Fill and Sign the Name of Judgment Creditor Plaintiff Form

STATE OF NORTH CAROLINA File No. I, the undersigned, move to set aside the property claimed below as exempt. NOTE TO DEBTOR (DEFENDANT):The Clerk of Superior Court cannot fill out this form for you. If you need assistance, you should talk with an attorney. VERSUS Estimated Value Of Residence (What You Think You Could Sell It For) Street Address Of Residence Legal Description (Attach a copy of your deed or other instrument of conveyance or d escribe property in as much detail as possible. Attach additional sheets if necessary.) 5. County Where Property Located Name(s) Of Owner(s) Of Record Of Residence Location Of Burial Plots ClaimedI wish to claim as exempt (keep from being taken) my interest in the following real or personal propert y that I use as a residence. I also wish to claim my interest in the follow ing burial plots for myself or my dependents. I understa nd that my total interest claimed in the residence and buri al plots may not exceed $10,000.00. Township No. By Which Tax Assessor Identifies Property $ Value Of Burial Plots Claimed$ Amount Of Lien(s) And Name(s) And Address(es) Of Lienholder(s): (How much money is owed on the property and to whom) Current Amount Owed Judgment Docket Book And Page No. a. I am a citizen and resident of b. 1. 3. 4. 2. My current address is . The following persons are dependent on me for support: Name(s) Of Person(s) Dependent On Me Age Relationship I am married to I am not married. . . County (Over) MOTION TO CLAIM EXEMPT PROPERTY (STATUTORY EXEMPTIONS) G.S. 1C-1603(c) Name Of Judgment Creditor (Plaintiff) Name Of Judgment Debtor (Defendant) (Use if judgment filed before 1/1/06) In The General Court Of Justice District Superior Court Division AOC-CV-407, Page 1 of 3, Rev. 2/06 © 2006 Administrative Office of the Courts (TYPE OR PRINT IN BLACK INK) Abstract No. $ $ Date Judgment FIled AOC-CV-407, Page 2 of 3, Rev. 2/06 © 2006 Administrative Office of the Courts I wish to claim the following personal property consisting of household furnishings, household goods, wearing apparel, appliances, books, animals, crops or musical instruments as exempt from the claims of my creditors (in other words, keep them from being taken from me). These items of personal property are held primarily for my person al, family or household use. 6. I understand that I am entitled to personal property worth the su m of $3,500.00. I understand I am also entitled to an additional $750.00 for each person dependent upon me for support, but not to exceed $3,000.00 for dependents. I further understand that I am entitled to this amount after deducting from the value of th e property the amount of any valid lien or security interest. Property purchased within ninety (90) days of this proceeding is not exempt. ( Some examples of household goods would be TV, appliances, furniture, clothing, radios, record players.) (This item is to claim any other property you own that you wish to exempt.) I wish to claim the following property as exempt because I claimed residential or real property as exempt that is worth less t han $3,500.00, or I made no claim for a residential exemption under section (5) above. I understand that I am ent itled to $3,500.00 in any property only if I made no claim under section (5) above and that if I make a claim under section (5), that I am entitled to $3,500.00 in any property minus any amount I claimed under section (5). (Examples: claim of $1,000.00 under section (5), $2,500.00 allowed here; claim of $3,600.00 under section (5), no claim under section (5), $3,500.00 in any property allowe d here.) I further understand that the amount of my claim under this section is after the deduction from the value of this pro perty of the amount of any valid lien or security interests and that tangible personal property purchased within ninety (90) days of this procee ding is not exempt. 8.I wish to claim my interest in the following motor vehicle as exempt from the claims of my creditors. I understand that I am entitled to my interest in one motor vehicle worth the sum of $1,500.00 aft er deduction of any valid liens or security interests. I understand that a motor vehicle purchased within ninety (90) days of this proceeding is not exempt. 7. Item Of Property Fair Market Value (What You Could Sell It For) Amount Of LienOr Security Interes t (Amount Owed On Property) Name(s) Of Lienholder(s) (To Whom Money Is Owed) Value Of Debtor's (Defendant's) Interest (Fair Market Value Less Amount Owed) Fair Market Value (What You Could Sell It For) Name Of Title Owner Of Record Year Make And Model Name Of Lienholder(s) Of Record (Person(s) To Whom Money Is Owed) Amount Of Liens (Amount Owed) Value Of Debtor's (Defendant's) Interest (Fair Market Value Less Amount Owed) Item Of Personal Property Claimed Fair Market Value Amount Of Lien(s) Name(s) Of Lienholder(s) Value Of Debtor's (Defendant's) Interest Current Amount Owed Current Amount Owed Real Property Claimed (I understand that if I wish to claim more than one parcel, I must attach additional pages setting forth the following information for each parcel claimed as exempt.) Estimated Value Of Property (What You Could Sell It For) $ $ $ $ $ $ $ $ $ $ $ $ $$ $ $ $ $ $ $ $ $ $ $ $ $ $ Street Address Description (Attach a copy of your deed or other instrument of conveyance or describe the property in as much detail as possible.) Name And Address Of Lienholder Name And Address Of Lienholder (Attach additional sheets for more lienholders.) No. By Which Tax Assessor Identifies Property Township County Where Property Located File No. VERSUS I wish to claim the following items of health care aid (wheelchairs, hearing aids, etc.) necessary for Signature Of Judgment Debtor/Attorney For Debtor (Defendant) I certify that the above statements are true. Name Of Judgment Creditor (Plaintiff) Judgment Docket Book And Page No. Abstract No. Item Purpose I wish to claim the following implements, professional books, or tools (not to exceed $750.00), of my trade or the trade of my dependent. I understand such property purchased within ninety (90) days of this proceeding is not exempt. 9. myselfmy dependents. Item Estimated Value (What You Could Sell It For) What Business Or Trade Used In $ $ $ 10. Name Of Insurer Policy Number Beneficiary(ies) I wish to claim the following life insurance policies whose sole beneficiaries are my spouse and/or my children as exempt. 11. I wish to claim as exempt the following compensation which I received for t he personal injury of myself or a person upon whom I was dependent for support or compensation which I received for the d eath of a person upon whom I was dependent for support. I understand that this compensation is not exempt from claims for fune ral, legal, medical, dental, hospital or health care charges related to the accident or injury which resulted in the payment of the compensation to me. 12. Item Location Estimated Value Method Of Payment Lump Sum Or Installments (If Installments, State Amount, Frequency And Duration Of Payments) $ $ $ $ I wish to claim my individual retirement accounts and individual retirement ann uities (IRA's) that are listed below. 13. Account Number The following is a complete list of persons or businesses that have judgmen ts for money against me. 14. The following is a complete listing of my property which I do NOT claim as exempt. 15. 16. Date Signature Of Judgment Debtor/Attorney For Debtor (Defendant) Date Address And Phone Number Of Attorney For Debtor (Defendant) AOC-CV-407, Page 3 of 3, Rev. 2/06 © 2006 Administrative Office of the Courts A copy of this Motion was served on the judgment creditor (plaintiff) by: personally attorney. judgment creditor (plaintiff) at the address shown on the notice of rig hts served on me. a post-paid properly addressed envelope in a post office, addressed t o the judgment creditor's (plaintiff's) attorney at the following address: 17. delivering a copy to the judgment creditor (plaintiff) delivering a copy to , the judgment creditor's depositing a copy of this Motion in a post-paid properly addressed envelope in a post office, addressed to the depositing a copy of this motion in Location Of Compensation Amount Of Compensation Name Of Custodian Of IRA Account Date Of Judgment