Form JD-CV-5B "Exemption Claim Form, Property Execution" - Connecticut

What Is Form JD-CV-5B?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2013;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-CV-5B by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-CV-5B "Exemption Claim Form, Property Execution" - Connecticut

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EXEMPTION CLAIM FORM
STATE OF CONNECTICUT
PROPERTY EXECUTION
MXMPEX
SUPERIOR COURT
JD-CV-5b Rev. 4-13
www.jud.ct.gov
*MXMPEX*
C.G.S. 52-321a, 52-352b, 52-361a, 52-361b
Name and mailing address of Judgment Debtor or Attorney
Instructions
(To be completed by judgment creditor or judgment creditor's attorney)
To Judgment Creditor or Judgment Creditor's
Attorney: Complete section 1 below and follow
instructions on form JD-CV-5.
To proper officer: Complete section 2 below and
follow instructions on form JC-CV-5.
To third person: Complete section 3 below and follow
instructions on form JD-CV-5.
To Judgment Debtor: Read section 4 below and
complete section 5 if it applies to you.
Section 1
(Must be completed by Judgment Creditor or Judgment Creditor's attorney)
u
Address of Court (Number, street, town, zip code)
Geographical Area
Judicial District
Housing Session
Name of Case
Docket number
Name of Judgment Debtor
Section 2
(Must be completed by proper officer)
Date of service of execution
Name and address of proper officer
Name and address of third person served with execution (if any)
Telephone number (if known)
Section 3
(Must be completed by third person served with execution (if any))
Date execution mailed to Judgment Debtor
Section 4 — Notice To Judgment Debtor
As a result of a judgment entered against you the attached execution has been issued against your personal property.
Some of your personal property may be exempt from execution — Certain classes of personal property may be protected
from execution by state statutes or other laws or regulations of this state or of the United States. A checklist and description of
the most common classes of personal property of a natural person exempt from execution are listed on page 2 of this form.
How to claim an exemption established by law — If you want to claim that the property levied on by the levying officer is
exempt by law from execution you must fill out and sign the Claim of Exemption on page 2 of this form and return this
exemption claim form to the clerk of the Superior court at the address above. The form must be received by the clerk of
the Superior Court within 20 days after levy on the property.
Upon receipt of this form, the court clerk will send you and the judgment creditor the date of the court hearing on your
claim.
Right to request installment payment order — If you are a consumer judgment debtor, you may seek to have the court
issue an installment payment order with a provision that compliance with the order prevents a levy on your property. (Section
52-356d of the Connecticut General Statutes.) An installment payment order is a court order that you pay a weekly amount to
the judgment creditor until the judgment is satisfied.
"Consumer Judgment" means a money judgment of less than $5,000 against a natural person resulting from a debt or
obligation incurred primarily for personal, family, or household purposes.
Setting aside the judgment — If the judgment was rendered against you because you did not come to court, you may ask
the court to set aside the judgment rendered against you within four months of the date judgment was rendered and upon
belief that you have reasonable cause. (Section 52-212 of the Connecticut General Statutes.)
FOR COURT USE ONLY
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans with
Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the
ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA.
EXEMPTION CLAIM FORM
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EXEMPTION CLAIM FORM
STATE OF CONNECTICUT
PROPERTY EXECUTION
MXMPEX
SUPERIOR COURT
JD-CV-5b Rev. 4-13
www.jud.ct.gov
*MXMPEX*
C.G.S. 52-321a, 52-352b, 52-361a, 52-361b
Name and mailing address of Judgment Debtor or Attorney
Instructions
(To be completed by judgment creditor or judgment creditor's attorney)
To Judgment Creditor or Judgment Creditor's
Attorney: Complete section 1 below and follow
instructions on form JD-CV-5.
To proper officer: Complete section 2 below and
follow instructions on form JC-CV-5.
To third person: Complete section 3 below and follow
instructions on form JD-CV-5.
To Judgment Debtor: Read section 4 below and
complete section 5 if it applies to you.
Section 1
(Must be completed by Judgment Creditor or Judgment Creditor's attorney)
u
Address of Court (Number, street, town, zip code)
Geographical Area
Judicial District
Housing Session
Name of Case
Docket number
Name of Judgment Debtor
Section 2
(Must be completed by proper officer)
Date of service of execution
Name and address of proper officer
Name and address of third person served with execution (if any)
Telephone number (if known)
Section 3
(Must be completed by third person served with execution (if any))
Date execution mailed to Judgment Debtor
Section 4 — Notice To Judgment Debtor
As a result of a judgment entered against you the attached execution has been issued against your personal property.
Some of your personal property may be exempt from execution — Certain classes of personal property may be protected
from execution by state statutes or other laws or regulations of this state or of the United States. A checklist and description of
the most common classes of personal property of a natural person exempt from execution are listed on page 2 of this form.
How to claim an exemption established by law — If you want to claim that the property levied on by the levying officer is
exempt by law from execution you must fill out and sign the Claim of Exemption on page 2 of this form and return this
exemption claim form to the clerk of the Superior court at the address above. The form must be received by the clerk of
the Superior Court within 20 days after levy on the property.
Upon receipt of this form, the court clerk will send you and the judgment creditor the date of the court hearing on your
claim.
Right to request installment payment order — If you are a consumer judgment debtor, you may seek to have the court
issue an installment payment order with a provision that compliance with the order prevents a levy on your property. (Section
52-356d of the Connecticut General Statutes.) An installment payment order is a court order that you pay a weekly amount to
the judgment creditor until the judgment is satisfied.
"Consumer Judgment" means a money judgment of less than $5,000 against a natural person resulting from a debt or
obligation incurred primarily for personal, family, or household purposes.
Setting aside the judgment — If the judgment was rendered against you because you did not come to court, you may ask
the court to set aside the judgment rendered against you within four months of the date judgment was rendered and upon
belief that you have reasonable cause. (Section 52-212 of the Connecticut General Statutes.)
FOR COURT USE ONLY
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans with
Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the
ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA.
EXEMPTION CLAIM FORM
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Section 5 — Claim Of Exemption Established By Law
I claim and certify under penalty of false statement that the property described below is exempt from execution as follows:
Name and address of person holding property
Telephone number
Property claimed to be exempt
Describe basis for exemption as established by law
Complete mailing address of Judgment Debtor
Telephone number
Signed (Judgment Debtor)
Date signed
Section 6 — Notice Of Hearing On Exemption/Modification Claim
Date of hearing
Time of hearing
Courtroom number
By the Assistant Clerk
__.M.
Section 7 — Order Of Court
Ordered that the following item(s) are exempt from execution:
Signed (Judge, Magistrate, Assistant Clerk)
Date signed
By Order of the Court
Checklist And Description Of Common Exemptions Allowed By Law
(Section 52-352b of the Connecticut General Statutes)
(a)
Necessary apparel, bedding, foodstuffs, household furniture and appliances;
(b)
Tools, books, instruments, farm animals and livestock feed, which are necessary to the exemptioner in the course of his or her
occupation, profession, farming operation or farming partnership;
(c)
Burial plot for the exemptioner and his or her immediate family;
(d)
Public assistance payments and any wages earned by a public assistance recipient under an incentive earnings or similar program;
(e)
Health and disability insurance payments;
(f)
Health aids necessary to enable the exemptioner to work or to sustain health;
(g)
Worker's compensation, social security, veterans and unemployment benefits;
(h)
Court approved payments for child support;
(i)
Arms and military equipment, uniforms or musical instruments owned by any member of the militia or armed forces of the United
States;
(j)
One motor vehicle to the value of $3,500, provided such value shall be determined as the fair market value of the motor vehicle less
the amount of all liens and security interests which encumber it.
(k)
Wedding and engagement rings;
(l)
Residential utility deposits for one residence and one residential security deposit;
(m)
Any assets or interests of an exemptioner in, or payments received by the exemptioner from, a plan or arrangement described in
section 52-321a;
(n)
Alimony and support, other than child support, but only to the extent that wages are exempt from execution under general statute
section 52-361a;
(o)
An award under a crime reparations act;
(p)
All benefits allowed by any association of persons in this state towards the support of any of its members incapacitated by sickness or
infirmity from attending to his usual business; and
(q)
All moneys due the exemptioner from any insurance company on any insurance policy issued on exempt property, to the same extent
that the property was exempt.
(r)
Any interest of the exemptioner in any property not to exceed in value $1,000;
(s)
Any interest of the exemptioner not to exceed in value $4,000 in any accrued dividend or interest under, or loan value of, any
unmatured life insurance contract owned by the exemptioner under which the insured is the exemptioner or an individual of whom the
exemptioner is a dependent; and
(t)
The homestead of the exemptioner to the value of $75,000 or, in the case of a money judgment arising out of services provided at a
hospital, to the value of $125,000, provided value shall be determined as the fair market value of the real property less the amount of
any statutory or consensual lien which encumbers it.
(u)
Irrevocable transfers of money to an account held by a debt adjuster licensed pursuant to sections 36a-655 to 36a-665 inclusive for the
benefit of creditors of the exemptioner.
JD-CV-5b (back/page 2) Rev. 4-13
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