IN THE UNITED STATES DISTRICT COURT FOR THE EA STERN DISTRI CT OF PENNSYLVAN IA : CIVIL ACTI ON : : : : : : : NO. CLAIM F OR EXEMP TIONTO THE U.S. MARSHAL: I, the above named defendant, claim exemption of property from levy or attachment: (1) From my personal property in my possession which has been levied upon, (a) I desire that my $300 statutory exemption be (i) set aside in kind (specify property to be set aside in kind): ; (ii) paid in cash following the sale of the property levied upon; or (b) I claim the following exemption (specify property and basis of exemption): (2) From my property which is in the possession of a third party, I claim the followingexemptions: (a) My $300 statutory exemption: in cash; in kind(specify property): (b) Social security benefits on deposit in the amount of $ (c) Other (specify amount and basis of exemption: Civ. 640 (10/99) >>>> 2 I request a prompt court hearing to determine the exemption. Notice of the hearing should be givento me at , (Address) ( Telephone number) I declare under penalty of perjury that the foregoing statements made in this claim for exemptionare true and correct. Date: (Signature of Defendant)THIS CLAIM TO BE FILED WITH THE OFFICE OF THE U.S. MARSHAL FOR THE EASTERN DISTRICT OF PENNSYLVANIA: 2110 United States Courthouse 601 Market Street Philadelphia, Pennsylvania 19106 (215) 597-7272 NOTE: Under paragraphs (1) and (2) of the writ, a description of specific property to be leviedupon or attached may be set forth in the writ or included in a separate direction to the United StatesMarshal. Under Paragraph (2) of the writ, if the attachment of a named garnishee is desired, his name shouldbe set forth in the space provided. Under Paragraph (3) of the writ, the United States Marshal may, as under prior practice, add asa garnishee any person not named in this writ who may be found in possession of property of thedefendant. See Rule 3111(a) . For limitations on the power to attach tangible personal property, see Rule3108(a). (b) Each court shall by local rule designate the officer, organization or person to be named in thenotice.