWN BELOW. YOU MUST ALSO SERVE A COPY ON THE JUDGMENT CREDITOR., Signature of judgment debtorReturn to clerk of the courtName of courtPrinted name of judgment debtorAddressStreet address or P.O. boxCity, state & zip codeCity, state & zip codeTelephone numberUSE NOTEThe judgment creditor may dispute any of the claimedexemptions. If the judgment creditor disputes claimedexemptions and files a request for hearing on the claimedexemptions, the clerk will schedule a hearing on theclaimed exemptions.[As amended, effective January 1, 1986; July 1, 1992; May 1, 1994; January 1, 1996; asamended by Supreme Court Order No. 09-8300-005, effective May 6, 2009.] American LegalNet, Inc. www.FormsWorkFlow.com