IN THE CHANCERY COURT FOR THE STATE OF TENNESSEE TWENTIETH JUDICIAL DISTRICT, DAVIDSON COUNTY ________________________________________ Plaintiff vs. ________________________________________ Defendant Docket No. _______________________ DEBTOR’S FILING OF EXEMPT PROPERTY (OR AMENDMENT TO DEBTOR’S FILING OF EXEMPT PROPERTY) I _______________________________________________, the Judgment Debtor herein and a resident of Tennessee, claim and declare the following items, the value of which does not exceed $10000.00, to be exempt from execution, seizure or attachment pursuant to Tennessee Code Annotated §26-2-102 and §26-2-114 (or to amend the previous list filed to assert such exemption). The following is my list (or revised list) of claimed exemptions, which I make oath is true and correct to the best of my knowledge, information and belief: Value Item Automobiles: ______________________________________________ ______________________________________________ ___________________ ___________________ Furniture: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ___________________ ___________________ ___________________ ___________________ Household Goods: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ___________________ ___________________ ___________________ ___________________ ___________________ Other (included, but not limited to, bank accounts, cash, etc.): ______________________________________________ ______________________________________________ ______________________________________________ ___________________ ___________________ ___________________ Total: _____________ I further declare the following items, the value of which does not exceed $1900.00, to be exempt tools of the trade: Item ______________________________________________ ______________________________________________ ______________________________________________ Value ___________________ ___________________ ___________________ Total: ______________ This personal property exemption right is in addition to certain items that are automatically exempt by law and do not need to be listed, including: 1) All necessary and proper wearing apparel for the actual use of the debtor and the debtor’s family and the trunks or receptacles necessary to contain them (T.C.A. §26-2-104(a)(1)), 2) All family portraits and pictures (T.C.A. §26-2-104(a)(2)), 3) The family Bible and school books (T.C.A. §26-2-104(a)(3), and is in addition to other exemption rights that may be provided by state or federal law. ________________________________________________ Judgment Debtor’s Signature American LegalNet, Inc. www.FormsWorkFlow.com Sworn to and subscribed before me this _____ day of ________________, 201___. __________________________________ Notary Public/(Deputy) Clerk & Master CERTIFICATE OF SERVICE I, the Judgment Debtor, certify that a true and correct copy of this document has been mailed by first class mail, postage prepaid or personally delivered to _______________________________________________________________________ (Judgment Creditor or Judgment Creditor’s attorney) at _____________________________________________________ on the _____ day of ___________________, 201___. (NOTE: You may obtain the Judgment Creditor’s address from the Clerk and Master’s office.) ________________________________________________ Judgment Debtor’s Signature American LegalNet, Inc. www.FormsWorkFlow.com