Fill and Sign the Judgment Debtors Name Last Known Address Other Identifying Information

County Court District Court ___________________________ County, Colorado Court Address: ________________________________________________________ Plaintiff(s)/Petitioner(s):________________________________ v. Defendant(s)/Respondent(s):______________________________ COURT USE ONLY Judgment Creditor’s Attorney or Judgment Creditor (Name and Address): Phone Number:__________________ E-mail: _________________ FAX Number:___________________ Atty. Reg. #: _____________ Case Number:__________________ Division _______ Courtroom _______ WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Judgment Debtor’s name, last known address, other identifying information: _______________________________________ ____________________________________________________________________________________________________ 1. Original Amount of Judgment Entered ___________________________(date) $ ____________________ 2. Plus any Interest Due on Judgment (________________% per annum) + $____________________ 3. Taxable Costs (including estimated cost of service of this Writ) + $____________________ 4. Less any Amount Paid - $____________________ 5. Principal Balance/Total Amount Due and Owing = $____________________ I affirm that I am authorized to act for the Judgment Creditor and this is a correct statement as of _________________ (date). Subscribed under oath before me on __________________ ___________________________________________ Print Judgment Creditor’s Name _______________________________________________ Address : ____________________________________ Notary Public or Deputy Clerk ___________________________________________ My Commission Expires: ___________________________ By: ________________________________________ Signature (Type Name, Title, Address and Phone No.) WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY THE PEOPLE OF THE STATE OF COLORADO to the Sheriff of any Colorado County, or to any person 18 years or older and who is not a party to this action: You are directed to serve a copy of this Writ of Garnishment upon ______________________________________, Garnishee, with proper return of service to be made to the Court. TO THE GARNISHEE: YOU ARE HEREBY SUMMONED AS GARNISHEE IN THIS ACTION AND ORDERED: a.To answer the following questions under oath and file your answers with the Clerk of the Court (AND to mail a completed copy with your answers to the Judgment Creditor or attorney when a stamped envelope is attached) within 10 days following service of this Writ upon you. YOUR FAILURE TO ANSWER THIS WRIT WITH NOTICE MAY RESULT IN THE ENTRY OF A DEFAULT AGAINST YOU. b.To hold pending court order any personal property (other than earnings) owed to or owned by the Judgment Debtor and in your possession or control on the date and time this Writ was served upon you. YOU ARE NOTIFIED: a. This Writ with Notice applies to all personal property (other than earnings) owed to or owned by the Judgment Debtor and in your possession or control as of the date and time this Writ was served upon you. b.In no case may you withhold any personal property greater than the amount on Line 5 on the front of this Writ unless the personal property is incapable of being divided. c. If you are ordered to pay funds to the Court, tender your check for the amount ordered PAYABLE TO THE CLERK OF THE ________________________________, COURT AT _________________________________________, COLORADO. CLERK OF THE COURT By Deputy Clerk: ___________________________________________ DATE: ___________________________________________ FORM 29 R7/07 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 1 of 3 QUESTIONS TO BE ANSWERED BY GARNISHEE Judgment Debtor’s Name: ___________________________________ Case Number: ___________________ The following questions MUST be answered by you under oath: a. On the date and time this Writ was served upon you, did you possess or control any personal property of the Judgment Debtor or did you owe any rents, payments, obligations, debts or moneys other than earnings to the Judgment Debtor? YES NO b. IfYES, list all items of personal property and their location(s) and/or describe the nature and amount of the debt or obligation: (Attach additional pages if necessary): _________________________________________________________ _______________________________________________________________________________________________ c. Do you claim any setoff against any property, debt or obligation listed above? YES NO d. I f you answered YES to question c, describe the nature and amount of the setoff claimed: (Attach additional pages if necessary): _______________________________________________________________ ______________________________________________________________________________________________ I affirm that I am authorized to act for the Garnishee and the above answers are true and correct. Name of Garnishee (Print) __________________________________ Subscribed under oath before me on ___________________ (date) Address: _________________________________________________ ________________________________________________________ ____________________________________________________ Phone Number ___________________________________________ Notary Public/Deputy Clerk My Commission Expires: ____________________________ _____ Name of Person Answering (Print) ____________________________ Signature of Person Answering _______________________________ NOTICE TO JUDGMENT DEBTOR OF EXEMPTION AND PENDING LEVY This Writ with Notice is a Court order which may cause your property or money to be held and taken to pay a judgment entered against you. You have legal rights which may prevent all or part of your money or property from being taken. That part of the money or property which may not be taken is called “exempt property”. A partial list of “exempt property” is shown below, along with the law which may make all or part of your money or property exempt. The purpose of this notice is to tell you about these rights. PARTIAL LIST OF EXEMPT PROPERTY 1.All or part of your property listed in Sections 13-54-101 and 102, C.R.S., including clothing, jewelry, books, burial sites, household goods, food and fuel, farm animals, seed, tools, equipment and implements, military allowances, stock-in-trade and certain items used in your occupation, bicycles, motor vehicles (greater for disabled persons), life insurance, income tax refunds, including a refund attributed to an earned income tax credit or child tax credit, money received because of loss of property or for personal injury, equipment that you need because of your health, or money received because you were a victim of a crime. 2.All or part of your earnings under Section 13-54-104, C.R.S. 3.Worker’s compensation benefits under Section 8-42-124, C.R.S. 4.Unemployment compensation benefits under Section 8-80-103, C.R.S. 5.Group life insurance benefits under Section 10-7-205, C.R.S. 6.Health insurance benefits under Section 10-16-212, C.R.S. 7.Fraternal society benefits under Section 10-14-403, C.R.S. 8.Family allowances under Section 15-11-404, C.R.S. 9.Teachers’ retirement fund benefits under Section 22-64-120, C.R.S. 10.Public employees’ retirement benefits (PERA) under Sections 24-51-212 and 24-54-111, C.R.S. 11.Social security benefits (OASDI, SSI) under 42 U.S.C. §407. 12.Railroad employee retirement benefits under 45 U.S.C. §231m. 13.Public assistance benefits (OAP, AFDC, TANF, AND, AB, LEAP) under Section 26-2-131, C.R.S. 14.Police Officer’s and Firefighter’s pension fund payments under Sections 31-30-1117 & 31-30.5-208 and 31-31-203, C.R.S. 15.Utility and security deposits under Section 13-54-102(1)(r), C.R.S. 16.Proceeds of the sale of homestead property under Section 38-41-207, C.R.S. 17.Veteran’s Administration benefits under 38 U.S.C. §5301. 18.Civil service retirement benefits under 5 U.S.C. §8346. 19.Mobile homes and trailers under Section 38-41-201.6, C.R.S. 20.Certain retirement and pension funds and benefits under Section 13-54-102(1)(s), C.R.S. 21.A Court-ordered child support or maintenance obligation or payment under Section 13-54-102(1)(u), C.R.S. 22.Public or private disability benefits under Section 13-54-102(1)(v), C.R.S. FORM 29 R7/07 WRIT OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 2 of 3 ✔ ✔ FORM 29 R7/07 OF GARNISHMENT WITH NOTICE OF EXEMPTION AND PENDING LEVY Page 3 of 3 WRIT If the money or property which is being withheld from you includes any “exempt property”, you must file within 10 days of receiving this notice a written Claim of Exemption with the Clerk of the Court describing what money or property you think is “exempt property” and the reason that it is exempt. YOU MUST USE THE APPROVED FORM attached to this Writ or a copy of it. When you file the claim, you must immediately deliver, by certified mail, return receipt requested, a copy of your claim to the Garnishee (person/place that was garnished) and to the Judgment Creditor’s attorney, or if none, to the Judgment Creditor at the address shown on this Writ with Notice. Notwithstanding your right to claim the property as “exempt,” no exemption other than the exemptions set forth in Section 13-54-104(3), C.R.S., may be claimed for a Writ which is the result of a judgment taken for arrearages for child support or for child support debt. Once you have properly filed you claim, the court will schedule a hearing within 10 days. The Clerk of the Court will notify you and the Judgment Creditor or attorney of the date and time of the hearing, by telephone, by mail or in person. When you come to your hearing, you should be ready to explain why you believe your money or property is “exempt property”. If you do not appear at the scheduled time, your money or property may be taken by the Court to pay the judgment entered against you. REMEMBER THAT THIS IS ONLY A PARTIAL LIST OF “EXEMPT PROPERTY”; you may wish to consult with a lawyer who can advise you of your rights. If you cannot afford one, there are listings of legal assistance and legal aid offices in the yellow pages of the telephone book. You must act quickly to protect your rights. Remember, you only have 10 days after receiving this notice to file your claim of exemption with the Clerk of the Court. RETURN OF SERVICE Judgment Debtor’s Name: __________________________________ Case Number: ___________________ I declare under oath that I am 18 years or older and not a party to the action and have served a copy of this Writ of Garnishment on _____________________________ (name of garnishee) in _________________ (County) ________________ (State) on ___________________________ (date) __________ (time) at the following location: ____________________________________________________________________________________________________ By (Check one): By handing it to a person identified to me as ______________________________ (name of garnishee). By leaving it with _________________________________________ (Type or write name legibly), who is designated to receive service because of a legal relationship with _______________________ (name of garnishee) as provided for in C.R.C.P. 4(e). I attempted to serve ___________________________ (name of garnishee) on _______ occasions but have not been able to locate him/her/it. Return to the Judgment Creditor is made on ___________________ (date). I attempted to leave it with __________________________ (name of person) who refused service. Private process server ___________________________________ Sheriff, _________________________County Signature of Process Server Fee $ ____________ Mileage $ __________ ___________________________________ Name (Print or type) Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______.Note: Not required for service by a sheriff or deputy. My Commission Expires: ________________________ ___________________________________ Notary Public/Clerk