1.1A bill for an act1.2relating to creditor remedies; modifying garnishment instructions, forms, 1.3procedures, and exemptions;amending Minnesota Statutes 2008, sections 1.4550.143; 550.37, subdivision 14; 551.05; 571.71; 571.72, by adding subdivisions; 1.5571.911; 571.912; 571.913; 571.914; 571.925.1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.7    Section 1. Minnesota Statutes 2008, section 550.143, is amended to read:1.8550.143 LEVY ON FUNDS AT A FINANCIAL INSTITUTION.1.9    Subdivision 1. Procedure. When the sheriff is levying upon funds at a financial 1.10institution, this section must be complied with, in addition to the general provisions set 1.11forth in section 
         550.135.1.12    Subd. 2. Disclosure form. Along with the writ of execution, the notice, instructions,1.13and the exemption notice described in subdivision 3, the sheriff shall serve upon the 1.14financial institution an execution disclosure form which must be substantially in the 1.15following form:

1.16STATE OF MINNESOTADISTRICT COURT1.17COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT1.18
                     							.....
                     						(Judgment Creditor)1.19againstFINANCIAL INSTITUTIONS1.20
                     							.....
                     						(Judgment Debtor)EXECUTION 1.21andDISCLOSURE1.22
                     							.....
                     						(Third Party)

1.23On the ..... day of ............., ......., the time of service of execution herein, there was 1.24due and owing the judgment debtor from the third party the following:2.1(1) Money. Enter on the line below any amounts due and owing the judgment debtor, 2.2except earnings, from the third party.
            							.....
            						2.32.4(2) Setoff. Enter on the line below the amount of any setoff, defense, lien, or claim 2.5which the third party claims against the amount set forth on line (1). State the facts by 2.6which such setoff, defense, lien, or claim is claimed. (Any indebtedness to a third party 2.7incurred by the judgment debtor within ten days prior to the receipt of the first execution 2.8levy on a debt is void as to the judgment creditor.)
            							.....
            						2.92.10(3) Exemption. Enter on the line below any amounts or property claimed by the 2.11judgment debtor to be exempt from execution.
            							.....
            						2.122.13(4) Adverse Interest. Enter on the line below any amounts claimed by other persons 2.14by reason of ownership or interest in the judgment debtor's property.
            							.....
            						2.152.16(5) Enter on the line below the total of lines (2), (3), and (4).
            							.....
            						2.172.18(6) Enter on the line below the difference obtained (never less than zero) when line 2.19(5) is subtracted from the amount on line (1).
            							.....
            						2.202.21(7) Enter on the line below 110 percent of the amount of the judgment creditor's 2.22claim which remains unpaid.
            							.....
            						2.232.24(8) Enter on the line below the lesser of line (6) and line (7). You are hereby 2.25instructed to remit this amount only if it is $10 or more.
            							.....
            						2.262.27AFFIRMATION2.28I, ....................... (person signing Affirmation), am the third party or I am authorized 2.29by the third party to complete this nonearnings disclosure, and have done so truthfully 2.30and to the best of my knowledge.

2.31Dated: 
                     							.....
                     						
                     							.....
                     						2.32Signature2.33
                     							.....
                     						2.34Title3.1
                     							.....
                     						3.2Telephone Number

3.3    Subd. 3. Notice, instructions, and exemption notice. If the levy is on funds of a 3.4judgment debtor who is a natural person and if the funds to be levied are held on deposit at 3.5any financial institution, the judgment creditor or its attorney shall provide the sheriff with 3.6a notice, instructions, and two copies of an exemption notice, which must be substantially 3.7in the form set forth below. The sheriff shall serve the notice, instructions, and both copies 3.8of the exemption notice on the financial institution, along with the writ of execution. 3.9Failure of the sheriff to serve the notice, instructions, and the exemption notices renders 3.10the levy void, and the financial institution shall take no action. However, if this subdivision 3.11is being used to execute on funds that have previously been garnished in compliance with 3.12section 
         571.71, the judgment creditor is not required to serve additional exemption notices. 3.13In that event, the execution levy shall only be effective as to the funds that were subject 3.14to the prior garnishment. Upon receipt of the writ of execution, notice, instructions, and 3.15exemption notices, the financial institution shall retain as much of the amount due under 3.16section 
         550.04 as the financial institution has on deposit owing to the judgment debtor, but 3.17not more than 110 percent of the amount remaining due on the judgment.

3.18STATE OF MINNESOTADISTRICT COURT3.19COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT3.203.21
                     							.....
                     						(Judgment Creditor)3.22
                     							.....
                     						(Judgment Debtor)3.23TO: DebtorEXEMPTION NOTICE

3.24An order for attachment, garnishment summons, or levy of execution (strike 3.25inapplicable language) has been served on ............. (Bank or other financial institution 3.26where you have an account.)3.27Your account balance is $........3.28The amount being held is $........3.29However, all or a portion of the funds in your account will normally be exempt from 3.30creditors' claims if they are in one of the following categories:3.31(1) relief based on need. This includes the Minnesota Family Investment Program 3.32(MFIP), Emergency Assistance (EA), Work First Program, Medical Assistance (MA), 3.33General Assistance (GA), General Assistance Medical Care (GAMC), Emergency General 3.34Assistance (EGA), Minnesota Supplemental Aid (MSA), MSA Emergency Assistance 3.35(MSA-EA), Supplemental Security Income (SSI), and Energy Assistance;3.36(2) Social Security benefits (Old Age, Survivors, or Disability Insurance);3.37(3) unemployment benefits, workers' compensation, or veterans' benefits;4.1(4) an accident, disability, or retirement pension or annuity;4.2(5) life insurance proceeds;4.3(6) the earnings of your minor child and any child support paid to you; or4.4(7) money from a claim for damage or destruction of exempt property (such as 4.5household goods, farm tools, business equipment, a mobile home, or a car).4.6The following funds are also exempt:4.7(8) all earnings of a person in category (1);4.8(9) all earnings of a person who has received relief based on need, or who has been 4.9an inmate of a correctional institution, within the last six months;4.10(10) 75 percent of every debtor's after tax earnings; and4.11(11) all of a judgment debtor's after tax earnings below 40 times the federal 4.12minimum wage.4.13TIME LIMIT ON EXEMPTIONS AFTER DEPOSIT IN BANK:4.14Categories (10) and (11): 20 days4.15Categories (8) and (9): 60 days4.16All others: no time limit, as long as funds are traceable to the exempt source. (In 4.17tracing funds, the first-in, first-out method is used. This means money deposited first 4.18is spent first.) The money being sought by the judgment creditor is being held in your 4.19account to give you a chance to claim an exemption.4.20TO CLAIM AN EXEMPTION:4.21Fill out, sign, and mail or deliver one copy of the attached exemption claim form to 4.22the institution which sent you this notice and mail or deliver one copy to the judgment 4.23creditor's attorney. In the event that there is no attorney for the judgment creditor, then 4.24the notice shall be sent directly to the judgment creditor. The address for the judgment 4.25creditor's attorney or the judgment creditor is set forth below. Both copies must be 4.26mailed or delivered on the same day.4.27NOTE: You may help resolve your claim faster if you send to the creditor's 4.28attorney written proof or documents that show why your money is exempt. If 4.29you have questions regarding the documents to send as proof of an exemption, 4.30call the creditor's attorney. If you do not send written proof and the creditor's 4.31attorney has questions about your exemption claim, the creditor's attorney 4.32may object to your claim which may result in a further delay in releasing your 4.33exempt funds.4.34If the financial institution does not get the exemption claim back from you within 14 4.35days of the date they mailed or gave it to you, they will be free to turn the money over to 5.1the sheriff or the judgment creditor. If you are going to claim an exemption, do so as soon 5.2as possible, because your money may be held until it is decided.5.3IF YOU CLAIM AN EXEMPTION:5.4(1) nonexempt money can be turned over to the judgment creditor or sheriff;5.5(2) the financial institution will keep holding the money claimed to be exempt; and5.6(3) seven days after receiving your exemption claim, the financial institution will 5.7release the money to you unless before then it receives an objection to your exemption 5.8claim.5.9IF THE JUDGMENT CREDITOR OBJECTS TO YOUR EXEMPTION CLAIM:5.10the institution will hold the money until a court decides if your exemption claim is 5.11valid, BUT ONLY IF the institution gets a copy of your court motion papers asserting 5.12the exemption WITHIN TEN DAYS after the objection is personally served on you, or 5.13within 13 days from the date the objection is mailed to you. You may wish to consult an 5.14attorney at once if the creditor objects to your exemption claim.5.15MOTION TO DETERMINE EXEMPTION:5.16At any time after your funds have been held, you may ask for a court decision on the 5.17validity of your exemption claim by filing a request for hearing which may be obtained 5.18at the office of the court administrator of the above court.5.19PENALTIES:5.20If you claim an exemption in bad faith, or if the judgment creditor wrongly objects 5.21to an exemption in bad faith, the court may order the person who acted in bad faith to pay 5.22costs, actual damages, attorney fees, and an additional amount of up to $100.

5.23
                     							.....
                     						5.24
                     							.....
                     						5.25
                     							.....
                     						5.26
                     							.....
                     						5.275.28Name and address of (Attorney for) Judgment Creditor

5.29EXEMPTION:5.30(a) Amount of exemption claim.5.31/ / I claim ALL the funds being held are exempt.5.32/ / I claim SOME of the funds being held are exempt.

5.33The exempt amount is $ 
                     							.....

5.34(b) Basis for exemption.5.35Of the 11 categories listed above, I am in category number ............ (If more than one 5.36category applies, you may fill in as many as apply.) The source of the exempt funds is 5.37the following:

6.1
                     							.....
                     						6.2
                     							.....
                     						6.3
                     							.....

6.4(If the source is a type of relief based on need, list the case number and county:6.5case number: ...............;6.6county: ....................)6.7I hereby authorize any agency that has distributed relief to me or any correctional 6.8institution in which I was an inmate to disclose to the above named creditor or its attorney 6.9only whether or not I am or have been a recipient of relief based on need or an inmate of a 6.10correctional institute within the last six months.6.11I have mailed or delivered a copy of the exemption notice to the judgment creditor 6.12or judgment creditor's attorney if represented at the address indicated above.

6.13
                     							.....
                     						6.14DEBTOR6.15DATED: 
                     							.....
                     						
                     							.....
                     						6.16
                     							.....
                     						6.17
                     							.....
                     						6.18DEBTOR ADDRESS6.19
                     							.....
                     						6.20DEBTOR TELEPHONE NUMBER

6.21    Subd. 3a.Form of notice.The notice required by subdivision 3 must be provided as 6.22a separate form and must be substantially in the following form:

6.23STATE OF MINNESOTADISTRICT COURT6.24COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT6.25
                     							.....
                     						(Creditor)6.26
                     							.....
                     						(Debtor)6.276.28
                     							.....
                     						(Financial institution)

6.29IMPORTANT NOTICE6.30YOUR FUNDS HAVE BEEN LEVIED6.31The Creditor has frozen money in your account at your financial institution.6.32Your account balance is $.......6.33The amount being held is $.......6.34The amount being held will be frozen for 14 days from the date of this notice.6.35Some of your money in your account may be protected (the legal word is 6.36exempt). You may be able to get it sooner than 14 days if you act quickly and follow 6.37the instructions on the next page.7.1The attached exemption form lists some different sources of money in your account 7.2that may be protected. If your money is from one or more of these sources, place a 7.3check on the line on the form next to the sources of your money. If it is from one of 7.4these sources, the Creditor cannot take it.7.5BUT, you must follow the instructions and return the exemption form and 7.6copies of your bank statements from the last 60 days to have the bank unfreeze your 7.7money. If you do not follow the instructions, your financial institution will give the money 7.8to the Sheriff. If that happens and it is protected, you can still get it back from the Creditor 7.9later, but that is not as easy to do as filling in the form now.7.10See next pages for instructions and the exemption form.7.11    Subd. 3b.Form of instructions.The instructions required by this section must be 7.12in a separate form and must be substantially in the following form:7.13INSTRUCTIONS7.14Note: The creditor is who you owe the money to. You are the debtor.7.151. Fill out both of the attached exemption forms in this packet.7.16If you check one of the lines, you should also give proof that shows that some 7.17or all of the money in your account is from one or more of the protected sources. 7.18Creditors may ask for a hearing if they question your exemptions. To avoid a hearing:7.19Case numbers should be added to the form. Copies of documents should be 7.20sent with the form.7.21NOTICE: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO 7.22THE CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS 7.23FOR THE PAST 60 DAYS BEFORE THE LEVY. Keep a copy of your bank 7.24statements in case there are questions about your claim. If you do not send to the 7.25creditor's attorney (or to the creditor, if no attorney) bank statements with your 7.26exemption claim, the financial institution may release your money to the sheriff.7.272. Sign the exemption forms. Make one copy to keep for yourself.7.283. Mail or deliver the other copies of the form by (insert date).7.29BOTH COPIES MUST BE MAILED OR DELIVERED THE SAME DAY.7.30One copy of the form and the copies of your bank statements go to:

7.31
                     							.....
                     						7.32(Insert name of creditor or creditor's attorney)7.33
                     							.....
                     						7.34(Insert address of creditor or creditor's attorney) 

7.35One copy goes to:

8.1
                     							.....
                     						8.2(Insert name of bank)8.3
                     							.....
                     						8.4(Insert address of bank)

8.5HOW THE PROCESS WORKS8.6If You Do Not Send in the Exemption Form and Bank Statements:8.714 days after the date of this letter some or all of your money may be turned over 8.8to the creditor or to the sheriff.8.9If You Send in the Exemption Form and Bank Statements:8.10Any money that is NOT protected can be turned over to the sheriff.8.11If the Creditor Does Not Object:8.12The financial institution will unfreeze your money six business days after the 8.13institution gets your completed form.8.14If the Creditor Objects:8.15The money you have said is protected on the form will be held by the bank. The 8.16creditor has six business days to object (disagree) and ask the court to hold a hearing. You 8.17will receive a Notice of Objection and a Notice of Hearing.8.18The financial institution will hold the money until a court decides whether your 8.19money is protected or not. Some reasons a creditor may object are because you did not 8.20send copies of your bank statements or other proof of the benefits you received. Be sure to 8.21include these when you send your exemption form.8.22You may want to talk to a lawyer for advice about this process. If you are low 8.23income you can call Legal Aid.8.24PENALTIES:8.25If you claim that your money is protected and a court decides you made that claim 8.26in bad faith, the court can order you to pay costs, actual damages, attorney fees, and an 8.27additional amount of up to $100. For example, it may be bad faith if you claim you receive 8.28government benefits that you do not receive.8.29If the creditor made a bad faith objection to your claim that your money is protected, 8.30the court can order them to pay costs, actual damages, attorney fees, and an additional 8.31amount of up to $100.8.32    Subd. 3c.Form of exemption form.The exemption form required by this 8.33subdivision must be sent as a separate form and must be in substantially the following 8.34form:

8.35STATE OF MINNESOTADISTRICT COURT8.36COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT9.1
                     							.....
                     						(Creditor)9.2
                     							.....
                     						(Debtor)9.39.4
                     							.....
                     						(Financial institution)

9.5EXEMPTION FORM

9.6A.HOW MUCH MONEY IS PROTECTED9.7
                     							.....
                     						I claim ALL of the money being frozen by the bank is protected.9.8
                     							.....
                     						I claim SOME of the money is protected. The amount I claim is protected is $.......9.9B.WHY THE MONEY IS PROTECTED9.109.11My money is protected because I get it from one or more of the following places: (Check all that apply)9.12
                     							.....
                     						Government benefits9.13Government benefits include, but are not limited to, the following:9.14MFIP - Minnesota family investment program, 9.15MFIP Diversionary Work Program,9.16Work participation cash benefit,9.17GA - general assistance,9.18EA - emergency assistance,9.19MA - medical assistance,9.20GAMC - general assistance medical care,9.21EGA - emergency general assistance,9.22MSA - Minnesota supplemental aid,9.23MSA-EA - MSA emergency assistance,9.24Food Support,9.25SSI - Supplemental Security Income,9.26MinnesotaCare,9.27Medicare part B premium payments,9.28Medicare part D extra help,9.29Energy or fuel assistance.9.30LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT9.31
                     							.....
                     						9.32LIST THE CASE NUMBER AND COUNTY9.33Case Number: 
                     							.....
                     						9.34County: 
                     							.....
                     						9.35Government benefits also include:9.36
                     							.....
                     						Social Security benefits9.37
                     							.....
                     						Unemployment benefits9.38
                     							.....
                     						Workers' compensation9.39
                     							.....
                     						Veterans benefits9.409.419.42If you receive any of these government benefits, include copies of any documents you have that show you receive Social Security, unemployment, workers' compensation, or veterans benefits.9.43
                     							.....
                     						Other assistance based on need

10.1You may have assistance based on need from another source that is not on the list. If you 10.2do, check this box, and fill in the source of your money on the line below:10.3Source: 
            							.....
            						10.4Include copies of any documents you have that show the source of this money.

10.5EARNINGS10.6ALL or SOME of your earnings (wages) may also be protected.10.7
                     							.....
                     						All of your earnings (wages) are protected if:10.8
                     							.....
                     						You get government benefits (see list of government benefits)10.9
                     							.....
                     						You currently receive other assistance based on need10.10
                     							.....
                     						You have received government benefits in the last six months10.11
                     							.....
                     						You were in jail or prison in the last six months10.1210.1310.1410.15If you check one of these lines, your wages are only protected for 60 days after they are deposited in your account so you MUST send the creditor a copy of BANK STATEMENTS that show what was in your account for the 60 days right before the bank froze your money.10.16
                     							.....
                     						Some of your earnings (wages) are protected.10.1710.1810.19If all of your earnings are not exempt, then some of your earnings are still protected for 20 days after they were deposited in your account. The amount protected is the larger amount of:10.2075 percent of your wages (after taxes are taken out); or10.21(insert the sum of the current federal minimum wage) multiplied by 40.10.22OTHER EXEMPT FUNDS10.2310.24The money from the following are also completely protected after they are deposited in your account.10.25
                     							.....
                     						An accident, disability, or retirement pension or annuity10.26
                     							.....
                     						Payments to you from a life insurance policy10.27
                     							.....
                     						Earnings of your child who is under 18 years of age10.28
                     							.....
                     						Child support10.2910.3010.3110.32
                     							.....
                     						Money paid to you from a claim for damage or destruction of propertyProperty includes household goods, farm tools or machinery, tools for your job, business equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, or appliances.10.33
                     							.....
                     						Death benefits paid to you

10.34I give permission to any agency that has given me cash benefits to give information 10.35about my benefits to the above-named creditor, or its attorney. The information will ONLY10.36concern whether I get benefits or not, or whether I have gotten them in the past six months.10.37If I was an inmate in the last six months, I give my permission to the correctional 10.38institution to tell the above-named creditor that I was an inmate there.10.39YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S 10.40ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. 10.41REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR 11.1THE PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE 11.2INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.11.3I have mailed or delivered a copy of this form to:

11.4
                     							.....
                     						11.5(Insert name of creditor or creditor's attorney)11.6
                     							.....
                     						11.7(Insert address of creditor or creditor's attorney)

11.8I have also mailed or delivered a copy of this exemption form to my bank at the 11.9address listed in the instructions.

11.10DATED: 
                     							.....
                     						
                     							.....
                     						11.11DEBTOR11.12
                     							.....
                     						11.13DEBTOR ADDRESS11.14
                     							.....
                     						11.15DEBTOR TELEPHONE NUMBER

11.16    Subd. 4. Effect of exemption notice. Within two business days after receipt of the 11.17writ of execution and, notice, instructions, and two copies of the exemption notices notice, 11.18the financial institution shall serve upon the judgment debtor the notice, instructions, 11.19and two copies of the exemption notice. The financial institution shall serve the notice11.20these forms by first class mail to the last known address of the judgment debtor. If no 11.21claim of exemption is received by the financial institution within 14 days after the notice, 11.22instructions, and exemption notices are mailed to the judgment debtor, the funds remain 11.23subject to the execution levy and shall be remitted to the sheriff within seven six business11.24days. If the judgment debtor elects to claim an exemption, the judgment debtor shall 11.25complete the exemption notice, sign it under penalty of perjury, and deliver one copy to 11.26the financial institution and one copy to the attorney for the judgment creditor within 11.2714 days of the date postmarked on the correspondence mailed to the debtor containing 11.28the exemption notices. The judgment debtor is also required to include copies of bank 11.29statements for the prior 60 days with the exemption notice delivered to the attorney for the 11.30judgment creditor. In the event that there is no attorney for the judgment creditor, then the 11.31notice and bank statements must be sent directly to the judgment creditor. Failure of the 11.32judgment debtor to deliver the executed exemption notice or copies of the required bank 11.33statements for the prior 60 days does not constitute a waiver of any claimed right to an 11.34exemption. Upon timely receipt of a claim of exemption, funds not claimed to be exempt 11.35by the debtor remain subject to the execution levy. All money claimed to be exempt shall 11.36be released to the judgment debtor upon the expiration of seven six business days after 11.37the date postmarked on the envelope containing the executed exemption notice mailed to 12.1the financial institution, or the date of personal delivery of the executed exemption notice 12.2to the financial institution, unless within that time the judgment creditor interposes an 12.3objection to the exemption.12.4    Subd. 5. Objection to exemption claim and request for hearing.(a) An objection 12.5shall be interposed within six business days of receipt by the creditor of an exemption 12.6claim from the debtor, by mailing or delivering one copy of the written objection Notice of 12.7Objection and Notice of Hearing to the financial institution and one copy of the written 12.8objection Notice of Objection and Notice of Hearing to the judgment debtor along with a 12.9copy of the judgment debtor's claimed exemption form. Both copies of an objection to an 12.10exemption claim shall be mailed or delivered on the same date. The financial institution 12.11may rely on the date of mailing or delivery of a notice to it in computing any time periods 12.12in this section. The written objection Notice of Objection and Notice of Hearing must be 12.13substantially in the form specified in subdivision 7.12.14(b) The court administrator may charge a fee of $1 for the filing of a Notice of 12.15Objection and Notice of Hearing. Upon the filing of a Notice of Objection and Notice of 12.16Hearing, the court administrator shall schedule the matter for hearing no sooner than five 12.17business days but no later than seven business days from the date of filing. A debtor may 12.18request continuance of the hearing by notifying the creditor and the court. The court shall 12.19schedule the continued hearing within seven days of the original hearing date.12.20(c) An order stating whether the debtor's funds are exempt must be issued by the 12.21court within three days of the date of the hearing.12.22    Subd. 6. Duties of financial institution if objection is made to exemption claim.12.23Upon receipt of a written objection Notice of Objection and Notice of Hearing from 12.24the judgment creditor or its attorney within the specified seven-day six-day period, the 12.25financial institution shall retain the funds claimed to be exempt. Unless the financial 12.26institution receives a request for hearing and notice of hearing from the judgment debtor 12.27asserting exemption rights within ten days after receipt of a written objection to the 12.28exemption, the funds remain subject to the execution levy as if no claim of exemption 12.29had been made and shall be remitted to the sheriff within seven days. If a request for 12.30hearing and notice of hearing to determine the validity of a claim of exemption is received 12.31by the financial institution within the period provided, it The financial institution shall 12.32retain the funds claimed to be exempt until otherwise ordered by the court or upon mutual 12.33agreement of the parties.12.34    Subd. 7. Form of Notice of Objection and Notice of Hearing. (a) The written 12.35objection to the judgment debtor's claim of exemptionWritten Objection and Notice of 12.36Hearing must be in substantially the following form:

13.1STATE OF MINNESOTADISTRICT COURT13.2COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT13.313.4
                     							.....
                     						(Judgment Creditor)OBJECTION TO13.5
                     							.....
                     						(Judgment Debtor)EXEMPTION CLAIM13.613.7
                     							.....
                     						(Garnishee) (Third Party)

13.8The judgment creditor objects to your claim for exemption from garnishment, 13.9levy of execution, order for attachment (strike inapplicable language) for the following 13.10reason(s): 
            							.....
            						
            							.....
            						13.11
            							.....
            						13.1213.13Because of this objection, your financial institution will retain the funds you claimed 13.14to be exempt for an additional ten days. If you wish to request a hearing on your exemption 13.15claim, you need to do so within ten days from the date the objection was personally served 13.16on you, or within 13 days of the date the objection was mailed to you. You may request a 13.17hearing by completing the attached form and filing it with the court administrator.13.181. The court administrator's office shall provide clerical assistance to help with the 13.19writing and filing of a Request for Hearing by any person not represented by counsel. The 13.20court administrator may charge a fee of $1 for the filing of a Request for Hearing.13.212. Upon the filing of a Request for Hearing, the court administrator shall schedule 13.22the matter for a hearing no later than five business days from the date of filing. The court 13.23administrator shall forthwith send a completed copy of the request, including the hearing 13.24date, time, and place to the adverse party and to the financial institution by first class mail.13.253. If it is possible that the financial institution might not receive the request mailed 13.26from the court administrator within ten days, then you may want to personally deliver a 13.27copy of the request to the financial institution after you have filed your request with the 13.28court.13.294. An order stating whether your funds are exempt shall be issued by the court 13.30within three days of the date of the hearing.13.31If you do not file a Request for Hearing within ten days of the date the objection was 13.32personally served on you, or within 13 days from the date the objection was mailed to you, 13.33your financial institution may turn your funds over to your creditor.13.34If you file a Request for Hearing and your financial institution receives it within ten 13.35days of the date it received this objection, your financial institution will retain your funds 13.36claimed to be exempt until otherwise ordered by the court.

14.1
                     							.....
                     						14.2Judgment Creditor or Attorney

14.3STATE OF MINNESOTADISTRICT COURT14.4COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT14.5
                     							.....
                     						14.6(Creditor)14.714.814.914.10CREDITOR'S NOTICE OF OBJECTION AND NOTICE OF HEARING ON EXEMPTION CLAIM14.11
                     							.....
                     						14.12(Debtor)14.13
                     							.....
                     						14.14(Financial Institution)14.15(DEBTOR)14.16
                     							.....
                     						14.17ADDRESS14.18
                     							.....
                     						14.19
                     							.....

14.20
                     							.....
                     						14.21
                     							.....
                     						14.22
                     							.....
                     						14.2314.24(CREDITOR OR CREDITOR'S ATTORNEY)

14.25NOTICE OF HEARING14.2614.2714.28The creditor objects to your exemption claim. This hearing is to resolve your exemption claim.14.29Hearing Date:
                     							.....
                     						14.30Time:
                     							.....
                     						14.31Hearing Place:
                     							.....

14.32The creditor objects to your claim of exemption from levy of execution for the 14.33following reason(s):

14.34
                     							.....
                     						14.35
                     							.....
                     						14.36
                     							.....

14.37(Note: Bring with you to the hearing all documents and materials supporting 14.38your exemption claim. Failure to do so could delay the court's decision.)14.39If the creditor receives all documents and materials supporting your exemption 14.40claim before the hearing date, the creditor may agree with your exemption claim and 14.41you might still be able to avoid a hearing.15.1Because a court hearing will be held on your claim that your funds are protected, 15.2your financial institution will retain the funds until it receives an order from the court or 15.3upon mutual agreement between you and your creditor.15.4    Subd. 8.Request for hearing and notice for hearing.The request for hearing 15.5accompanying the objection notice must be in substantially the following form:

15.6STATE OF MINNESOTADISTRICT COURT15.7COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT15.815.9
                     							.....
                     						(Judgment Creditor)REQUEST FOR HEARING15.10
                     							.....
                     						(Judgment Debtor)AND15.11
                     							.....
                     						(Third Party)NOTICE FOR HEARING

15.12I hereby request a hearing to resolve the exemption claim which has been made 15.13in this case regarding funds in the account of ............. (Judgment Debtor) at the ......... 15.14(Financial Institution).15.15    I believe the property being held is exempt because
            							.....
            						15.16    
            							.....
            						15.17

15.18Dated: 
                     							.....
                     						15.19(JUDGMENT DEBTOR)15.20
                     							.....
                     						15.21(ADDRESS)15.22
                     							.....
                     						15.23(DEBTOR PHONE NUMBER)15.24
                     							.....
                     						15.25HEARING DATE: 
                     							.....
                     						TIME: 
                     							.....
                     						15.26HEARING PLACE: 
                     							.....

15.27(Note to both parties: Bring with you to the hearing all documents and materials 15.28relevant to the exemption claim and objection. Failure to do so could delay the court's 15.29decision.)15.30    Subd. 9. Release of funds. At any time during the procedure specified in this 15.31section, the judgment debtor or the judgment creditor may, by a writing dated after the 15.32service of the execution, direct the sheriff or the financial institution to release the funds in 15.33question to the other party. Upon receipt of a release, the sheriff or the financial institution 15.34shall release the funds as directed.15.35    Subd. 10. Subsequent proceedings; bad faith claims. If in subsequent proceedings 15.36brought by the judgment debtor or the judgment creditor, the claim of exemption is not 15.37upheld, and the court finds that it was asserted in bad faith, the judgment creditor shall be 16.1awarded actual damages, costs, and reasonable attorney fees resulting from the additional 16.2proceedings, and an amount not to exceed $100. If the claim of exemption is upheld, and 16.3the court finds that the judgment creditor disregarded the claim of exemption in bad faith, 16.4the judgment debtor shall be awarded costs, reasonable attorney fees, actual damages, and 16.5an amount not to exceed $100. The underlying judgment must be modified to reflect 16.6assessment of damages, costs, and attorney fees. However, if the party in whose favor a 16.7penalty assessment is made is not actually indebted to the party's attorney for fees, the 16.8attorney's fee award shall be made directly to the attorney and, if not paid, an appropriate 16.9judgment in favor of the attorney shall be entered. Upon motion of any party in interest, 16.10on notice, the court shall determine the validity of any claim of exemption, and may make 16.11any order necessary to protect the rights of those interested. No financial institution is 16.12liable for damages for complying with this section. Both copies of an exemption claim 16.13or an objection to an exemption claim must be mailed or delivered on the same date. 16.14The financial institution may rely on the date of mailing or delivery of a notice to it in 16.15computing any time periods in this section.16.16    Sec. 2. Minnesota Statutes 2008, section 550.37, subdivision 14, is amended to read:16.17    Subd. 14. Public assistance. All relief government assistance based on need, 16.18and the earnings or salary of a person who is a recipient of relief government assistance16.19based on need, shall be exempt from all claims of creditors including any contractual 16.20setoff or security interest asserted by a financial institution. For the purposes of this 16.21chapter, reliefgovernment assistance based on need includes MFIP, work first, general 16.22assistance medical care, supplemental security income, medical assistance, Minnesota 16.23supplemental assistance, and general assistance but is not limited to Minnesota family 16.24investment program, general assistance medical care, Supplemental Security Income, 16.25medical assistance, MinnesotaCare, payment of Medicare part B premiums or receipt of 16.26part D extra help, MFIP diversionary work program, work participation cash benefit, 16.27Minnesota supplemental assistance, emergency Minnesota supplemental assistance, 16.28general assistance, emergency general assistance, emergency assistance or county crisis 16.29funds, energy or fuel assistance, and food support. The salary or earnings of any debtor 16.30who is or has been an eligible recipient of relief government assistance based on need, or 16.31an inmate of a correctional institution shall, upon the debtor's return to private employment 16.32or farming after having been an eligible recipient of relief government assistance based on 16.33need, or an inmate of a correctional institution, be exempt from attachment, garnishment, 16.34or levy of execution for a period of six months after the debtor's return to employment or 16.35farming and after all public assistance for which eligibility existed has been terminated. 17.1The exemption provisions contained in this subdivision also apply for 60 days after deposit 17.2in any financial institution, whether in a single or joint account. In tracing the funds, the 17.3first-in first-out method of accounting shall be used. The burden of establishing that funds 17.4are exempt rests upon the debtor. Agencies distributing relief government assistance and 17.5the correctional institutions shall, at the request of creditors, inform them whether or not 17.6any debtor has been an eligible recipient of relief government assistance based on need, or 17.7an inmate of a correctional institution, within the preceding six months.17.8    Sec. 3. Minnesota Statutes 2008, section 551.05, is amended to read:17.9551.05 ATTORNEY'S SUMMARY EXECUTION UPON FUNDS AT A 17.10FINANCIAL INSTITUTION.17.11    Subdivision 1. Procedure. When levying upon funds at a financial institution, 17.12this section must be complied with, in addition to the general provisions specified in 17.13section 
         551.04.17.14    Subd. 1a. Notice, instructions, and exemption notice. If the writ of execution is 17.15being used by the attorney to levy funds of a judgment debtor who is a natural person and 17.16if the funds to be levied are held on deposit at any financial institution, the attorney for the 17.17judgment creditor shall serve with the writ of execution a notice, instructions, and two 17.18copies of an exemption notice. The notice, instructions, and exemption notice must be 17.19substantially in the form set forth below. Failure of the attorney for the judgment creditor 17.20to send the exemption noticethese forms renders the execution levy void, and the financial 17.21institution shall take no action. However, if this subdivision is being used to execute on 17.22funds that have previously been garnished in compliance with section 
         571.71, the attorney 17.23for judgment creditor is not required to serve an additional exemption notice. In that event, 17.24the execution levy shall only be effective as to the funds that were subject to the prior 17.25garnishment. Upon receipt of the writ of execution and exemption notices, the financial 17.26institution shall retain as much of the amount due under section 
         550.04 as the financial 17.27institution has on deposit owing to the judgment debtor, but not more than 100 percent of 17.28the amount remaining due on the judgment, or $10,000, whichever is less.17.29    Subd. 1b.Form of notice. The notice informing a judgment debtor that an 17.30execution levy has been used to attach funds of the judgment debtor to satisfy a claim17.31must be a separate form and must be substantially in the following form:

17.32STATE OF MINNESOTADISTRICT COURT17.33County of 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT17.3417.35
                     							.....
                     						(Judgment Creditor)18.1
                     							.....
                     						(Judgment Debtor)18.2TO: Judgment DebtorEXEMPTION NOTICE

18.3An order for attachment, garnishment summons, or levy of execution (strike 18.4inapplicable language) has been served on ............. (bank or other financial institution 18.5where you have an account).18.6Your account balance is $........18.7The amount being held is $........18.8However, all or a portion of the funds in your account will normally be exempt from 18.9creditors' claims if they are in one of the following categories:18.10(1) relief based on need. This includes the Minnesota Family Investment Program 18.11(MFIP), Work First Program, Medical Assistance (MA), General Assistance (GA), 18.12General Assistance Medical Care (GAMC), Emergency General Assistance (EGA), 18.13Minnesota Supplemental Aid (MSA), MSA Emergency Assistance (MSA-EA), 18.14Supplemental Security Income (SSI), and Energy Assistance;18.15(2) Social Security benefits (Old Age, Survivors, or Disability Insurance);18.16(3) unemployment benefits, workers' compensation, or veterans' benefits;18.17(4) an accident, disability, or retirement pension or annuity;18.18(5) life insurance proceeds;18.19(6) the earnings of your minor child and any child support paid to you; or18.20(7) money from a claim for damage or destruction of exempt property (such as 18.21household goods, farm tools, business equipment, a mobile home, or a car).18.22The following funds are also exempt:18.23(8) all earnings of a person in category (1);18.24(9) all earnings of a person who has received relief based on need, or who has been 18.25an inmate of a correctional institution, within the last six months;18.26(10) 75 percent of every judgment debtor's after tax earnings; or18.27(11) all of a judgment debtor's after tax earnings below 40 times the federal 18.28minimum wage.18.29TIME LIMIT ON EXEMPTIONS AFTER DEPOSIT IN BANK:18.30Categories (10) and (11): 20 days18.31Categories (8) and (9): 60 days18.32All others: no time limit, as long as funds are traceable to the exempt source. (In 18.33tracing funds, the first-in, first-out method is used. This means money deposited first 18.34is spent first.) The money being sought by the judgment creditor is being held in your 18.35account to give you a chance to claim an exemption.18.36TO CLAIM AN EXEMPTION:19.1Fill out, sign, and mail or deliver one copy of the attached exemption claim form to 19.2the institution which sent you this notice and mail or deliver one copy to the judgment 19.3creditor's attorney. The address for the judgment creditor's attorney is set forth below. 19.4Both copies must be mailed ordelivered on the same day.19.5NOTE: You may help resolve your claim faster if you sendto the creditor's 19.6attorney written proof or documents thatshow why your money is exempt. If 19.7you have questionsregarding the documents to send as proof of an exemption,19.8call the creditor's attorney. If you do not send writtenproof and the creditor's 19.9attorney has questions about yourexemption claim, the creditor's attorney 19.10may object to yourclaim which may result in a further delay in releasing your19.11exempt funds.19.12If they do not get the exemption claim back from you within 14 days of the date 19.13they mailed or gave it to you, they will be free to turn the money over to the attorney for 19.14the judgment creditor. If you are going to claim an exemption, do so as soon as possible, 19.15because your money may be held until it is decided.19.16IF YOU CLAIM AN EXEMPTION:19.17(1) nonexempt money can be turned over to the judgment creditor or sheriff;19.18(2) the financial institution will keep holding the money claimed to be exempt; and19.19(3) seven days after receiving your exemption claim, the financial institution will 19.20release the money to you unless before then it receives an objection to your exemption 19.21claim.19.22IF THE JUDGMENT CREDITOR OBJECTS TO YOUR EXEMPTION CLAIM:19.23the institution will hold the money until a court decides if your exemption claim is 19.24valid, BUT ONLY IF the institution gets a copy of your court motion papers asserting the 19.25exemption WITHIN TEN DAYS after the objection is personally served on you, or within 19.2613 days from the date the objection is mailed to you. You may wish to consult an attorney 19.27at once if the judgment creditor objects to your exemption claim.19.28MOTION TO DETERMINE EXEMPTION:19.29At any time after your funds have been held, you may ask for a court decision on the 19.30validity of your exemption claim by filing a request for hearing which may be obtained 19.31at the office of the court administrator of the above court.19.32PENALTIES:19.33If you claim an exemption in bad faith, or if the judgment creditor wrongly objects 19.34to an exemption in bad faith, the court may order the person who acted in bad faith to pay 19.35costs, actual damages, attorney fees, and an additional amount of up to $100.

20.1
                     							.....
                     						20.2
                     							.....
                     						20.3
                     							.....
                     						20.4
                     							.....
                     						20.520.6Name and address of (Attorney for) Judgment Creditor

20.7EXEMPTION:20.8(a) Amount of exemption claim.20.9/ / I claim ALL the funds being held are exempt.20.10/ / I claim SOME of the funds being held are exempt.

20.11The exempt amount is $
                     							.....

20.12(b) Basis for exemption.20.13Of the 11 categories listed above, I am in category number ............ (If more than one 20.14category applies, you may fill in as many as apply.) The source of the exempt funds is 20.15the following:
            							.....
            						20.16
            							.....
            						20.17
            							.....
            						20.1820.19(If the source is a type of relief based on need, list the case number and county:20.20case number: ...............;20.21county: ....................)20.22I hereby authorize any agency that has distributed relief to me or any correctional 20.23institution in which I was an inmate to disclose to the above named judgment creditor's 20.24attorney only whether or not I am or have been a recipient of relief based on need or an 20.25inmate of a correctional institute within the last six months.20.26I have mailed or delivered a copy of the exemption notice to the judgment creditor's 20.27attorney at the address indicated above.

20.28
                     							.....
                     						20.29DEBTOR20.30DATED: 
                     							.....
                     						
                     							.....
                     						20.31
                     							.....
                     						20.32
                     							.....
                     						20.33DEBTOR ADDRESS20.34
                     							.....
                     						20.35DEBTOR TELEPHONE NUMBER

20.36STATE OF MINNESOTADISTRICT COURT20.37COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT21.1
                     							.....
                     						(Creditor)21.2
                     							.....
                     						(Debtor)21.321.4
                     							.....
                     						(Financial institution)

21.5IMPORTANT NOTICE21.6YOUR FUNDS HAVE BEEN LEVIED21.7The Creditor has frozen money in your account at your financial institution.21.8Your account balance is $.......21.9The amount being held is $.......21.10The amount being held will be frozen for 14 days from the date of this notice.21.11Some of your money in your account may be protected (the legal word is 21.12exempt). You may be able to get it sooner than 14 days if you act quickly and follow 21.13the instructions on the next page.21.14The attached exemption form lists some different sources of money in your account 21.15that may be protected. If your money is from one or more of these sources, place a 21.16check on the line on the form next to the sources of your money. If it is from one of 21.17these sources, the Creditor cannot take it.21.18BUT, you must follow the instructions and return the exemption form and 21.19copies of your bank statements from the last 60 days to have the bank unfreeze your 21.20money. If you do not follow the instructions, your financial institution will give the money 21.21to the Creditor. If that happens and it is protected, you can still get it back from the 21.22Creditor later, but that is not as easy to do as filling in the form now.21.23See next pages for instructions and the exemption form.21.24    Subd. 1c.Form of instructions.The instructions required must be in a separate 21.25form and must be substantially in the following form:21.26INSTRUCTIONS21.27Note: The creditor is who you owe the money to. You are the debtor.21.281. Fill out both of the attached exemption forms in this packet.21.29If you check one of the lines, you should also give proof that shows that some 21.30or all of the money in your account is from one or more of the protected sources. 21.31Creditors may ask for a hearing if they question your exemptions. To avoid a hearing:21.32Case numbers should be added to the form. Copies of documents should be 21.33sent with the form.21.34NOTICE: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO 21.35THE CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS 21.36FOR THE PAST 60 DAYS BEFORE THE LEVY. Keep a copy of your bank 21.37statements in case there are questions about your claim. If you do not send to the 22.1creditor's attorney (or to the creditor, if no attorney) bank statements with your 22.2exemption claim, the financial institution may release your money to the creditor.22.32. Sign the exemption forms. Make one copy to keep for yourself.22.43. Mail or deliver the other copies of the form by (insert date).22.5BOTH COPIES MUST BE MAILED OR DELIVERED THE SAME DAY.22.6One copy of the form and the copies of your bank statements go to:

22.7
                     							.....
                     						22.8(Insert name of creditor or creditor's attorney)22.9
                     							.....
                     						22.10(Insert address of creditor or creditor's attorney)

22.11One copy goes to:

22.12
                     							.....
                     						22.13(Insert name of bank)22.14
                     							.....
                     						22.15(Insert address of bank)

22.16HOW THE PROCESS WORKS22.17If You Do Not Send in the Exemption Form and Bank Statements:22.1814 days after the date of this letter some or all of your money may be turned over to 22.19the creditor pursuant to Minnesota statute.22.20If You Send in the Exemption Form and Bank Statements:22.21Any money that is NOT protected can be turned over to the creditor.22.22If the Creditor Does Not Object:22.23The financial institution will unfreeze your money six business days after the 22.24institution gets your completed form.22.25If the Creditor Objects:22.26The money you have said is protected on the form will be held by the bank. The 22.27creditor has six business days to object (disagree) and ask the court to hold a hearing. You 22.28will receive a Notice of Objection and a Notice of Hearing.22.29The financial institution will hold the money until a court decides whether your 22.30money is protected or not. Some reasons a creditor may object are because you did not 22.31send copies of your bank statements or other proof of the benefits you received. Be sure to 22.32include these when you send your exemption form.22.33You may want to talk to a lawyer for advice about this process. If you are low 22.34income you can call Legal Aid.22.35PENALTIES:22.36If you claim that your money is protected and a court decides you made that claim 22.37in bad faith, the court can order you to pay costs, actual damages, attorney fees, and an 23.1additional amount of up to $100. For example, it may be bad faith if you claim you receive 23.2government benefits that you do not receive.23.3If the creditor made a bad faith objection to your claim that your money is protected, 23.4the court can order them to pay costs, actual damages, attorney fees, and an additional 23.5amount of up to $100.23.6    Subd. 1d.Form of exemption form.The exemption form required by this 23.7subdivision must be a separate form and must be in substantially the following form:

23.8STATE OF MINNESOTADISTRICT COURT23.9COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT23.10
                     							.....
                     						(Creditor)23.11
                     							.....
                     						(Debtor)23.1223.13
                     							.....
                     						(Financial institution)

23.14EXEMPTION FORM

23.15A.HOW MUCH MONEY IS PROTECTED23.16
                     							.....
                     						I claim ALL of the money being frozen by the bank is protected.23.17
                     							.....
                     						I claim SOME of the money is protected. The amount I claim is protected is $.......23.18B.WHY THE MONEY IS PROTECTED23.1923.20My money is protected because I get it from one or more of the following places: (Check all that apply)23.21
                     							.....
                     						Government benefits23.22Government benefits include, but are not limited to, the following:23.23MFIP - Minnesota family investment program, 23.24MFIP Diversionary Work Program,23.25Work participation cash benefit,23.26GA - general assistance,23.27EA - emergency assistance,23.28MA - medical assistance,23.29GAMC - general assistance medical care,23.30EGA - emergency general assistance,23.31MSA - Minnesota supplemental aid,23.32MSA-EA - MSA emergency assistance,23.33Food Support,23.34SSI - Supplemental Security Income,23.35MinnesotaCare,23.36Medicare part B premium payments,23.37Medicare part D extra help,23.38Energy or fuel assistance.23.39LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT23.40
                     							.....
                     						23.41LIST THE CASE NUMBER AND COUNTY24.1Case Number: 
                     							.....
                     						24.2County: 
                     							.....
                     						24.3Government benefits also include:24.4
                     							.....
                     						Social Security benefits24.5
                     							.....
                     						Unemployment benefits24.6
                     							.....
                     						Workers' compensation24.7
                     							.....
                     						Veterans benefits24.824.924.10If you receive any of these government benefits, include copies of any documents you have that show you receive Social Security, unemployment, workers' compensation, or veterans benefits.24.11
                     							.....
                     						Other assistance based on need

24.12You may have assistance based on need from another source that is not on the list. If you 24.13do, check this box, and fill in the source of your money on the line below:24.14Source: 
            							.....
            						24.15Include copies of any documents you have that show the source of this money.

24.16EARNINGS24.17ALL or SOME of your earnings (wages) may also be protected.24.18
                     							.....
                     						All of your earnings (wages) are protected if:24.19
                     							.....
                     						You get government benefits (see list of government benefits)24.20
                     							.....
                     						You currently receive other assistance based on need24.21
                     							.....
                     						You have received government benefits in the last six months24.22
                     							.....
                     						You were in jail or prison in the last six months24.2324.2424.2524.26If you check one of these lines, your wages are only protected for 60 days after they are deposited in your account so you MUST send the creditor a copy of BANK STATEMENTS that show what was in your account for the 60 days right before the bank froze your money.24.27
                     							.....
                     						Some of your earnings (wages) are protected.24.2824.2924.30If all of your earnings are not exempt, then some of your earnings are still protected for 20 days after they were deposited in your account. The amount protected is the larger amount of:24.3175 percent of your wages (after taxes are taken out); or24.32(insert the sum of the current federal minimum wage) multiplied by 40.24.33OTHER EXEMPT FUNDS24.3424.35The money from the following are also completely protected after they are deposited in your account.24.36
                     							.....
                     						An accident, disability, or retirement pension or annuity24.37
                     							.....
                     						Payments to you from a life insurance policy24.38
                     							.....
                     						Earnings of your child who is under 18 years of age24.39
                     							.....
                     						Child support24.4024.4124.4224.43
                     							.....
                     						Money paid to you from a claim for damage or destruction of propertyProperty includes household goods, farm tools or machinery, tools for your job, business equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, or appliances.24.44
                     							.....
                     						Death benefits paid to you

25.1I give permission to any agency that has given me cash benefits to give information 25.2about my benefits to the above-named creditor, or its attorney. The information will ONLY25.3concern whether I get benefits or not, or whether I have gotten them in the past six months.25.4If I was an inmate in the last six months, I give my permission to the correctional 25.5institution to tell the above-named creditor that I was an inmate there.25.6YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S 25.7ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. 25.8REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR 25.9THE PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE 25.10INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.25.11I have mailed or delivered a copy of this form to:

25.12
                     							.....
                     						25.13(Insert name of creditor or creditor's attorney)25.14
                     							.....
                     						25.15(Insert address of creditor or creditor's attorney)

25.16I have also mailed or delivered a copy of this exemption form to my bank at the 25.17address listed in the instructions.

25.18DATED: 
                     							.....
                     						
                     							.....
                     						25.19DEBTOR25.20
                     							.....
                     						25.21DEBTOR ADDRESS25.22
                     							.....
                     						25.23DEBTOR TELEPHONE NUMBER

25.24    Subd. 2. Effect of exemption notice. Within two business days after receipt of the 25.25execution levy and the notice, instructions, and two copies of the exemption notices, the 25.26financial institution shall serve upon the judgment debtor the notice, instructions, and two 25.27copies of the exemption notice. The financial institution shall serve the notice by first 25.28class mail to the last known address of the judgment debtor. If no claim of exemption 25.29is received by the financial institution within 14 days after the exemption notices are 25.30mailed to the judgment debtor, the funds remain subject to the execution levy and shall 25.31be remitted to the judgment creditor's attorney within seven six business days. If the 25.32judgment debtor elects to claim an exemption, the judgment debtor shall complete the 25.33exemption notice, sign it under penalty of perjury, and deliver one copy to the financial 25.34institution and one copy to the attorney for the judgment creditor within 14 days of the 25.35date postmarked on the correspondence mailed to the judgment debtor containing the 25.36exemption notices. The debtor is also required to include copies of bank statements for 25.37the prior 60 days with the exemption notice. In the event that there is no attorney for the 26.1judgment creditor, the notice must be sent directly to the judgment creditor. Failure of the 26.2judgment debtor to deliver the executed exemption notice or copies of the required bank 26.3statements for the prior 60 days does not constitute a waiver of any claimed right to an 26.4exemption. Upon timely receipt of a claim of exemption, funds not claimed to be exempt 26.5by the judgment debtor remain subject to the execution levy. All money claimed to be 26.6exempt shall be released to the judgment debtor upon the expiration of seven six business26.7days after the date postmarked on the envelope containing the executed exemption 26.8notice mailed to the financial institution, or the date of personal delivery of the executed 26.9exemption notice to the financial institution, unless within that time the attorney for the 26.10judgment creditor interposes an objection to the exemption.26.11    Subd. 3. Objection to exemption claim Objections and request for hearing.26.12An objection shall be interposed, within six business days of receipt by the creditor of 26.13an exemption claim from the debtor, by mailing or delivering one copy of the written 26.14objection Notice of Objection and Notice of Hearing to the financial institution and one 26.15copy of the written objection Notice of Objection and Notice of Hearing to the judgment26.16debtor along with a copy of the judgment debtor's claimed exemption form. Both copies 26.17of an objection to an exemption claim shall be mailed or delivered on the same date. 26.18The financial institution may rely on the date of mailing or delivery of a notice to it in 26.19computing any time periods in this section. The written objection Notice of Objection and 26.20Notice of Hearing form must be substantially in the form specified set out in subdivision 5.26.21The court administrator may charge a fee of $1 for the filing of a Notice of Objection 26.22and Notice of Hearing. Upon the filing of a Notice of Objection and Notice of Hearing, 26.23the court administrator shall schedule the matter for hearing no sooner than five business 26.24days but no later than seven business days from the date of filing. A debtor may request 26.25continuance of the hearing by notifying the creditor and the court. The court shall schedule 26.26the continued hearing within seven days of the original hearing date.26.27An order stating whether the debtor's funds are exempt shall be issued by the court 26.28within three days of the date of the hearing.26.29    Subd. 4. Duties of financial institution if objection is made to exemption claim.26.30Upon receipt of a written objection Notice of Objection and Notice of Hearing from the 26.31judgment creditor within the specified seven-day six-day period, the financial institution 26.32shall retain the funds claimed to be exempt. Unless the financial institution receives a 26.33request for hearing and notice of hearing from the judgment debtor asserting exemption 26.34rights within ten days after receipt of a written objection to the exemption, the funds 26.35remain subject to the execution levy as if no claim of exemption had been made and shall 26.36be remitted to the judgment creditor's attorney within seven days. If a request for hearing 27.1and notice of hearing to determine the validity of a claim of exemption is received by the 27.2financial institution within the period provided, it shall retain the funds claimed to be 27.3exempt until otherwise ordered by the court. The financial institution shall retain the funds 27.4claimed to be exempt until otherwise ordered by the court, upon mutual agreement of the 27.5parties, or until the garnishment lapses pursuant to subdivision 7.27.6    Subd. 5. Form of Notice of Objection and Notice of Hearing.(a) The written 27.7objection to the judgment debtor's claim of exemption must be in substantially the 27.8following form:

27.9STATE OF MINNESOTADISTRICT COURT27.10County of 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT27.1127.12
                     							.....
                     						(Judgment Creditor)OBJECTION TO27.13
                     							.....
                     						(Judgment Debtor)EXEMPTION CLAIM27.1427.15
                     							.....
                     						(Garnishee) (Third Party)

27.16The judgment creditor objects to your claim for exemption from garnishment, levy of 27.17execution, order for attachment (strike inapplicable language) for the following reason(s):
            							.....
            						27.18
            							.....
            						27.19
            							.....
            						27.2027.21Because of this objection, your financial institution will retain the funds you claimed 27.22to be exempt for an additional ten days. If you wish to request a hearing on your exemption 27.23claim, you need to do so within ten days from the date the objection was personally served 27.24on you, or within 13 days from the date the objection was mailed to you. You may request 27.25a hearing by completing the attached form and filing it with the court administrator.27.261. The court administrator's office shall provide clerical assistance to help with the 27.27writing and filing of a Request for Hearing by any person not represented by counsel. The 27.28court administrator may charge a fee of $1 for the filing of a Request for Hearing.27.292. Upon the filing of a Request for Hearing, the court administrator shall schedule 27.30the matter for a hearing no later than five business days from the date of filing. The court 27.31administrator shall forthwith send a completed copy of the request, including the hearing 27.32date, time, and place to the adverse party and to the financial institution by first class mail.27.333. If it is possible that the financial institution might not receive the request mailed 27.34from the court administrator within ten days, then you may want to personally deliver a 27.35copy of the request to the financial institution after you have filed your request with the 27.36court.28.14. An order stating whether your funds are exempt shall be issued by the court 28.2within three days of the date of the hearing.28.3If you do not file a Request for Hearing within ten days of the date the objection was 28.4personally served on you, or within 13 days from the date the objection was mailed to you, 28.5your financial institution may turn your funds over to your judgment creditor.28.6If you file a Request for Hearing and your financial institution receives it within ten 28.7days of the date it received this objection, your financial institution will retain your funds 28.8claimed to be exempt until otherwise ordered by the court.

28.9
                     							.....
                     						28.10Attorney for Judgment Creditor

28.11(a) The Written Objection and Notice of Hearing must be in substantially the 28.12following form:

28.13STATE OF MINNESOTADISTRICT COURT28.14COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT28.15
                     							.....
                     						28.16(Creditor)28.1728.1828.1928.20CREDITOR'S NOTICE OF OBJECTION AND NOTICE OF HEARING ON EXEMPTION CLAIM28.21
                     							.....
                     						28.22(Debtor)28.23
                     							.....
                     						28.24(Financial Institution)28.25(DEBTOR)28.26
                     							.....
                     						28.27ADDRESS28.28
                     							.....
                     						28.29
                     							.....

28.30
                     							.....
                     						28.31
                     							.....
                     						28.32
                     							.....
                     						28.3328.34(CREDITOR OR CREDITOR'S ATTORNEY)28.35
                     							.....
                     						28.36NOTICE OF HEARING28.3728.3828.39The creditor objects to your exemption claim. This hearing is to resolve your exemption claim.28.40Hearing Date:
                     							.....
                     						28.41Time:
                     							.....
                     						28.42Hearing Place:
                     							.....

29.1The creditor objects to your claim of exemption from levy of execution for the 29.2following reason(s):

29.3
                     							.....
                     						29.4
                     							.....
                     						29.5
                     							.....

29.6(Note: Bring with you to the hearing all documents and materials supporting 29.7your exemption claim. Failure to do so could delay the court's decision.)29.8If the creditor receives all documents and materials supporting your exemption 29.9claim before the hearing date, the creditor may agree with your exemption claim and you 29.10might be able to avoid a hearing.29.11Because a court hearing will be held on your claim that your funds are protected, 29.12your financial institution will retain the funds until it receives an order from the court or 29.13upon mutual agreement between you and the creditor.29.14    Subd. 6.Request for hearing and notice for hearing.The request for hearing 29.15accompanying the objection notice must be in substantially the following form:

29.16STATE OF MINNESOTADISTRICT COURT29.17County of 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT29.1829.19
                     							.....
                     						(Judgment Creditor)REQUEST FOR HEARING29.20
                     							.....
                     						(Judgment Debtor)AND NOTICE FOR HEARING29.2129.22
                     							.....
                     						(Garnishee) (Third Party)

29.23I hereby request a hearing to resolve the exemption claim which has been made 29.24in this case regarding funds in the account of ............. (Judgment Debtor) at the ......... 29.25(Financial Institution).29.26I believe the property being held is exempt because
            							.....
            						29.27
            							.....
            						29.28

29.29Dated: 
                     							.....
                     						
                     							.....
                     						29.30(JUDGMENT DEBTOR)29.31
                     							.....
                     						29.32(ADDRESS)29.33
                     							.....
                     						29.34HEARING DATE: 
                     							.....
                     						TIME: 
                     							.....
                     						29.35HEARING PLACE: 
                     							.....

29.36(Note to both parties: Bring with you to the hearing all documents and materials 29.37relevant to the exemption claim and objection. Failure to do so could delay the court's 29.38decision.)30.1    Subd. 7. Release of funds. At any time during the procedure specified in this 30.2section, the judgment debtor or the attorney for the judgment creditor may, by a writing 30.3dated after the service of the writ of execution, direct the financial institution to release the 30.4funds in question to the other party. Upon receipt of a release, the financial institution 30.5shall release the funds as directed.30.6    Subd. 8. Subsequent proceedings; bad faith claims. If in subsequent proceedings 30.7brought by the judgment debtor or the judgment creditor, the claim of exemption is not 30.8upheld, and the court finds that it was asserted in bad faith, the judgment creditor shall be 30.9awarded actual damages, costs, and reasonable attorney fees resulting from the additional 30.10proceedings, and an amount not to exceed $100. If the claim of exemption is upheld, and 30.11the court finds that the judgment creditor disregarded the claim of exemption in bad faith, 30.12the judgment debtor shall be awarded costs, reasonable attorney fees, actual damages, and 30.13an amount not to exceed $100. The underlying judgment must be modified to reflect 30.14assessment of damages, costs, and attorney fees. However, if the party in whose favor a 30.15penalty assessment is made is not actually indebted to the party's attorney for fees, the 30.16attorney's fee award shall be made directly to the attorney and if not paid, an appropriate 30.17judgment in favor of the attorney shall be entered. Upon motion of any party in interest, 30.18on notice, the court shall determine the validity of any claim of exemption, and may make 30.19any order necessary to protect the rights of those interested. No financial institution is 30.20liable for damages for complying with this section. Both copies of an exemption claim 30.21or an objection to an exemption claim must be mailed or delivered on the same date. 30.22The financial institution may rely on the date of mailing or delivery of a notice to it in 30.23computing any time periods in this section.30.24    Sec. 4. Minnesota Statutes 2008, section 571.71, is amended to read:30.25571.71 GARNISHMENT; WHEN AUTHORIZED.30.26As an ancillary proceeding to a civil action for the recovery of money, a creditor 30.27may issue a garnishment summons as provided in this chapter against any third party in 30.28the following instances:30.29(1) at the time the civil action is commenced or at any time after the commencement 30.30of the civil action, but before the entry of a judgment, if the court orders the issuance of 30.31the garnishment summons pursuant to section 
         571.93;30.32(2) at any time 40 45 days or more after service of the summons and complaint 30.33upon the debtor in the civil action when a judgment by default could have, but has not, 30.34been entered pursuant to rule 55.01(a) of the Minnesota Rules of Civil Procedure for the 30.35District Courts. Garnishment under this clause is effective only after the Notice of Intent 31.1to Garnish form in section 571.72, subdivision 11, and the Exemption form in section 31.2571.72, subdivision 10, are served on the debtor at any time 20 or more days after the 31.3service of the Summons and Complaint and, in addition, the creditor does not receive an 31.4Answer from the debtor within 25 days after service of the Notice of Intent to Garnish. 31.5The Notice of Intent to Garnish form and the Exemption form must be substantially in the 31.6form set forth in section 571.72, subdivisions 10 and 11. If a creditor sends a Notice of 31.7Intent to Garnish form to a debtor under this clause, the creditor cannot obtain a default 31.8judgment against the debtor under rule 55.01(a) of the Minnesota Rules of Civil Procedure 31.9for the District Court until 25 days after the service of the Notice of Intent to Garnish 31.10form. No filing of a pleading or other documents by the creditor is required to issue 31.11a garnishment summons under this clause; however, the creditor must comply with the 31.12service requirement of section 
         571.72, subdivision 4; or31.13(3) at any time after entry of a money judgment in the civil action.31.14    Sec. 5. Minnesota Statutes 2008, section 571.72, is amended by adding a subdivision 31.15to read:31.16    Subd. 10.Exemption notice for prejudgment garnishment.31.17EXEMPTION NOTICE31.18IMPORTANT NOTICE: A garnishment summons may be served on your 31.19employer, bank, or other third parties without any further court proceeding or notice 31.20to you. See the attached Notice of Intent to Garnish for more information.31.21The following money and wages may be protected (the legal word is exempt) 31.22from garnishment:31.231. Financial institutions/bank31.24Some of the money in your account may be protected because you receive 31.25government benefits from one or more of the following places:31.26MFIP - Minnesota family investment program,31.27MFIP Diversionary Work Program,31.28Work participation cash benefit,31.29GA - general assistance,31.30EA - emergency assistance,31.31MA - medical assistance,31.32GAMC - general assistance medical care,31.33EGA - emergency general assistance or county crisis funds,31.34MSA - Minnesota supplemental aid,31.35MSA-EA - MSA emergency assistance,32.1Food Support,32.2SSI - Supplemental Security Income,32.3MinnesotaCare,32.4Medicare part B premium payments,32.5Medicare part D extra help,32.6Energy or fuel assistance,32.7Social Security benefits,32.8Unemployment benefits,32.9Workers' compensation,32.10Veterans benefits.32.11Sending the creditor's attorney (or creditor, if no attorney) a copy of BANK 32.12STATEMENTS that show what was in your account for the past 60 days may give 32.13the creditor enough information about your exemption claim to avoid a garnishment.32.142. Earnings32.15All or some of your earnings may be completely protected from garnishment if:32.16All of your earnings (wages) may be protected if:32.17You get government benefits (see list of government benefits)32.18You currently receive other assistance based on need32.19You have received government benefits in the last six months32.20You were in jail or prison in the last six months32.21Your wages are only protected for 60 days after they are deposited in your account 32.22so it would be helpful if you immediately send the undersigned creditor a copy of 32.23BANK STATEMENTS that show what was in your account for the past 60 days.32.24Some of your earnings (wages) may be protected if:32.25If all of your earnings are not exempt, some of your earnings may still be protected 32.26for 20 days after they were deposited in your account. The amount protected is the larger 32.27amount of:32.2875 percent of your wages (after taxes are taken out); or32.29(insert the sum of the current federal minimum wage) multiplied by 40.32.30The money from the following are also exempt for 20 days after they are 32.31deposited in your account.32.32An accident, disability, or retirement pension or annuity32.33Payments to you from a life insurance policy32.34Earnings of your child who is under 18 years of age32.35Child support33.1Money paid to you from a claim for damage or destruction of property.33.2Property includes household goods, farm tools or machinery, tools for your job, business 33.3equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, 33.4furniture, or appliances.33.5Death benefits paid to you.33.6YOU WILL BE ABLE TO CLAIM THESE EXEMPTIONS WHEN YOU 33.7RECEIVE A NOTICE. You will get the notice at least ten days BEFORE a wage 33.8garnishment. BUT if the creditor garnishes your bank account, you will not get 33.9the notice until AFTER the account has been frozen. IF YOU BELIEVE THE 33.10MONEY IN YOUR BANK ACCOUNT OR YOUR WAGES ARE EXEMPT, YOU 33.11SHOULD IMMEDIATELY CONTACT THE PERSON BELOW. YOU SHOULD 33.12TELL THEM WHY YOU THINK YOUR ACCOUNT OR WAGES ARE EXEMPT 33.13TO SEE IF YOU CAN AVOID GARNISHMENT.

33.14Creditor 
                     							.....
                     						33.15Creditor address 
                     							.....
                     						33.16Creditor telephone number 
                     							.....

33.17    Sec. 6. Minnesota Statutes 2008, section 571.72, is amended by adding a subdivision 33.18to read:33.19    Subd. 11.Notice of intent to garnish.The notice of intent to garnish must be in 33.20substantially the following form:33.21IMPORTANT! READ THIS CAREFULLY!33.22NOTICE OF INTENT TO GARNISH

33.23
                     							.....
                     						against 
                     							.....
                     						33.24Plaintiff/CreditorDefendant/Debtor

33.25Your money, property, or earnings are in danger of being garnished because 33.26you did not send a written "Answer" to the Summons and Complaint served on you 33.27over 20 days ago.33.28There may not be a case filed in court, BUT because you did not send a written 33.29"Answer" the creditor may serve a garnishment summons on your employer, bank, or 33.30other third parties. This means that your money or wages can be garnished (held or taken). 33.31Under Minnesota law, this can happen any time 20 days after the date you receive this 33.32notice.33.33There will be NO COURT HEARING or any further notice to you prior to a 33.34garnishment if you do nothing. There may not be a file open at the Clerk of the Court's 33.35office. There are things you can do to avoid a garnishment, but you must act quickly.34.1Please read these instructions carefully. You have 20 days to do one of the following:34.21. Send an Answer. If you do not think you owe the money or if you have a legal 34.3reason that you did not pay, send a written "Answer" to the Summons and Complaint. 34.4Your "Answer" should tell the creditor why you think you do not owe some or all of the 34.5money. Contact a lawyer if you do not know what to do, need help with an answer, or 34.6have any questions about the debt.34.72. Claim an Exemption. Even if you do not have a defense to the complaint, some 34.8of your money may be protected (the legal word is exempt) from garnishment. This 34.9means it is protected and cannot be taken. The creditor will send you a form to claim these 34.10exemptions at a later time, but you can possibly avoid the garnishment by contacting 34.11the person below immediately to claim your exemption. Attached to this notice is a list 34.12of exemptions you may be able to claim.34.133. If you do not have a defense and your money is not exempt you can call the 34.14person below before the 20 days are up and try to set up a payment plan that works for 34.15both you and your creditor. You can contact the person below at any time to try to work 34.16out a payment plan, but if you wait too long or cannot agree on a payment plan, they may 34.17garnish your wages, bank accounts, or assets.34.18If you do not do any of these things, your money can be garnished. The creditor 34.19can garnish your wages, bank accounts, or other assets. They do not have to go to court to 34.20let you know when they start taking your money.

34.21LAW FIRM34.22Dated:
                     							.....
                     						By:
                     							.....
                     						34.23Attorney, #34.24Attorneys for Plaintiff34.25Address34.26Telephone

34.27    Sec. 7. Minnesota Statutes 2008, section 571.911, is amended to read:34.28571.911 EXEMPTION NOTICE; DUTY OF FINANCIAL INSTITUTION.34.29If the garnishment summons is used to garnish funds of a debtor who is a natural 34.30person and if the funds to be garnished are held on deposit at a financial institution, the 34.31creditor shall serve with the garnishee summons a notice, instructions, and two copies of 34.32an exemption notice. The notice, instructions, and exemption notices must be substantially 34.33in the form forms set forth in section 
         571.912. Failure of the creditor to send the exemption 34.34notice renders the garnishment void, and the financial institution shall take no action. 34.35Upon receipt of the garnishment summons and exemption notices, the financial institution 35.1shall retain as much of the amount under section 
         571.73 as the financial institution has on 35.2deposit owing to the debtor, but not more than 110 percent of the creditor's claim.35.3    Sec. 8. Minnesota Statutes 2008, section 571.912, is amended to read:35.4571.912 FORM OF NOTICE, INSTRUCTIONS, AND EXEMPTION NOTICE.35.5    Subdivision 1.Form of notice. The notice, instructions, and exemption notice35.6informing a debtor that an order for attachment,a garnishment summons, or levy by 35.7execution has been used to attach funds of the debtor to satisfy a claim must be a separate 35.8notice and must be substantially in the following form:

35.9STATE OF MINNESOTADISTRICT COURT35.10COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT35.11
                     							.....
                     						 (Creditor)35.12
                     							.....
                     						 (Debtor)35.13TO: DebtorEXEMPTION NOTICE

35.14STATE OF MINNESOTADISTRICT COURT35.15COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT35.16
                     							.....
                     						(Creditor)35.17
                     							.....
                     						(Debtor)35.1835.19
                     							.....
                     						(Financial institution)

35.20IMPORTANT NOTICE35.21YOUR FUNDS HAVE BEEN GARNISHED35.22The Creditor has frozen money in your account at your financial institution.35.23Your account balance is $.......35.24The amount being held is $.......35.25The amount being held will be frozen for 14 days from the date of this notice.35.26Some of your money in your account may be protected (the legal word is 35.27exempt). You may be able to get it sooner than 14 days if you act quickly and follow 35.28the instructions on the next page.35.29The attached exemption form lists some different sources of money in your account 35.30that may be protected. If your money is from one or more of these sources, place a 35.31check on the line on the form next to the sources of your money. If it is from one of 35.32these sources, the Creditor cannot take it.35.33BUT, you must follow the instructions and return the exemption form and 35.34copies of your bank statements from the last 60 days to have the bank unfreeze your 35.35money. If you do not follow the instructions or your Creditor gets an order from the court 35.36or writ of execution, your financial institution will give the money to your Creditor. If that 36.1happens and it is protected, you can still get it back from the Creditor later, but that is not 36.2as easy to do as filling in the form now.36.3See next pages for instructions and the exemption form.36.4    Subd. 2.Form of instructions.The instructions required must be in a separate form 36.5and must be substantially in the following form:36.6INSTRUCTIONS36.7Note: The creditor is who you owe the money to. You are the debtor.36.81. Fill out both of the attached exemption forms in this packet.36.9If you check one of the lines, you should also give proof that shows that some 36.10or all of the money in your account is from one or more of the protected sources. 36.11Creditors may ask for a hearing if they question your exemptions.36.12To avoid a hearing:36.13Case numbers should be added to the form.36.14Copies of documents should be sent with the form.36.15NOTICE: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO 36.16THE CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS 36.17FOR THE PAST 60 DAYS BEFORE THE GARNISHMENT. Keep a copy of your 36.18bank statements in case there are questions about your claim. If you do not send to 36.19the creditor's attorney (or to the creditor, if no attorney) bank statements with your 36.20exemption claim, the financial institution may release your money to the creditor 36.21once the creditor gives the financial institution a court order directing it to turn 36.22over the funds.36.232. Sign the exemption forms. Make one copy to keep for yourself.36.243. Mail or deliver the other copies of the form by (insert date).36.25BOTH COPIES MUST BE MAILED OR DELIVERED THE SAME DAY.36.26One copy of the form and the copies of your bank statements go to:

36.27
                     							.....
                     						36.28(Insert name of creditor or creditor's attorney)36.29
                     							.....
                     						36.30(Insert address of creditor or creditor's attorney)

36.31One copy goes to:

36.32
                     							.....
                     						36.33(Insert name of bank)36.34
                     							.....
                     						36.35(Insert address of bank)

36.36HOW THE PROCESS WORKS36.37If You Do Not Send in the Exemption Form and Bank Statements:37.114 days after the date of this letter some or all of your money may be turned over to 37.2the creditor once they get an order from the court telling the financial institution to do this.37.3If You Send in the Exemption Form and Bank Statements:37.4Any money that is NOT protected can be turned over to the creditor once they get 37.5an order from the court.37.6If the Creditor Does Not Object:37.7The financial institution will unfreeze your money six business days after the 37.8institution gets your completed form.37.9If the Creditor Objects:37.10The money you have said is protected on the form will be held by the bank. The 37.11creditor has six business days to object (disagree) and ask the court to hold a hearing. You 37.12will receive a Notice of Objection and a Notice of Hearing.37.13The financial institution will hold the money until a court decides whether your 37.14money is protected or not. Some reasons a creditor may object are because you did not 37.15send copies of your bank statements or other proof of the benefits you received. Be sure to 37.16include these when you send your exemption form.37.17You may want to talk to a lawyer for advice about this process. If you are low 37.18income you can call Legal Aid.37.19PENALTIES:37.20If you claim that your money is protected and a court decides you made that claim 37.21in bad faith, the court can order you to pay costs, actual damages, attorney fees, and an 37.22additional amount of up to $100. For example, it may be bad faith if you claim you receive 37.23government benefits that you do not receive.37.24If the creditor made a bad faith objection to your claim that your money is protected, 37.25the court can order them to pay costs, actual damages, attorney fees, and an additional 37.26amount of up to $100.37.27    Subd. 3.Exemption notice.The exemption notice must be a separate form and 37.28must be in substantially the following form:

37.29STATE OF MINNESOTADISTRICT COURT37.30COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT37.31
                     							.....
                     						(Creditor)37.32
                     							.....
                     						(Debtor)37.3337.34
                     							.....
                     						(Financial institution)

37.35EXEMPTION FORM

37.36A.HOW MUCH MONEY IS PROTECTED37.37
                     							.....
                     						I claim ALL of the money being frozen by the bank is protected.38.1
                     							.....
                     						I claim SOME of the money is protected. The amount I claim is protected is $.......38.2B.WHY THE MONEY IS PROTECTED38.338.4My money is protected because I get it from one or more of the following places: (Check all that apply)38.5
                     							.....
                     						Government benefits38.6Government benefits include, but are not limited to, the following:38.7MFIP - Minnesota family investment program, 38.8MFIP Diversionary Work Program,38.9Work participation cash benefit,38.10GA - general assistance,38.11EA - emergency assistance,38.12MA - medical assistance,38.13GAMC - general assistance medical care,38.14EGA - emergency general assistance,38.15MSA - Minnesota supplemental aid,38.16MSA-EA - MSA emergency assistance,38.17Food Support,38.18SSI - Supplemental Security Income,38.19MinnesotaCare,38.20Medicare part B premium payments,38.21Medicare part D extra help,38.22Energy or fuel assistance.38.23LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT38.24
                     							.....
                     						38.25LIST THE CASE NUMBER AND COUNTY38.26Case Number: 
                     							.....
                     						38.27County: 
                     							.....
                     						38.28Government benefits also include:38.29
                     							.....
                     						Social Security benefits38.30
                     							.....
                     						Unemployment benefits38.31
                     							.....
                     						Workers' compensation38.32
                     							.....
                     						Veterans benefits38.3338.3438.35If you receive any of these government benefits, include copies of any documents you have that show you receive Social Security, unemployment, workers' compensation, or veterans benefits.38.36
                     							.....
                     						Other assistance based on need

38.37You may have assistance based on need from another source that is not on the list. If you 38.38do, check this box, and fill in the source of your money on the line below:38.39Source: 
            							.....
            						38.40Include copies of any documents you have that show the source of this money.

39.1EARNINGS39.2ALL or SOME of your earnings (wages) may also be protected.39.3
                     							.....
                     						All of your earnings (wages) are protected if:39.4
                     							.....
                     						You get government benefits (see list of government benefits)39.5
                     							.....
                     						You currently receive other assistance based on need39.6
                     							.....
                     						You have received government benefits in the last six months39.7
                     							.....
                     						You were in jail or prison in the last six months39.839.939.1039.11If you check one of these lines, your wages are only protected for 60 days after they are deposited in your account so you MUST send the creditor a copy of BANK STATEMENTS that show what was in your account for the 60 days right before the bank froze your money.39.12
                     							.....
                     						Some of your earnings (wages) are protected.39.1339.1439.15If all of your earnings are not exempt, then some of your earnings are still protected for 20 days after they were deposited in your account. The amount protected is the larger amount of:39.1675 percent of your wages (after taxes are taken out); or39.17(insert the sum of the current federal minimum wage) multiplied by 40.39.18OTHER EXEMPT FUNDS39.1939.20The money from the following are also completely protected after they are deposited in your account.39.21
                     							.....
                     						An accident, disability, or retirement pension or annuity39.22
                     							.....
                     						Payments to you from a life insurance policy39.23
                     							.....
                     						Earnings of your child who is under 18 years of age39.24
                     							.....
                     						Child support39.2539.2639.2739.28
                     							.....
                     						Money paid to you from a claim for damage or destruction of propertyProperty includes household goods, farm tools or machinery, tools for your job, business equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, or appliances.39.29
                     							.....
                     						Death benefits paid to you

39.30I give permission to any agency that has given me cash benefits to give information 39.31about my benefits to the above-named creditor, or its attorney. The information will ONLY39.32concern whether I get benefits or not, or whether I have gotten them in the past six months.39.33If I was an inmate in the last six months, I give my permission to the correctional 39.34institution to tell the above-named creditor that I was an inmate there.39.35YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S 39.36ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. 39.37REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR 39.38THE PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE 39.39INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.39.40I have mailed or delivered a copy of this form to:

39.41
                     							.....
                     						39.42(Insert name of creditor or creditor's attorney)40.1
                     							.....
                     						40.2(Insert address of creditor or creditor's attorney)

40.3I have also mailed or delivered a copy of this exemption form to my bank at the 40.4address listed in the instructions.

40.5DATED: 
                     							.....
                     						
                     							.....
                     						40.6DEBTOR40.7
                     							.....
                     						40.8DEBTOR ADDRESS40.9
                     							.....
                     						40.10DEBTOR TELEPHONE NUMBER

40.11An order for attachment, garnishment summons, or levy of execution (strike 40.12inapplicable language) has been served on ............ (bank or other financial institution) 40.13............... where you have an account.40.14Your account balance is $..................40.15The amount being held is $.................40.16However, all or a portion of the funds in your account will normally be exempt from 40.17creditors' claims if they are in one of the following categories:40.18(1) relief based on need. This includes the Minnesota Family Investment Program 40.19(MFIP), Emergency Assistance (EA), Work First Program, Medical Assistance (MA), 40.20General Assistance (GA), General Assistance Medical Care (GAMC), Emergency General 40.21Assistance (EGA), Minnesota Supplemental Aid (MSA), MSA Emergency Assistance 40.22(MSA-EA), Supplemental Security Income (SSI), and Energy Assistance;40.23(2) Social Security benefits (Old Age, Survivors, or Disability Insurance);40.24(3) unemployment benefits, workers' compensation, or veterans' benefits;40.25(4) an accident, disability, or retirement pension or annuity;40.26(5) life insurance proceeds;40.27(6) the earnings of your minor child and any child support paid to you; or40.28(7) money from a claim for damage or destruction of exempt property (such as 40.29household goods, farm tools, business equipment, a mobile home, or a car).40.30The following funds are also exempt:40.31(8) all earnings of a person in category (1);40.32(9) all earnings of a person who has received relief based on need, or who has been 40.33an inmate of a correctional institution, within the last six months;40.34(10) 75 percent of every debtor's after tax earnings; and40.35(11) all of a debtor's after tax earnings below 40 times the federal minimum wage.40.36TIME LIMIT ON EXEMPTIONS AFTER DEPOSIT IN BANK:40.37Categories (10) and (11): 20 days41.1Categories (8) and (9): 60 days41.2All others: no time limit, as long as funds are traceable to the exempt source. (In 41.3tracing funds, the first-in, first-out method is used. This means money deposited first is 41.4spent first.) The money being sought by the creditor is being held in your account to 41.5give you a chance to claim an exemption.41.6TO CLAIM AN EXEMPTION:41.7Fill out, sign, and mail or deliver one copy of the attached exemption claim form to 41.8the institution which sent you this notice and mail or deliver one copy to the creditor's 41.9attorney. In the event that there is no attorney for the creditor, then such notice shall be 41.10sent directly to the creditor. The address for the creditor's attorney or the creditor is set 41.11forth below. Both copies must be mailed or delivered on the same day.41.12NOTE: You may help resolve your claim faster if you send to the creditor's 41.13attorney written proof or documents that show why your money is exempt. If 41.14you have questions regarding the documents to send as proof of an exemption, 41.15call the creditor's attorney. If you do not send written proof and the creditor's 41.16attorney has questions about your exemption claim, the creditor's attorney 41.17may object to your claim which may result in a further delay in releasing your 41.18exempt funds.41.19If they do not get the exemption claim back from you within 14 days of the date 41.20they mailed or gave it to you, they will be free to turn the money over to the sheriff or 41.21the creditor. If you are going to claim an exemption, do so as soon as possible, because 41.22your money may be held until it is decided.41.23IF YOU CLAIM AN EXEMPTION:41.24(1) nonexempt money can be turned over to the creditor or sheriff;41.25(2) the financial institution will keep holding the money claimed to be exempt; and41.26(3) seven days after receiving your exemption claim, the financial institution will 41.27release the money to you unless before then it receives an objection to your exemption 41.28claim.41.29IF THE CREDITOR OBJECTS TO YOUR EXEMPTION CLAIM:41.30The institution will hold the money until a court decides if your exemption claim is 41.31valid, BUT ONLY IF the institution gets a copy of your court motion papers asserting 41.32the exemption WITHIN TEN DAYS after the objection is personally served on you, or 41.33within 13 days from the date the objection is mailed to you. You may wish to consult an 41.34attorney at once if the creditor objects to your exemption claim.41.35MOTION TO DETERMINE EXEMPTION:42.1At any time after your funds have been held, you may ask for a court decision on the 42.2validity of your exemption claim by filing a request for hearing which may be obtained 42.3at the office of the court administrator of the above court.42.4PENALTIES:42.5If you claim an exemption in bad faith, or if the creditor wrongly objects to an 42.6exemption in bad faith, the court may order the person who acted in bad faith to pay costs, 42.7actual damages, attorney fees, and an additional amount of up to $100.

42.8
                     							.....
                     						42.9
                     							.....
                     						42.10
                     							.....
                     						42.11
                     							.....
                     						42.1242.13Name and address of (Attorney for) Judgment Creditor

42.14EXEMPTION:42.15(If you claim an exemption complete the following):42.16(a) Amount of exemption claim.42.17/ / I claim ALL the funds being held are exempt.42.18/ / I claim SOME of the funds being held are exempt.

42.19The exempt amount is $............

42.20(b) Basis for exemption.42.21Of the eleven categories listed above, I am in category number ............ (If more 42.22than one category applies, you may fill in as many as apply.) The source of the exempt 42.23funds is the following:

42.24
                     							.....
                     						42.25
                     							.....
                     						42.26
                     							.....

42.27(If the source is a type of relief based on need, list the case number and county:42.28case number: ...............;42.29county: ....................)42.30I hereby authorize any agency that has distributed relief to me or any correctional 42.31institution in which I was an inmate to disclose to the above named creditor or its attorney 42.32only whether or not I am or have been a recipient of relief based on need or an inmate of a 42.33correctional institute within the last six months.42.34I have mailed or delivered a copy of the exemption notice to the creditor's attorney 42.35at the address indicated above.

43.143.2DATED: 
                     							.....
                     						
                     							.....
                     						DEBTOR43.343.4
                     							.....
                     						DEBTOR ADDRESS43.543.6
                     							.....
                     						DEBTOR TELEPHONE NUMBER

43.7    Sec. 9. Minnesota Statutes 2008, section 571.913, is amended to read:43.8571.913 EFFECT OF EXEMPTION NOTICE.43.9Within two business days after receipt of the garnishment summons and, the notice, 43.10instructions, and two copies of the exemption notices notice, the financial institution 43.11shall serve upon the debtor the notice, instructions, and two copies of the exemption 43.12notice. The financial institution shall serve the noticethese forms by first class mail to the 43.13last known address of the debtor. If no claim of exemption is received by the financial 43.14institution within 14 days after the exemption notices are mailed to the debtor, the funds 43.15remain subject to the garnishment summons. If the debtor elects to claim an exemption, 43.16the debtor shall complete the exemption notice notices, sign itthem under penalty of 43.17perjury, and deliver one copy to the financial institution and one copy to the attorney for 43.18the creditor within 14 days of the date postmarked on the correspondence mailed to the 43.19debtor containing the exemption notices. The debtor is also required to include copies of 43.20bank statements for the prior 60 days with the exemption notice delivered to the attorney 43.21for the creditor. In the event that there is no attorney for the creditor, then the notice and 43.22the bank statements must be sent directly to the creditor. Failure of the debtor to deliver 43.23the executed exemption notice or copies of the required bank statements for the prior 60 43.24days does not constitute a waiver of a claimed right to an exemption. Upon timely receipt 43.25of a claim of exemption, funds not claimed to be exempt by the debtor remain subject 43.26to the garnishment summons. All money claimed to be exempt shall be released to the 43.27debtor upon the expiration of seven six business days after the date postmarked on the 43.28envelope containing the executed exemption notice mailed to the financial institution, or 43.29the date of personal delivery of the executed exemption notice to the financial institution, 43.30unless within that time the creditor interposes an objection to the exemption.43.31    Sec. 10. Minnesota Statutes 2008, section 571.914, is amended to read:43.32571.914 OBJECTION TO EXEMPTION CLAIM.43.33    Subdivision 1. Objections and request for hearing. An objection shall be 43.34interposed, within six business days of receipt by the creditor of an exemption claim from 43.35the debtor, by mailing or delivering one copy of the written objectionNotice of Objection 44.1and Notice of Hearing to the financial institution and one copy of the written objection44.2Notice of Objection and Notice of Hearing to the debtor. A Request for Hearing and 44.3Notice of Hearing form must accompany each copy of the written objection.44.4Both copies of an objection to an exemption claim must be mailed or delivered on 44.5the same date. The financial institution may rely on the date of mailing or delivery of a 44.6notice to it in computing any time periods in this section.44.7The written objection, and Request for HearingNotice of Objection and Notice of 44.8Hearing,form must be substantially in the formsform set out in subdivisionssubdivision 44.92 and 3.44.10The court shall provide clerical assistance to help with the writing and filing of a 44.11Request for Hearing by any person not represented by counsel. The court administrator 44.12may charge a fee of $1 for the filing of a Request forNotice of Objection and Notice of 44.13Hearing. Upon the filing of a Request forNotice of Objection and Notice of Hearing, the 44.14court administrator shall schedule the matter for hearing no sooner than five business days 44.15but no later than fiveseven business days from the date of filing. The court administrator 44.16shall immediately send a completed copy of the request, including the hearing date, time, 44.17and place to the adverse party and to the financial institution by first class mail. A debtor 44.18may request continuance of the hearing by notifying the creditor and the court. The court 44.19shall schedule the continued hearing within seven days of the original hearing date.44.20An order stating whether the debtor's funds are exempt shall be issued by the court 44.21within three days of the date of the hearing.44.22    Subd. 2. Form of notice of objection and notice of hearing.(a) The written 44.23objection to the debtorWritten Objection and Notice of Hearing must be in substantially 44.24the following form:

44.25STATE OF MINNESOTADISTRICT COURT44.26COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT44.27
                     							.....
                     						 (Creditor)44.2844.29
                     							.....
                     						 (Debtor)CREDITOR'S NOTICE OF 
                  		OBJECTION44.3044.31
                     							.....
                     						 (Garnishee)TOAND NOTICE OF HEARING ON EXEMPTION CLAIM

44.32
                     							.....
                     						44.33
                     							.....
                     						44.34
                     							.....
                     						44.3544.36(CREDITOR OR CREDITOR'S ATTORNEY)44.37
                     							.....
                     						44.38NOTICE OF HEARING45.145.245.3The creditor objects to your exemption claim. This hearing is to resolve your exemption claim.45.4Hearing Date:
                     							.....
                     						45.5Time:
                     							.....
                     						45.6Hearing Place:
                     							.....

45.7The creditor objects to your claim forof exemption from garnishment, levy of 45.8execution, order for attachment (strike inapplicable language) for the following reason(s):

45.9
                     							.....
                     						45.10
                     							.....
                     						45.11
                     							.....

45.12(Note: Bring with you to the hearing all documents and materials supporting 45.13your exemption claim. Failure to do so could delay the court's decision.)45.14If the creditor receives all documents and materials supporting your exemption 45.15claim before the hearing date, the creditor may agree with your claim and you can avoid 45.16a hearing.45.17Because of this objection,a court hearing will be held on your claim that your funds 45.18are protected, your financial institution will retain the funds you claimed to be exempt 45.19for an additional ten days. If you wish to request a hearing on your exemption claim, 45.20you need to do so within ten days from the date the objection was personally served on 45.21you, or within 13 days of the date the objection was mailed to you. You may request a 45.22hearing by completing the attached form and filing it with the court administrator until it 45.23receives an order from the court.45.241. The court shall provide clerical assistance to help with the writing and filing of a 45.25Request for Hearing by any person not represented by counsel. The court administrator 45.26may charge a fee of $1 for the filing of a Request for Hearing.45.272. Upon the filing of a Request for Hearing, the clerk shall schedule the matter for a 45.28hearing no later than five business days from the date of filing. The court administrator 45.29shall forthwith send a completed copy of the request, including the hearing date, time, and 45.30place to the adverse party and to the financial institution by first class mail.45.313. If it is possible that the financial institution might not receive the request mailed 45.32from the court administrator within ten days, then you may want to personally deliver a 45.33copy of the request to the financial institution after you have filed your request with the 45.34court.45.354. An order stating whether your funds are exempt shall be issued by the court 45.36within three days of the date of the hearing.46.1If you do not file a Request for Hearing within ten days of the date the objection was 46.2personally served on you, or within 13 days from the date the objection was mailed to you, 46.3your financial institution may turn your funds over to your creditor.46.4If you file a Request for Hearing and your financial institution receives it within ten 46.5days of the date it received this objection, your financial institution will retain your funds 46.6claimed to be exempt until otherwise ordered by the court, or until the garnishment lapses 46.7pursuant to Minnesota Statutes, section 571.79.

46.8
                     							.....
                     						46.9(CREDITOR OR CREDITOR'S ATTORNEY.)

46.10    Subd. 3.Request for hearing and notice for hearing.The request for hearing 46.11accompanying the objection notice must be in substantially the following form:

46.12STATE OF MINNESOTADISTRICT COURT46.13COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT46.14
                     							.....
                     						 (Creditor)46.1546.16
                     							.....
                     						 (Debtor)REQUEST FOR HEARING AND NOTICE FOR HEARING46.17
                     							.....
                     						 (Garnishee)

46.18I hereby request a hearing to resolve the exemption claim which has been made in 46.19this case regarding funds in the account of ............. (Debtor) at the ......... (Financial 46.20Institution).46.21    I believe the property being held is exempt because

46.22
                     							.....
                     						46.23
                     							.....
                     						46.24Dated: 
                     							.....
                     						46.2546.26(DEBTOR)
                     							.....
                     						46.2746.28(ADDRESS)
                     							.....

46.29HEARING DATE: 
                     							.....
                     						TIME: 
                     							.....
                     						46.30HEARING PLACE: 
                     							.....

46.31(Note to both parties: Bring with you to the hearing all documents and materials 46.32relevant to the exemption claim. Failure to do so could delay the court's decision.)46.33    Subd. 4. Duties of financial institution if objection is made to exemption claim.46.34Upon receipt of a written objectionNotice of Objection and Notice of Hearing from the 46.35creditor within the specified seven-day period, the financial institution shall retain the 46.36funds claimed to be exempt. Unless the financial institution receives a request for hearing 46.37from the debtor asserting exemption rights within ten days after receipt of the written 46.38objection to the exemption, the funds remain subject to the garnishment summons as if 47.1no claim of exemption had been made. If a notice of motion and motion to determine 47.2the validity of a claim of exemption is received by the financial institution within the 47.3period provided, The financial institution shall retain the funds claimed to be exempt 47.4until otherwise ordered by the court, upon mutual agreement of the parties, or until the 47.5garnishment lapses pursuant to section 
         571.79.47.6    Sec. 11. Minnesota Statutes 2008, section 571.925, is amended to read:47.7571.925 FORM OF NOTICE.47.8The ten-day notice informing a debtor that a garnishment summons may be used to 47.9garnish the earnings of an individual must be substantially in the following form:

47.10STATE OF MINNESOTADISTRICT COURT47.11COUNTY OF 
                     							.....
                     						
                     							.....
                     						JUDICIAL DISTRICT47.1247.13
                     							.....
                     						 (Creditor)
                  		against47.14GARNISHMENT EXEMPTION47.15
                     							.....
                     						 (Debtor)NOTICE AND NOTICE OF47.16andINTENT TO GARNISH EARNINGS47.17
                     							.....
                     						 (Garnishee)

47.18PLEASE TAKE NOTICE that a garnishment summons or levy may be served upon 47.19your employer or other third parties, without any further court proceedings or notice to 47.20you, ten days or more from the date hereof. Some or all of your earnings are exempt 47.21from garnishment. If your earnings are garnished, your employer must show you how 47.22the amount that is garnished from your earnings was calculated. You have the right to 47.23request a hearing if you claim the garnishment is incorrect.47.24Your earnings are completely exempt from garnishment if you are now a recipient of 47.25relief assistance based on need, if you have been a recipient of reliefassistance based on 47.26need within the last six months, or if you have been an inmate of a correctional institution 47.27in the last six months.47.28Relief based on need includes the Minnesota Family Investment Program (MFIP), 47.29Emergency Assistance (EA), Work First Program, Medical Assistance (MA), General 47.30Assistance (GA), General Assistance Medical Care (GAMC), Emergency General 47.31Assistance (EGA), Minnesota Supplemental Aid (MSA), MSA Emergency Assistance 47.32(MSA-EA), Supplemental Security Income (SSI), and Energy Assistance.47.33Assistance based on need includes, but is not limited to:

47.34MFIP - Minnesota family investment program,47.35MFIP Diversionary Work Program,47.36Work participation cash benefit,48.1GA - general assistance,48.2EA - emergency assistance,48.3MA - medical assistance,48.4GAMC - general assistance medical care,48.5EGA - emergency general assistance,48.6MSA - Minnesota supplemental aid,48.7MSA-EA - MSA emergency assistance,48.8Food Support,48.9SSI - Supplemental Security Income,48.10MinnesotaCare,48.11Medicare part B premium payments,48.12Medicare part D extra help,48.13Energy or fuel assistance.

48.14If you wish to claim an exemption, you should fill out the appropriate form below, 48.15sign it, and send it to the creditor's attorney and the garnishee.48.16You may wish to contact the attorney for the creditor in order to arrange for a 48.17settlement of the debt or contact an attorney to advise you about exemptions or other rights.48.18PENALTIES48.19(1) Be advised that even if you claim an exemption, a garnishment summons may 48.20still be served on your employer. If your earnings are garnished after you claim an 48.21exemption, you may petition the court for a determination of your exemption. If the 48.22court finds that the creditor disregarded your claim of exemption in bad faith, you 48.23will be entitled to costs, reasonable attorney fees, actual damages, and an amount 48.24not to exceed $100.48.25(2) HOWEVER, BE WARNED if you claim an exemption, the creditor can also 48.26petition the court for a determination of your exemption, and if the court finds that 48.27you claimed an exemption in bad faith, you will be assessed costs and reasonable 48.28attorney's fees plus an amount not to exceed $100.48.29(3) If after receipt of this notice, you in bad faith take action to frustrate the 48.30garnishment, thus requiring the creditor to petition the court to resolve the problem, 48.31you will be liable to the creditor for costs and reasonable attorney's fees plus an 48.32amount not to exceed $100.

48.3348.34Dated: 
                     							.....
                     						
                     							.....
                     						
                  		(Attorney for) Creditor48.3548.36
                     							.....
                     						
                  		Address48.3748.38
                     							.....
                     						
                  		Telephone

48.39DEBTOR'S EXEMPTION CLAIM NOTICE49.1I hereby claim that my earnings are exempt from garnishment because:49.2(1) I am presently a recipient of relief based on need. (Specify the program, case 49.3number, and the county from which relief is being received.)

49.449.549.6
                     							.....
                     						
                  		Program
                     							.....
                     						
                  		Case Number (if 
                  		known)
                     							.....
                     						
                  		County

49.7(2) I am not now receiving relief based on need, but I have received relief based on 49.8need within the last six months. (Specify the program, case number, and the county 49.9from which relief has been received.)

49.1049.1149.12
                     							.....
                     						
                  		Program
                     							.....
                     						
                  		Case Number (if 
                  		known)
                     							.....
                     						
                  		County

49.13(3) I have been an inmate of a correctional institution within the last six months. 49.14(Specify the correctional institution and location.)

49.1549.16
                     							.....
                     						
                  		Correctional Institution
                     							.....
                     						
                  		Location

49.17I hereby authorize any agency that has distributed relief to me or any correctional 49.18institution in which I was an inmate to disclose to the above-named creditor or the 49.19creditor's attorney only whether or not I am or have been a recipient of relief based on 49.20need or an inmate of a correctional institution within the last six months. I have mailed or 49.21delivered a copy of this form to the creditor or creditor's attorney.

49.2249.23
                     							.....
                     						
                  		Date
                     							.....
                     						
                  		Debtor49.2449.25
                     							.....
                     						
                  		Address49.2649.27
                     							.....
                     						
                  		Debtor Telephone Number

49.28STATE OF MINNESOTADISTRICT COURT49.29COUNTY OF 
                     							.....
                     						
                     							.....
                     						 JUDICIAL DISTRICT49.30
                     							.....
                     						(Creditor)49.31
                     							.....
                     						(Debtor)49.3249.33
                     							.....
                     						(Financial institution)