Fill and Sign the Claim Exemption Garnishment Form

In the District Court of _______________________ County State of Oklahoma __________________________ ) Plaintiff ) ) vs. ) ) ____________________________ ) Case No. _______________ Defendant ) ) and ) ) ____________________________ ) Garnishee ) Claim for Exemption and Request for Hearing 1. Funds sought in garnishment are exempt from execution because they are (check applicable box): A. Social Security benefits – 42 U.S.C. § 407. B. Supplemental security income – 42 U.S.C. §1383(d). C. Unemployment benefits – 40 O.S. §2-303. D. Workmen’s Compensation benefits – 85 O.S. §48. E. Welfare benefits – 56 O.S. §173. F. Veterans’ benefits – 38 U.S.C. §3101, 31 O.S. §7. G. Monies in Possession of Police Pensions – 11 O.S. §50-124. H. Monies in Possession of Firemen’s Relief & Pension Fund – 11 O.S. §49-126. I. Monies in Possession of County Employee’s Retirement System – 19 O.S. §959. J. Monies in Possession of Public Employee’s Retirement Fund – 74 O.S. §923. K. Teacher’s Annuities or Retirement Allowance – 70 O.S. §17-109. L. Annuities and pension payments under Railroad Retirement Act – 45 U.S.C. §231(m) M. United States Civil Service Retirement and Disability Pension Fund Payments – 5 U.S.C. §8346. N. United States Civil Service Survivor Annuities – 5 U.S.C. §8346. O. Interest in Retirement, Pension and Profit Sharing Plans – 60 O.S. §327, 60 O.S. §328. P. The Wages of Seamen – 46 U.S.C. §601. Q. Funds vested in the Alien Property Custodian – 50 U.S.C. Appx. §9(f). R. Prepaid Burial Benefits – 36 O.S. §6125. S. Proceeds of Group-Life Insurance Policy – 36 O.S. 3632, and 36 O.S. §4026. T. Alimony, support, separate maintenance, or child support necessary for support of judgment debtor or dependent – 31 O.S. §1.1. U. Personal wage exemption because of undue hardship – 31 O.S. §1.1. V. Other ( please state ): ________________________________________________ 2. Check one box: All funds are exempt, or, I believe the following amount of money is exempt: $__________________________ (Fill in the amount of funds to be exempt) . 3. Check if applicable: I have attached copies of the documents that show that my money is exempt. 4. If garnishment is for wages, this claim and request is filed for the pay period _________________ through ________________, inclusive. 5. I request that this matter be set for hearing. _________________________________________ Signature Address for mailing of Court Hearing Notice _________________________________________ _________________________________________ Address for mailing a copy of Claim to Judgment Creditor’s Attorney: _________________________________________ _________________________________________ You must mail the original to the Court Clerk of ____________________County at the following address: _________________________________________________________________ _________________________________________________________________________ AOC Form 22 Revised 8/05