Fill and Sign the Do Not Use This Form for as 09

CIV -515 ( 12/12 )(st 3) Civil Rule 69 CLAIM OF EXEMPTIONS AS 09.38.035 -.080 Do not use this form for AS 09.38.020 property. IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) Plaintiff(s), ) vs. ) ) ) ) CASE NO. Defendant(s). ) ) CLAIM OF EXEMPTIONS 1. I do not wish to claim exemptions for the money or property listed in the Credito r’s Affidavit. 2. I do wish to claim exemption (s) for the following property : a. Money in the amount of $ seized on from an account at (name of bank) . This money belongs to . I believe t his money is exempt because it comes from Veteran’s Benefits Social Security Other b. Money in the amount of $ seized on from an account at (name of bank) . This money belongs to . I believe t his money is exempt because it comes from Veteran’s Benefits Social Security Other IMPORTANT NOT E: If you attach copies of bank statements or the seizure notice from your bank to prove where the money in the account (s) came from, be sure to black out all account numbers. These documents will be stored in a public file. A copy of this document with all attachments will be sent to the creditor. c. Other property valued at $ . Description: Reason it is exempt: (Attach additional pages if ne cessary. Do not write on the back of this form. ) Date Signature of Debtor Print Debtor’s Name Mailing Address City State Zip E-mail Address Daytime Telep hone I certify that on , a copy of this claim and form CIV -516 were sent to: Debtor Creditor/Atty: By Clerk: