Fill and Sign the Notice to Judgment Debtor How to Claim Exemptions from Form

NOTICE TO JUDGMENT DEBTOR HOW TO CLAIM EXEMPTIONS FROM GARNISHMENT AND LIEN The attached Summons in Garnishment or Notice of Lien has been issued on request of a creditor who holds a judgment against you. The Summons may cause your property or wages to be held or taken to pay the judgment. The law provides that certain property and wages cannot be taken in garnishment. Such property is said to be exempted. A summary of some of the major exemptions is set forth in the request for hearing form. There is no exemption solely because you are having difficulty paying your debts. If you claim an exemption, you should (i) fill out the cl aim for exemption form and (ii) deliver or mail the form to the clerk’s office of this court. You have a right to a hearing within seven busin ess days from the date you file your claim with the court. If the creditor is asking that your wages be withheld, the method of computing the amount of wages which are exempt from garnishment by law is indicated on the Summons in Garnishment attached. You do not need to file a claim for exemption to receive this exemption, but if you believe the wrong amount is being withheld, you may file a claim for exemption. On the day of the hearing, you should come to court ready to explain why your property is exempted, and you should bring any documents which may help you prove your case. If you do not come to court at the designated time and prove that your property is exempt, you may lose some of your rights. If you do not claim an exemption and do not otherwise contest the garnishment, you are not required to appear in court on the ret urn date on the Garnishment Summons. It may be helpful for you to seek the advice of an attorney in this matter. THE REQUEST FOR HEARING FORM IS PRINTED ON THE REVERSE OF THIS FORM. FORM DC-454 FRONT 07/10 REQUEST FOR HEARING – Case No. ........................................................................\ .... GARNISHMENT/LIEN EXEMPTION CLAIM Commonwealth of Virginia VA. CODE § 8.01-512.4 ........................................................................\ ...............................................................................................................................\ ................................................... COURT NAME ........................................................................\ ............................................. v. ........................................................................\ .......................................... JUDGMENT CREDITOR JUDGMENT DEBTOR and ........................................................................\ ........................................... GARNISHEE I claim that the exemption(s) from garnishment or lien which are checked below apply in this case: Major Exemptions Under Federal and State Law _______ 1. Social Security benefits and Supplemental Security Income (SSI) (42 U.S.C. § 407). _______ 2. Veterans’ benefits (38 U.S.C. § 5301). _______ 3. Federal civil service retirement benefits (5 U.S.C. § 8346). _______ 4. Annuities to survivors of fe deral judges (28 U.S.C. § 376(n) ). _______ 5. Longshore and Harbor Workers' Compensation Act (33 U.S.C. § 916). _______ 6. Black Lung benefits. Exemptions listed under 1 through 6 above may not be applicable in child support and alimony cases (42 U.S.C. § 659). _______ 7. Seaman’s, master’s or fisherman’s wages, except for child support or spousal support and maintenance (46 U.S.C. § 11109). _______ 8. Unemployment compensation benefits (§ 60.2-600, Code of Virginia). This exemption may not be applicable in child support cases (§ 60.2-608, Code of Virginia). _______ 9. Amounts in excess of portions of wages subject to garnishment (§ 34-29, Code of Virginia). _______ 10. Public assistance payments (§ 63.2-506, Code of Virginia). _______ 11. Homestead exemption of $5,000 in cash, or $10,000 if the householder is 65 years of age or older. (§ 34-4, Code of Virginia). This exemption may not be claimed in certain cases, such as payment of child or spousal support (§ 34-5, Code of Virginia). _______ 12. Property of disabled veterans – add itional $10,000 cash (§ 34-4.1, Code of Virginia). _______ 13. Worker’s Compensation benefits (§ 65.2-531, Code of Virginia). _______ 14. Growing crops (§ 8.01-489, Code of Virginia). _______ 15. Benefits from group life insurance policies (§ 38.2-3339, Code of Virginia). _______ 16. Proceeds from industrial sick benefits insurance (§ 38.2-3549, Code of Virginia). _______ 17. Assignments of certain salary and wages (§ 55-165, Code of Virginia). _______ 18. Benefits for victims of crime (§ 19.2-368.12, Code of Virginia). _______ 19. Proceeds from funeral trusts (§ 54.1-2823, Code of Virginia). _______ 20. Certain retirement benefits (§ 34-34, Code of Virginia). _______ 21. Child support payments (§ 20-108.1, Code of Virginia). _______ 22. Support for dependent children (§ 34-4.2, Code of Virginia). To claim this exemption, an affidavit that complies with the requirements of subsection B of § 34-4.2 and two items of proof showing entitlement to this exemption must be attached to this ex emption form. (The affidavit, form DC-449, A FFIDAVIT CONCERNING DEPENDENT CHILDREN AND HOUSEHOLD INCOME , is available at www.courts.state.va.us/forms/district/civil.html or the clerk’s office.) _______ 23. Other (describe exemption): $ ........................................................................\ ............................................................................. I request a court hearing to decide the validity of my claim. Notice of hearing should be given to me at: ........................................................................\ ....................................................... ..................................................... ............................................................... ADDRESS TELEPHONE NUMBER The statements made in this request are true to the best of my knowledge and belief. ....................................................................... ___________________________________________________________ DATE SIGNATURE OF JUDGMENT DEBTOR FORM DC-454 REVERSE 07/12