Protected Income and Assets Page 1 of 3 This Protected Income and Assets form is: New/First time filed Changed/Modified You may use this form to tell the court about any income, property, or benefits that are protected from sale or seizure (garnishment) under state or federal law. You should file this form for each judgment you have against you. You may have to pay a filing fee. Can222t afford the fee? Ask the court clerk for a paper called a Request to Postpone Filing Fees and Order (Uniform Civil Affidavit of Indigency). Or go on the internet to www.tncourts.gov or www.justiceforalltn.com to get the form. Fill out the form. Make a copy for each judgment against you before you write in the file number and before signing the form. Sign each copy. You can update this form if you need to protect new property. You must file an update for all unpaid judgments against you. IMPORTANT! You can protect up to $10,000.00 worth of personal property (lines 1-6), and only up to $750.00 for line 7. Some things are automatically protected. You do not have to list them below, such as: your family222s clothing and suitcases or trunks where the clothing is stored, family portraits and photographs, the family bible and schoolbooks. I am the Defendant/Debtor in the court case listed above. I live in Tennessee and I claim that the following items are protected from garnishment. (TCA 247247 26-2-102 and 26-2-114). This personal property exemption right is in addition to certain items that are automatically exempt by law and do not need to be included in my $10,000 total, including funds on deposit in checking and/or savings accounts at: Name of Bank consisting solely of Social Security, SSI, Unemployment, Workers Comp, AFDC/Families First, Veteran222s benefits, alimony or child support, and/or state, federal or city pension. Item Describe Value 1. Car, truck, or other vehicle $ State of Tennessee Court (Must Be Completed) County (Must Be Completed) Protected Income and Assets (Affidavit of Claim Exemptions) File No. (Must Be Completed) Division (Large Counties Only) Plaintiff/Creditor (Name: First, Middle, Last of person/company that filed lawsuit) Defendant/Debtor (Name: Firs t , Middle, Last of the other person) American LegalNet, Inc. www.FormsWorkFlow.com Protected Income and Assets Page 2 of 3 2. Furniture/Electronics $ 3. Household goods $ 4. Bank Accounts Bank Name Balance 5. Other $ $ $ 6. Cash $ 7. Tools of the Trade (Things I need to earn a living) $ Read below then sign: I declare under penalty of perjury under the laws of the State of Tennessee that: The information on this form is true to the best of my knowledge. The information I provided is a correct and complete list of all of my income and assets to be protected. Defendant/Debtor Signs here: Date: Sworn to and subscribed before me this day of , 20. Deputy Clerk or Notary Public Bring the original and 2 copies of this form to the Court Clerk to be date stamped. Give the original to the Court Clerk. Bring a stamped envelope addressed for each plaintiff to the Court Clerk. Mail one copy to the lawyer or if there is no lawyer, mail it to the plaintiff or company that sued you. Keep one copy for yourself. American LegalNet, Inc. www.FormsWorkFlow.com Protected Income and Assets Page 3 of 3 Certificate of Service (How I gave this paper to the Plaintiff/Creditor) I certify that I (check one box) hand delivered or mailed by first-class mail, properly addressed, a true and correct copy of this paper to the person listed below at the address below: Name of Who You Are Giving This To (The creditor222s lawyer or the creditor if no lawyer) Address of the Lawyer or the Creditor (Include City, State and Zip Code) on . (Date you mailed/hand-delivered the copy) Sign Your Name IMPORTANT! The court and clerks are not allowed to give you legal advice, even if you don222t have a lawyer. This form is a public record. It is not legal advice. The law may change and it is best to consult with a lawyer if possible. American LegalNet, Inc. www.FormsWorkFlow.com