"Claim of Exemption and Request for Hearing" - Florida

This fillable "Claim of Exemption and Request for Hearing" is a document issued by the Florida Department of Juvenile Justice specifically for Florida residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

ADVERTISEMENT

Download "Claim of Exemption and Request for Hearing" - Florida

175 times
Rate
4.7(4.7 / 5) 12 votes
IN THE COUNTY COURT OF THE
JUDICIAL
CIRCUIT IN AND FOR
COUNTY, FLORIDA
Plaintiff
Case No.:
Vs.
Defendant
And
STATE OF FLORIDA DEPARTMENT OF JUVENILE JUSTICE,
Garnishee_______________________________/
CLAIM OF EXEMPTION AND REQUEST FOR HEARING
I claim exemptions from garnishment under the following categories as checked:
_____ 1. Head of family wages. (You must check a or b below.)
_____ a. I provide more than one-half of the support for a child or other
dependent and have net earnings of $750 or less per week.
_____ b. I provide more than one-half of the support for a child or other
dependent, have net earnings of more than $750 per week, but
have not agreed in writing to have my wages garnished.
_____ 2. Social Security benefits.
_____ 3. Supplemental Security Income benefits.
_____ 4. Public Assistance (welfare).
_____ 5. Workers’ Compensation.
_____ 6. Unemployment Compensation.
_____ 7. Veterans’ benefits.
_____ 8. Retirement or profit-sharing benefits or pension money.
_____ 9. Life insurance benefits or case surrender value of a life insurance policy or
proceeds of annuity contract.
IN THE COUNTY COURT OF THE
JUDICIAL
CIRCUIT IN AND FOR
COUNTY, FLORIDA
Plaintiff
Case No.:
Vs.
Defendant
And
STATE OF FLORIDA DEPARTMENT OF JUVENILE JUSTICE,
Garnishee_______________________________/
CLAIM OF EXEMPTION AND REQUEST FOR HEARING
I claim exemptions from garnishment under the following categories as checked:
_____ 1. Head of family wages. (You must check a or b below.)
_____ a. I provide more than one-half of the support for a child or other
dependent and have net earnings of $750 or less per week.
_____ b. I provide more than one-half of the support for a child or other
dependent, have net earnings of more than $750 per week, but
have not agreed in writing to have my wages garnished.
_____ 2. Social Security benefits.
_____ 3. Supplemental Security Income benefits.
_____ 4. Public Assistance (welfare).
_____ 5. Workers’ Compensation.
_____ 6. Unemployment Compensation.
_____ 7. Veterans’ benefits.
_____ 8. Retirement or profit-sharing benefits or pension money.
_____ 9. Life insurance benefits or case surrender value of a life insurance policy or
proceeds of annuity contract.
_____ 10. Disability income benefits.
_____ 11. Prepaid College Trust Fund or Medical Savings Accounts.
Other exemptions as provided by law. (Explain)
I request a hearing to decide the validity of my claim. Notice of the hearing should be given to
me at:
Address:_____________________________________________________________________
_____________________________________________________________________
Telephone: __________________________________________________________________
The statements made in this request are true to the best of my knowledge and belief. A copy of
this Claim for Exemption has been [ ] hand delivered or [ ] mailed to the plaintiff or plaintiff’s
attorney this ________ day of ____________________, 20__.
________________________ ___________________________________________________
Defendant’s Signature
Date
STATE OF FLORIDA
:
COUNTY OF
:
Sworn and subscribed to before me this ________ day of ____________________,
20__, by _____________________________________who is personally known to me or who
has produced _____________________________________as identification and who did
[ ]
did not [ ] take an oath.
______________________________________
Notary Public
ADVERTISEMENT
Fill PDF online
Page of 2