IN THE CHANCERY COURT OF HAMILTON COUNTY, TENNESSEE ___________________________________________________________ * P laintiff * * N0._____________ vs. * * PART__________ ___________________________________________________________ * D efendant * DEBTORS FILING OF EXEMPT PROPERTY (OR AMENDMENT TO DEBTORS FILING OF EXEMPT PROPERTY) I, the undersigned, being the Judgment Debtor herein and a resident of the State of Tennessee, claim and declare the following items, the value of which does not exceed Four Thousand and 00/100 ($4,000.00) Dollars to be exempt from execution, seizure or attachment pursuant to the provisions of Tennessee Code Annotated 26-2-102 and 26-2-114 (or to amend the pstre vious lifiled to assert such exemption). The following is my list (or revised list) of claimed exemptions, which I make oath isd co trurreect anto the best of my knowledge, information and belief: ITEM V ALUE Automobiles: _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Furniture : _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Household Goods: _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Other (including but not limited to bank accounts, cash, et: c.) _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ To tal Value:________________ I further declare the following items, the value of which does not exceed Seven Hundred Fifty and 00/100 ($750.00) Dollars, to be except tools of the trade: ITEM V ALUE _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ T o tal Value: ________________ This personal property exemption right is in addition to certain items that are automatically exempt by law and do n ot need tobe listed, including: (1) all necessary and proper wearing apparel for the actual use of the debtor and the debtord ts fahmilye antrunks or receptacles necessary to contain them {TCA 26103(a-2- )(1)}; (2) all family portraits and pictures {TCA 26-2-103(a)(2)}; and (3) the family Bible and school books {TCA 26-2-103(a)(3)}, and is in addition to other exemption rights that may beed p byrovi dstate or federal law. __________________________________________________ ______-____-________ (______)_____________________ Signature of Judgment Debtor S oc ial S ec uri ty N0. Phone N0. Address:____________________________________________________________________________________________________ CERTIFICATE OF SERVICE I, the undersigned Judgment Debtor, hereby certify that a true and correct copy of this document has been personally delivered or mailed by First Class Mail, postage prepaid, to the Judgment Creditor or said Judgment Creditors attorney,_________________________________________, at their last known address of___________________________________ ___________________________________________________________________________________________________________ ________________________________________, on this _______ day of _____________________, 20_______. NOTE: You may obtain the address of the Judgment Creditor or Judgment Creditors attorney from the Clerk & Masters Office. __________________________________________________ Judgment Debtor [Form 027, Rev. 2002.10111]