IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF DESCHUTES Case No. Plaintiff , CHALLENGE TO GARNISHMENT v. Defendant. I/We claim that the following described property or money is exempt from execution or is not subject to garnishment: I/We believe this property is exempt from or not subject to garnishment because (the Notice of Exempt Property that you received lists most types of property that you can claim as exempt from or not subject to garnishment): I am a person other than the Debtor and I have the following interest in the property: Name: Name: Signature: Signature: Address: Address: Telephone: Telephone: (Required) NOTICE OF EXEMPT PROPERTY Property belonging to you may have been taken or held in order to satisfy a debt. The debt may be reflected in a judgment or in a warrant or order issued by a state agency. YOU MAY BE ABLE TO GET YOUR PROPERTY BACK, SO READ THIS NOTICE CAREFULLY. State and Federal law specify that certain property may not be taken. Some of the property that you may be able to get back is listed below: 1)Wages or a salary as described in ORS 23.175 and ORS 23.186. Whichever of thefollowing amounts is greater.a.75 per cent of your take-home wagesb.$170 per work week2)Social Security benefits American LegalNet, Inc. www.FormsWorkFlow.com Supplemental Security Income (SSI)Public Assistance (welfare)Unemployment benefitsDisability Benefits (other than SSI benefits)Workers Compensation benefitsExempt wages, Social Security benefits (other than SSI), welfare, unemployment benefitsand disability benefits when placed in a check or savings account (up to $7500)Spousal support, child support or separate maintenance to extent reasonably necessaryfor your support or the support of any of your dependentsA homestead (home, farm, manufactured dwelling or houseboat) if you live in it, to thevalue of $20,000 ($23,000 for a manufactured dwelling with land included; $25,000 forany other homestead with land included) or proceeds from its sale for one year.Household goods, furniture, radios, a television set and utensils with a combined valuenot to exceed $3000* An automobile, truck trailer or other vehicle with a value not to exceed $1700* Tools, implements, apparatus, team, harness or library that are necessary to carry onyour occupation, with a combined value not to exceed $3000* Books, pictures and musical instruments with a combined value not to exceed $600* Wearing apparel, jewelry and other personal items with a combined value not to exceed$1800Domestic animals and poultry for family use with a combined value not to exceed $1000and their food for 60 days.Provisions (food) and fuel for your family for 60 days.One rifle or shotgun and one pistol. The combined value of all firearms claimed asexempt may not exceed $1000Public or private pensions Veteran222s benefits and loansMedical assistance benefits Health insurance proceeds and disability proceeds of life insurance policies Cash surrender value of life insurance policies not payable to your estate Federal annuities Other annuities to $250 per month (excess over $250 per month is subject to the sameexemption as wages) Professionally prescribed health aids for you or any of your dependents* Elderly rental assistance allowed pursuant to OR 310.635* Your right to receive, or property traceable to:* An award under any crime victim reparation law* A payment or payments, not exceeding total of $10,000, on account of personalbodily injury suffered by you or an individual of whom you are a dependent* A payment in compensation of loss of future earnings of you and an individualof whom you are or were a dependent, to the extent of reasonably necessary foryour support and the support of any dependents Interest in personal property to the vlue of $400, but this cannot be used to increase theamount of any other exemption. Equitable interests in propertyIf the amount shown owing on the Debt Calculation form exceeds the amount youactually owe to the creditor, the difference between the amount owed and the amountshown on the Debt Calculation form. NOTE: If two or more people in your household owe the claim or judgment, each of them may claim the exemptions marked by an asterisk(*). American LegalNet, Inc. www.FormsWorkFlow.com SPECIAL RULES APPLY FOR DEBTS THAT ARE OWED FOR CHILD SUPPORT AND SPOUSAL SUPPORT Some property that may not otherwise be taken for payment against the debt may be taken to pay for overdue support. For instance, Social Security benefits, workers compensation benefits, unemployment benefits, veteran222s benefits and pensions are normally exempt, but only 75 percent of a lump sum payment of these benefits is exempt if the debt is owed for a support obligation. YOU MUST ACT PROMPTLY IF YOU WANT TO GET YOUR MONEY OR PROPERTY BACK. You may seek reclaim of your exempt property by doing the following: 1)Fill out the Challenge to Garnishment form2)Mail or deliver the Challenge to Garnishment form to the clerk or the court at theaddress shown on the writ of garnishment. If you wish to claim wages or salary asexempt, you must mail or deliver the form within 120 days after you receive thegarnishment. If you wish to claim that the other money or property is exempt or claimthat the property is not subject to garnishment, you must mail or deliver the form within30 days after you receive this notice. You have the burden of showing that yourchallenge is made on time, so you should keep records showing when the challenge wasmailed or delivered.3)The law only requires that the Garnishor hold the garnished money or property for 10days before applying it to the Creditor222s use. You may be able to keep the property frombeing used by the Creditor by promptly following (1) and (2) above. You should be prepared to explain your exemption in court. If you have any questions about the garnishment or debt, you should see an attorney. IF YOU CLAIM AN EXEMPTION IN BAD FAITH, YOU MAY BE SUBJECT TO PENALITIES IMPOSED BY THE COURT THAT COULD INCLUDE A FINE. Penalties that you could be subject to are listed in ORS 18.715. When you file a Challenge to Garnishment form, the Garnishee may be required to make all payments under the garnishment to the Court, and the Garnishor may be required to pay to the Court all amounts received by the Garnishor that are subject to the challenge to the garnishment. The Garnishee and Garnishor are subject to penalties if they do not. For complete explanation of their responsibilities, see ORS 18.705 and ORS 18.708. American LegalNet, Inc. www.FormsWorkFlow.com