Fill and Sign the Amount Exempt Earnings Form

 County Court  District Court ______________________County, Colorado Court address: Plaintiff(s): v. Defendant(s): COURT USE ONLY Judgment Debtor’s Attorney or Judgment Debtor (Name and Address): Phone Number: E-mail: FAX Number: Atty.Reg. #: Case Number: Division Courtroom OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS Instructions to Judgment Debtor: Use this form to object to the calculations of your exempt earnings. Name: ______________________________________________________Phone Number: _________________________ Street Address: _________________________________________________________________________________ Mailing Address, if different: _____________________________________________________________________________ City: ____________________________ State: _______________________________ Zip Code: ______________________ EXEMPTION CHART (“Minimum Hourly Wage” means state or federal minimum wage, whichever is greater.) PAY PERIOD Weekly Bi-Weekly Semi-monthly Monthly AMOUNT EXEMPT IS THE GREATER OF: 30 x Minimum Hourly Wage or 75% of Disposable Earnings 60 x Minimum Hourly Wage or 75% of Disposable Earnings 65 x Minimum Hourly Wage or 75% of Disposable Earnings 130 x Minimum Hourly Wage or 75% of Disposable Earnings 1. Judgment Debtor’s objection to the Garnishee’s Calculation of the Amount of Exempt Earnings because I believe that the correct calculation is: Gross Earnings for My Pay Period from ___________________thru _________________ $ ____________ Less Deductions Required by Law (For Example, Withholding Taxes, FICA) - $ ____________ Disposable Earnings (Gross Earnings Less Deductions) = $ ____________ Less Statutory Exemption (Use Exemption Chart on Writ) - $ ____________ Net Amount Subject to Garnishment = $ ____________ Less Wage/Income Assignment(s) During Pay Period (If Any) - $ ____________ Amount which should be withheld = $ ____________ OR 2. The earnings garnished are pension or retirement benefits/deferred compensation/health, accident or disability insurance and they are totally exempt because : I understand that I must make a good faith effort to resolve my dispute with the Garnishee. I  have  have not attempted to resolve this dispute with the Garnishee. FORM 28SC R3/18 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS Name of Person I Talked to: _________________________________________________ Position: _________________________________________ Phone Number: __________________________________ FORM 28SC R3/18 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS Debtor’s Notice to Garnishee: Even though I am filing this Objection, you are directed to send my nonexempt earnings to the Court at the address noted instead of to the party designated in paragraph “e” on the front of the Writ of Continuing Garnishment. The Court will hold my nonexempt earnings in its registry until my Objection is resolved. I certify that the above is correct to the best of my knowledge and belief and that I sent a copy of this document by  certified mail (return receipt requested) to both the Garnishee and to the Judgment Creditor, or if the Judgment Creditor is represented by Counsel,  certified mail (return receipt requested) to the Judgment Creditor’s Attorney or  E-Service to the Judgment Creditor’s Attorney.  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form . Garnishee Judgment Creditor or Attorney Address: ________________________________________ Address: ___________________________________ ________________________________________________ ___________________________________________ ___________________________________________ Signature of Judgment Debtor or Judgment Debtor’s Counsel and Reg. Number FORM 28SC R3/18 OBJECTION TO CALCULATION OF THE AMOUNT OF EXEMPT EARNINGS