Form SC-EM 3103.1 Emergency Motion to Claim Exemption - Illinois

Form SC-EM3103.1 or the "Emergency Motion To Claim Exemption" is a form issued by the Illinois Circuit Court.

Download a PDF version of the Form SC-EM3103.1 down below or find it on the Illinois Circuit Court Forms website.

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This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
EMERGENCY MOTION TO CLAIM
EXEMPTION
COUNTY
Instructions
Enter above the
Plaintiff (First, middle, last name)
county name where
the Citation to
Discover Assets to
v.
Debtor's Bank was
filed.
Defendant (First, middle, last name)
Case Number
Fill in the rest of the
information by
copying it from the
Respondent (Bank’s name)
Citation.
1. I am the debtor.
In 2, enter the name of
2. My accounts at
have been frozen.
your bank.
Name of bank
In 3, check all that
3. My accounts contain money from the following sources:
(check all that apply)
apply.
Social Security, SSI benefits, and disability
Pension and retirement benefits and refunds
Public assistance benefits
Child support
Unemployment compensation benefits
Workers’ compensation benefits
Veterans’ benefits
Circuit breaker property tax relief benefits
Any other source, up to $4,000 ("wildcard exemption")
4. This money is exempt under these laws:
42 USC §
407(a);
735 ILCS
5/12-1001; and
735 ILCS
5/12-1006.
In 5, enter the amount
5. I claim
$
as exempt.
of money you are
Amount of money in account
claiming as exempt.
I ask for the following:
Declare my funds to be exempt.
Order the bank to remove the hold on my accounts.
Dismiss the Citation to Discover Assets to a Debtor's Bank.
Grant any other relief that is fair.
Under the Code of
I certify that everything in the Emergency Motion to Claim Exemption is true and correct.
Civil Procedure,
735
I understand that making a false statement on this form is perjury and has penalties provided
ILCS
5/1-109, making
by law under
735 ILCS
5/1-109.
a statement on this
form that you know to
be false is perjury, a
/s/
Class 3 Felony.
Your Signature
Street Address
If you are completing
this form on a
computer, sign your
Your Name
City, State, ZIP
name by typing it. If
you are completing it
by hand, sign and
Telephone
print your name.
SC-EM 3103.1
Page 1 of 1
(03/18)
PRINT FORM
SAVE FORM
RESET FORM
This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
EMERGENCY MOTION TO CLAIM
EXEMPTION
COUNTY
Instructions
Enter above the
Plaintiff (First, middle, last name)
county name where
the Citation to
Discover Assets to
v.
Debtor's Bank was
filed.
Defendant (First, middle, last name)
Case Number
Fill in the rest of the
information by
copying it from the
Respondent (Bank’s name)
Citation.
1. I am the debtor.
In 2, enter the name of
2. My accounts at
have been frozen.
your bank.
Name of bank
In 3, check all that
3. My accounts contain money from the following sources:
(check all that apply)
apply.
Social Security, SSI benefits, and disability
Pension and retirement benefits and refunds
Public assistance benefits
Child support
Unemployment compensation benefits
Workers’ compensation benefits
Veterans’ benefits
Circuit breaker property tax relief benefits
Any other source, up to $4,000 ("wildcard exemption")
4. This money is exempt under these laws:
42 USC §
407(a);
735 ILCS
5/12-1001; and
735 ILCS
5/12-1006.
In 5, enter the amount
5. I claim
$
as exempt.
of money you are
Amount of money in account
claiming as exempt.
I ask for the following:
Declare my funds to be exempt.
Order the bank to remove the hold on my accounts.
Dismiss the Citation to Discover Assets to a Debtor's Bank.
Grant any other relief that is fair.
Under the Code of
I certify that everything in the Emergency Motion to Claim Exemption is true and correct.
Civil Procedure,
735
I understand that making a false statement on this form is perjury and has penalties provided
ILCS
5/1-109, making
by law under
735 ILCS
5/1-109.
a statement on this
form that you know to
be false is perjury, a
/s/
Class 3 Felony.
Your Signature
Street Address
If you are completing
this form on a
computer, sign your
Your Name
City, State, ZIP
name by typing it. If
you are completing it
by hand, sign and
Telephone
print your name.
SC-EM 3103.1
Page 1 of 1
(03/18)
PRINT FORM
SAVE FORM
RESET FORM

Download Form SC-EM 3103.1 Emergency Motion to Claim Exemption - Illinois

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