STATE OF NORTH CAROLINA County File No. Judgment Abstract No. OR Judgment Docket Book & Page No. In Original County In The General Court Of Justice District Superior Court Division Name Of Judgment Creditor (Plaintiff) Name Of Judgment Debtor (Defendant) VERSUS MOTION TO CLAIM EXEMPT PROPERTY (CONSTITUTIONAL EXEMPTIONS) G.S. 1C-1602 NOTE TO JUDGMENT DEBTOR: The Clerk of Superior Court cannot fill out this form for you. If you need assistance, you should talk with an attorney. I, the undersigned, am a citizen and resident of North Carolina and move to claim my constitutional exemptions and ask to have the following property set aside as exempt. I understand that I can claim these exemptions even though I have waived my rights to statutory exemptions. 1. I wish to claim as exempt my interest in the real property (land and anything permanently attached to the land) described below. I understand that my total interest claimed in this real property may not exceed $1,000. Street Address Or Description Of Real Property Name(s) Of Owner(s) Of Property County Where Property Located No. By Which Tax Assessor Identifies Property Name(s) And Address(es) Of Lienholders Estimated Value Of Property (What You Think You Could Sell It For) $ Current Amount Owed On Lien $ 2. I wish to claim as exempt the personal property (any property that is not real property) described below. I understand that I am entitled to my interest in personal property not exceeding $500. Item(s) Of Property Fair Market Value Amount Of Lien Or (What You Could Sell For) Security Interest $ $ $ $ $ $ 3. I certify that the above statements are true. Date Signature Of Judgment Debtor (Defendant) 4. A copy of this Motion was served on the judgment creditor (plaintiff) by: delivering a copy to the judgment creditor (plaintiff) delivering a copy to , the judgment creditor's attorney. personally. depositing a copy of this Motion in a post-paid properly addressed wrapper in a post office, addressed to the judgment creditor depositing a copy of this Motion in a post-paid properly (plaintiff) at the address shown on the notice of rights served on me. addressed wrapper in a post office, addressed to the judgment creditor's (plaintiff's) attorney at the following address: Date Signature Of Judgment Debtor/Attorney For Debtor (Defendant) Address And Phone No. Of Attorney For Debtor (Defendant) . AOC-CV-411, Rev. 10/14 © 2014 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com