1.1 	A bill for an act
1.2 	relating to commerce; modifying various statutory forms pertaining to garnishment; 
1.3 	amending Minnesota Statutes 2024, sections 550.136, subdivisions 6, 9; 550.143, 
1.4 	subdivisions 2, 3a, 3b, 3c; 551.05, subdivisions 1b, 1c, 1d; 551.06, subdivisions 
1.5 	6, 9; 571.72, subdivisions 8, 10; 571.74; 571.75, subdivision 2; 571.912; 571.914, 
1.6 	subdivision 2; 571.925; 571.931, subdivision 6; 571.932, subdivision 2.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. Minnesota Statutes 2024, section 550.136, subdivision 6, is amended to read:
1.9 		Subd. 6.Earnings exemption notice. Before the first levy on earnings under this chapter, 
1.10 	the judgment creditor shall serve upon the judgment debtor no less than ten days before the 
1.11 	service of the writ of execution, a notice that the writ of execution may be served on the 
1.12 	judgment debtor's employer. The notice must: (1) be substantially in the form set forth 
1.13 	below; (2) be served personally, in the manner of a summons and complaint, or by first 
1.14 	class mail to the last known address of the judgment debtor; (3) inform the judgment debtor 
1.15 	that an execution levy may be served on the judgment debtor's employer in ten days, and 
1.16 	that the judgment debtor may, within that time, cause to be served on the judgment creditor 
1.17 	a signed statement under penalties of perjury asserting an entitlement to an exemption from 
1.18 	execution; (4) inform the judgment debtor of the earnings exemptions contained in section 
1.19 	550.37, subdivision 14; and (5) advise the judgment debtor of the relief set forth in this 
1.20 	chapter to which the debtor may be entitled if a judgment creditor in bad faith disregards a 
1.21 	valid claim and the fee, costs, and penalty that may be assessed against a judgment debtor 
1.22 	who in bad faith falsely claims an exemption or in bad faith takes action to frustrate the 
1.23 	execution process. The notice requirement of this subdivision does not apply to a levy on 
2.1 	earnings being retained by an employer pursuant to a garnishment previously served in 
2.2 	compliance with chapter 571.
2.3 	The ten-day notice informing a judgment debtor that a writ of execution may be used 
2.4 	to levy the earnings of an individual must be substantially in the following form:

2.5	STATE OF MINNESOTA
		DISTRICT COURT
	
2.6	COUNTY OF ........
		........ JUDICIAL DISTRICT
	
2.7	........ (Judgment Creditor)
			
2.8	against
		EXECUTION EXEMPTION
	
2.9	........ (Judgment Debtor)
		NOTICE AND NOTICE OF INTENT TO
	
2.10	and
		LEVY ON EARNINGS
	
2.11	........ (Third Party)

2.12	State of Minnesota
		District Court
	
2.13	County of: ........
		Judicial District: ........
	
2.14			Court File Number: ........
	
2.15			Case Type: ........
	
2.16	Creditor's full name
			
2.17	........
		Execution Exemption
	
2.18	against
		Notice and Notice of
	
2.19	Debtor's full name
		Intent to Levy on Earnings
	
2.20	........
			
2.21	and
			
2.22	Third Party (bank, employer, or other)
			
2.23	........
			
2.24 	PLEASE TAKE NOTICE that a levy may be served upon your employer or other third 
2.25 	parties, without any further court proceedings or notice to you, ten days or more from the 
2.26 	date hereof. Your earnings are completely exempt from execution levy if you are now a 
2.27 	recipient of relief based on need, if you have been a recipient of relief within the last six 
2.28 	months, or if you have been an inmate of a correctional institution in the last six months.
2.29 	Relief based on need includes Minnesota Family Investment Program (MFIP), Emergency 
2.30 	Assistance (EA), Work First, Medical Assistance (MA), General Assistance (GA), Emergency 
2.31 	General Assistance (EGA), Minnesota Supplemental Aid (MSA), MSA Emergency 
2.32 	Assistance (MSA-EA), Supplemental Security Income (SSI), and Energy Assistance.
2.33 	If you wish to claim an exemption, you should fill out the appropriate form below, sign 
2.34 	it, and send it to the judgment creditor's attorney.
3.1 	You may wish to contact the attorney for the judgment creditor in order to arrange for 
3.2 	a settlement of the debt or contact an attorney to advise you about exemptions or other 
3.3 	rights.
3.4 	Notice: A levy may be served on your employer or other third parties. A levy means 
3.5 	that part of your earnings can be taken to pay off debts that you owe. This can happen 
3.6 	in 10 days or more after you get this notice. This can happen without any other court action 
3.7 	or notice to you. But some of your money may be protected.
3.8 	Your earnings cannot be taken if:
3.9 	(i) you are getting government assistance based on need,
3.10 	(ii) you got any government assistance based on need in the last 6 months, or
3.11 	(iii) you were an inmate of a correctional institution in the last 6 months.
3.12 	These are called exemptions. Your money is NOT protected unless you fill out the 
3.13 	Exemption Claim Notice attached and send it back to the creditor or the creditor's 
3.14 	lawyer. If you are not sure if you have any exemptions, talk to a lawyer.
3.15 	You can also contact the creditor or their lawyer to talk about a settlement of the debt.
3.16 	Examples of government assistance based on need:
3.17 	(i) MFIP - Minnesota Family Investment Program
3.18 	(ii) DWP - MFIP Diversionary Work Program
3.19 	(iii) SNAP - Supplemental Nutrition Assistance Program
3.20 	(iv) GA - General Assistance
3.21 	(v) EGA - Emergency General Assistance
3.22 	(vi) MSA - Minnesota Supplemental Aid
3.23 	(vii) MSA-EA - MSA Emergency Assistance
3.24 	(viii) EA - Emergency Assistance
3.25 	(ix) Energy or Fuel Assistance
3.26 	(x) Work Participation Cash Benefit
3.27 	(xi) MA - Medical Assistance
3.28 	(xii) MinnesotaCare
3.29 	(xiii) Medicare Part B - Premium Payments help
4.1 	(xiv) Medicare Part D - Extra
4.2 	(xv) SSI - Supplemental Security Income
4.3 	(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), MN Working family 
4.4 	credit
4.5 	(xvii) Renter's Refund (also called Renter's Property Tax Credit)
4.6 	PENALTIES
4.7 	Warnings and Fines
4.8 	(1) Be advised that Even if you claim an exemption, an execution a levy may still be 
4.9 	served on your employer. If your earnings are levied on they take money from you after 
4.10 	you claim an exemption, you may petition ask the court for a determination of to review
4.11 	your exemption. If the court finds that the judgment creditor disregarded ignored your 
4.12 	claim of exemption in bad faith, you will be are entitled to costs, reasonable attorney
4.13 	lawyer fees, actual damages, and an amount not a fine up to exceed $100. Bad faith is 
4.14 	when someone does something wrong on purpose.
4.15 	(2) HOWEVER, BE WARNED BUT if you claim an exemption, the judgment creditor 
4.16 	can also petition ask the court for a determination of to review your exemption, and. If 
4.17 	the court finds that you claimed an exemption in bad faith, you will be assessed are 
4.18 	charged costs and reasonable attorney's lawyer fees plus an amount not and a fine up to 
4.19 	exceed $100.
4.20 	(3) If after receipt of this notice, you in bad faith take action to frustrate the execution 
4.21 	levy, thus requiring the judgment creditor to petition the court to resolve the problem, 
4.22 	you will be liable to the judgment creditor for costs and reasonable attorney's fees plus 
4.23 	an amount not to exceed $100.
4.24 	(3) If you get this notice, then do something in bad faith to try to block or stop the levy 
4.25 	and the creditor has to take you to court because of it, you will have to pay the creditor's 
4.26 	costs, and reasonable lawyer fees, and a fine up to $100.

4.27	DATED: ........
		........
	
4.28			(Attorney for Judgment Creditor)
	
4.29			........
	
4.30			Address
	
4.31			........
	
4.32			Telephone

5.1	Date: ........
		
5.2	Creditor's Signature: ........
		
5.3	(or creditor's lawyer's signature)

5.4	Creditor's Name: ........
		
5.5	(or creditor's lawyer's name)

5.6	Street Address: ........
		
5.7	City/State/Zip: ........
		
5.8	Phone: ........
	Fax: ........
		
5.9	Email: ........
		
5.10 	JUDGMENTDebtor's Exemption Claim Notice
5.11 	I hereby claim that my earnings are exempt from execution because: (check all that 
5.12 	apply)
5.13 	(1) ... I am presently a recipient of relief getting government assistance based on need. 
5.14 	(Specify State the program, case number if you know it, and the county from which 
5.15 	relief is being received you got it from.)

5.16	........
	........
	........
	
5.17	Program
	Case Number (if known)
	County

5.18	Program: ........
	Case #: ........
	County: ........
	
5.19	Program: ........
	Case #: ........
	County: ........
	
5.20	Program: ........
	Case #: ........
	County: ........
	
5.21 	(2) ... I am not now receiving relief getting assistance based on need right now, but I 
5.22 	have received relief did get government assistance based on need within the last six 6
5.23 	months. (Specify State the program, case number if you know it, and the county you got 
5.24 	it from which relief has been received.)

5.25	........
	........
	........
	
5.26	Program
	Case Number (if known)
	County

5.27	Program: ........
	Case #: ........
	County: ........
	
5.28	Program: ........
	Case #: ........
	County: ........
	
5.29	Program: ........
	Case #: ........
	County: ........
	
5.30 	(3) ... I have been was an inmate of a correctional institution within the last six 6 months. 
5.31 	(Specify State the correctional institution and location.)

5.32	........
	........
	
5.33	Correctional Institution........
	Location........
	
6.1 	I hereby authorize any agency that has distributed relief to me or any correctional 
6.2 	institution in which I was an inmate to disclose to the above-named judgment creditor or 
6.3 	the judgment creditor's attorney only whether or not I am or have been a recipient of relief 
6.4 	based on need or an inmate of a correctional institution within the last six months. I have 
6.5 	mailed or delivered a copy of this form to the judgment creditor or judgment creditor's 
6.6 	attorney.

6.7	........
	........
	
6.8		Debtor
	
6.9		........
	
6.10		Address
	
6.11		........
	
6.12		Debtor Telephone Number
	
6.13 	I give my permission to any agency listed above to give information about my benefits 
6.14 	to the creditor named above, or to the creditor's lawyer. The information will ONLY be if 
6.15 	I get assistance, or if I have gotten assistance in the past 6 months. If I was an inmate in the 
6.16 	last 6 months, I give my permission to the correctional institution to tell the creditor named 
6.17 	above or the creditor's lawyer that I was an inmate there.

6.18	Date: ........
		
6.19	Debtor's Signature: ........
		
6.20	Debtor's Name: ........
		
6.21	Street Address: ........
		
6.22	City/State/Zip: ........
		
6.23	Phone: ........
		
6.24	Email: ........

6.25 	Sec. 2. Minnesota Statutes 2024, section 550.136, subdivision 9, is amended to read:
6.26 		Subd. 9.Execution earnings disclosure form and worksheet. The judgment creditor 
6.27 	shall provide to the sheriff for service upon the judgment debtor's employer an execution 
6.28 	earnings disclosure form and an earnings disclosure worksheet with the writ of execution, 
6.29 	that must be substantially in the form set forth below.

6.30	STATE OF MINNESOTA
			DISTRICT COURT
	
6.31	COUNTY OF ........
			........ JUDICIAL DISTRICT
	
6.32						FILE NO. ........
	
6.33	........
	(Judgment Creditor)
				
6.34	against
					EARNINGS
	
7.1	........
	(Judgment Debtor)
			EXECUTION
	
7.2	and
					DISCLOSURE
	
7.3	........
	(Third Party)

7.4	State of Minnesota
		District Court
	
7.5	County of: ........
		Judicial District: ........
	
7.6			Court File Number: ........
	
7.7			Case Type: ........
	
7.8	Creditor's full name
			
7.9	........
		Earnings Execution Disclosure
	
7.10	and
		For Non-Child Support Judgments
	
7.11	Debtor's full name
			
7.12	........
			
7.13	Third Party (bank, employer, or other)
			
7.14	........
			
7.15 	This form is called an "Earnings Execution Disclosure" or "Disclosure." It is for the 
7.16 	employer to fill out. The "debtor" is the person who owes money. The debtor gets a copy 
7.17 	of this form for their own information.
7.18 	The employer is also called the "third party garnishee" or "third party." The debtor is 
7.19 	also called a "judgment debtor." If the debtor asks how the calculations in this document 
7.20 	were made, the employer must provide information about it.
7.21 	"EARNINGS": For the purpose of execution, "earnings" means compensation paid or 
7.22 	payable to an employee for personal services or compensation paid or payable to the producer 
7.23 	for the sale of agricultural products; milk or milk products; or fruit or other horticultural 
7.24 	products produced when the producer is operating a family farm, a family farm corporation, 
7.25 	or an authorized farm corporation, as defined in section 500.24, subdivision 2, whether 
7.26 	denominated as wages, salary, commission, bonus, or otherwise, and includes periodic 
7.27 	payments pursuant to a pension or retirement.
7.28 	"DISPOSABLE EARNINGS": Means that part of the earnings of an individual remaining 
7.29 	after the deduction from those earnings of amounts required by law to be withheld. (Amounts 
7.30 	required by law to be withheld do not include items such as health insurance, charitable 
7.31 	contributions, or other voluntary wage deductions.)
7.32 	DEFINITIONS
7.33 	"Earnings": what is paid or payable to an employee, independent contractor, or 
7.34 	self-employed person for personal services (a job). Also called compensation. Compensation 
8.1 	can be wages, salary, commission, bonuses, payments, profit-sharing distributions, severance 
8.2 	payment, fees, or other. It includes periodic payments from a pension or retirement. It can 
8.3 	also be compensation paid or payable to a producer for the sale of agricultural products. 
8.4 	This can be things like milk or milk products, or fruit or other horticultural products. Or 
8.5 	things produced in the operation of a family farm, a family farm corporation, or an authorized 
8.6 	farm corporation. This is defined in Minnesota Statutes, section 500.24, subdivision 2.
8.7 	"Disposable Earnings": the part of a person's earnings that are left after subtracting 
8.8 	the amounts required by law to be withheld. Note: Amounts required by law to be withheld 
8.9 	do not include things like health insurance, charitable contributions, or other voluntary wage 
8.10 	deductions.
8.11 	"Payday":For the purpose of execution, "payday(s)" means the date(s) upon which
8.12 	the date when the employer pays earnings to the debtor in the ordinary course of business
8.13 	for doing their job. If the judgment debtor has no regular payday, payday(s) then "payday"
8.14 	means the 15th and the last day of each month.
8.15 	The Third Party/Employer Must Answer The Following Questions:
8.16 	(1) Right now, do you now owe, or within 90 days from the date the execution levy was 
8.17 	served on you, will you or may you owe money to the judgment debtor for earnings?

8.18	Yes .....
	No .....
		
8.19 	(2) Does the judgment debtor earn more than $... per week? (this amount is the greater 
8.20 	of $9.50 per hour or the federal minimum wage per week)
8.21 	(2) Within 90 days from the date you were served with the levy, will you or may you 
8.22 	owe money to the debtor for earnings?

8.23	Yes .....
	No .....
		
8.24 	(3) Does the debtor earn more than the current Minnesota or federal minimum wage per 
8.25 	week? (use the number that is more)

8.26	Yes .....
	No .....
		
8.27 	A. If you  answer "No" to question 1, 2, or 3, you don't need to answer the rest of the 
8.28 	questions. You don't have to do the Earnings Disclosure Worksheet. Sign the Earnings 
8.29 	Disclosure Affirmation below and return this disclosure form to the sheriff. You must return 
8.30 	it within 20 days after it was served on you.
9.1 	B. If you answer "Yes" to question 1 or 2, and "Yes" to question 3, sign the Earnings 
9.2 	Disclosure Affirmation below. You must return it to the sheriff within 20 days. You must 
9.3 	also fill out the rest of this form. Read the instructions for the Earnings Disclosure Worksheet.
9.4 	Earnings Disclosure Affirmation
9.5 	I, ................... (person signing Affirmation), am the third party/employer or I am 
9.6 	authorized by the third party/employer to complete this earnings disclosure and have done 
9.7 	so truthfully and to the best of my knowledge.

9.8	Date: ........
		
9.9	Third Party's Name: ........
		
9.10	Third Party's Signature: ........
		
9.11	Phone: ........
	Fax: ........
		
9.12	Email: ........
		
9.13 	Instructions for Completing the Earnings Disclosure Worksheet
9.14 	A. If your answer to either question 1 or 2 is "No," then you must sign the affirmation 
9.15 	below and return this disclosure to the sheriff within 20 days after it was served on you, 
9.16 	and you do not need to answer the remaining questions.
9.17 	B. If your answers to both questions 1 and 2 are "Yes," you must complete this form 
9.18 	and the Earnings Disclosure Worksheet as follows:
9.19 	For each payday that falls within 90 days from the date the execution levy was served 
9.20 	on you, you must calculate the amount of earnings to be retained by completing steps 
9.21 	3 through 11 on page 2, and enter the amounts on the Earnings Disclosure Worksheet. 
9.22 	UPON REQUEST, THE EMPLOYER MUST PROVIDE THE DEBTOR WITH 
9.23 	INFORMATION AS TO HOW THE CALCULATIONS REQUIRED BY THIS 
9.24 	DISCLOSURE WERE MADE withheld. Enter the amounts on the Earnings Disclosure 
9.25 	Worksheet.
9.26 	You must:
9.27 	(1) Withhold the amount of earnings listed in Column I on the Earnings Disclosure 
9.28 	Worksheet each payday.
9.29 	(2) After 90 days, return this Earnings Disclosure Worksheet to the sheriff. Include all 
9.30 	the money withheld. Sign the Affirmation at the end of the worksheet before returning.
9.31 	(3) Deliver a copy of the disclosure and worksheet to the debtor within 10 days after the 
9.32 	last payday that falls within the 90-day period.
10.1 	If the debt (judgment) is fully paid off or if the debtor's job ends before the 90-day period 
10.2 	is over, you need to do the last disclosure and withholdings within 10 days of their last 
10.3 	payday that you withheld money.
10.4 	Each payday, you must retain the amount of earnings listed in column I on the Earnings 
10.5 	Disclosure Worksheet.
10.6 	You must pay the attached earnings and return this earnings disclosure form and the 
10.7 	Earnings Disclosure Worksheet to the sheriff and deliver a copy of the disclosure and 
10.8 	worksheet to the judgment debtor within ten days after the last payday that falls within 
10.9 	the 90-day period. If the judgment is wholly satisfied or if the judgment debtor's 
10.10 	employment ends before the expiration of the 90-day period, your disclosure and 
10.11 	remittance should be made within ten days after the last payday for which earnings were 
10.12 	attached.
10.13 	For steps 3 through 11, "columns" refers to columns on the Earnings Disclosure 
10.14 	Worksheet.

10.15	(3)
	COLUMN A.
		Enter the date of judgment debtor's payday.
	
10.16	(4)
	COLUMN B.
		Enter judgment debtor's gross earnings for each payday.
	
10.1710.18	(5)
	COLUMN C.
		Enter judgment debtor's disposable earnings for each 
payday.
	
10.1910.20	(6)
	COLUMN D.
		Enter 25 percent of disposable earnings. (Multiply 
column C by .25.)
	
10.2110.22
10.23
10.24
10.25
10.26
10.27
10.28	(7)
	COLUMN E.
		Enter here the greater of 40 times $9.50 or 40 times the 
hourly federal minimum wage ($..........) times the 
number of work weeks included in each payday. (Note: 
If a payday includes days in excess of whole work 
weeks, the additional days should be counted as a 
fraction of a work week equal to the number of 
workdays in excess of a whole work week divided by 
the number of workdays in a normal work week.)
	
10.2910.30	(8)
	COLUMN F.
		Subtract the amount in column E from the amount in 
column C, and enter here.
	
10.3110.32	(9)
	COLUMN G.
		Enter here the lesser of the amount in column D and the 
amount in column F.
	
10.3310.34
10.35
10.36
10.37
10.38
10.39
10.40
10.41
10.42
10.43	(10)
	COLUMN H.
		Enter here any amount claimed by you as a setoff, 
defense, lien, or claim, or any amount claimed by any 
other person as an exemption or adverse interest which 
would reduce the amount of earnings owing to the 
judgment debtor. (Note: Any indebtedness to you 
incurred within ten days prior to your receipt of the first 
execution levy on a debt may not be set off against the 
earnings otherwise subject to this levy. Any wage 
assignment made by the judgment debtor within ten 
days prior to your receipt of the first execution levy on 
a debt is void.)
	
11.1
11.2
11.3
11.4				You must also describe your claim(s) and the claims of 
others, if known, in the space provided below the 
worksheet and state the name(s) and address(es) of these 
persons.
	
11.5
11.6
11.7				Enter zero in column H if there are no claims by you or 
others which would reduce the amount of earnings 
owing to the judgment debtor.
	
11.811.911.10
11.11
	(11)
	COLUMN I.
		Subtract the amount in column H from the amount in 
column G and enter here. This is the amount of earnings 
that you must remit for the payday for which the 
calculations were made.
	
11.12 	AFFIRMATION
11.13 	I, ................... (person signing Affirmation), am the third party/employer or I am 
11.14 	authorized by the third party/employer to complete this earnings disclosure, and have done 
11.15 	so truthfully and to the best of my knowledge.

11.16	DATED: ........
		........
	
11.17			Signature
	
11.18			........
	
11.19			Title
	
11.20			........
	
11.21			Telephone Number
	
11.22	EARNINGS DISCLOSURE WORKSHEET
		........
	
11.23			Debtor's Name
	
11.24 	Calculating Percentage of Disposable Earnings
11.25 	Note to Creditor: You must fill out this chart before sending this form to the employer. 
11.26 	Use the current minimum wage found online at: https://www.dli.mn.gov/minwage.
11.27 	Minimum Wage = $MW/hour.

11.2911.28
		if the weekly gross earnings are:
	then this percentage of the disposable 
earnings are withheld:
		
11.30		Less than [40 X MW]
	0%
		
11.31		[40 X MW + .01] to [60 X MW]
	10%
		
11.32		[60 X MW + .01] to [80 X MW]
	15%
		
11.33		[80 x MW + .01] or more
	25%
		
11.34 	Employer: Use this creditor's calculation chart to know what percentage of earnings 
11.35 	should be withheld.
11.36 	Earnings Disclosure Worksheet

12.1	........
		
12.2	Debtor's name

12.412.3
	A - Payday Date
		B - Gross 
Earnings
		C - Disposable 
Earnings

12.5	1.
	........
		$........
		$........
	
12.6	2.
	........
		........
		........
	
12.7	3.
	........
		........
		........
	
12.8	4.
	........
		........
		........
	
12.9	5.
	........
		........
		........
	
12.10	6.
	........
		........
		........
	
12.11	7.
	........
		........
		........
	
12.12	8.
	........
		........
		........
	
12.13	9.
	........
		........
		........
	
12.14	10.
	........
		........
		........
	
12.15 	Column A. Enter the debtor's payday.
12.16 	Column B. Enter the debtor's gross earnings for each payday.
12.17 	Column C. Enter the debtor's disposable earnings for each payday.

12.18
12.19
12.20
12.21	D 25 - % of 
withholding of 
Column C (Use the 
creditor's calculation)
		E - Greater of 40 
X $9.50 or 40 X
MN or Fed. 
Min. Wage
		F - Column C 
minus Column E

12.22	1.
	........
		........
		........
	
12.23	2.
	........
		........
		........
	
12.24	3.
	........
		........
		........
	
12.25	4.
	........
		........
		........
	
12.26	5.
	........
		........
		........
	
12.27	6.
	........
		........
		........
	
12.28	7.
	........
		........
		........
	
12.29	8.
	........
		........
		........
	
12.30	9.
	........
		........
		........
	
12.31	10.
	........
		........
		........
	
12.32 	Column D. Enter the percentage of disposable earnings that will be withheld. Get this 
12.33 	number from the creditor's calculation chart.
12.34 	Column E. Calculate 40 times the current MN minimum wage (or 40 times the current 
12.35 	federal minimum wage) times the number of work weeks in each payday. Enter the bigger 
12.36 	number here. Note: If a payday has extra days that are more than a full work week, count 
13.1 	those extra days as part of a work week. Do this by dividing the number of extra workdays 
13.2 	by the number of workdays in a normal week.
13.3 	Column F. Subtract the amount in Column E from the amount in Column C and enter 
13.4 	here.

13.6
13.7
13.813.5
	G - Lesser of 
Column D and 
Column F
		H - Setoff, Lien, 
Adverse 
Interest, or 
Other Claims
		I - Column G 
minus Column 
H

13.9	1.
	........
		........
		........
	
13.10	2.
	........
		........
		........
	
13.11	3.
	........
		........
		........
	
13.12	4.
	........
		........
		........
	
13.13	5.
	........
		........
		........
	
13.14	6.
	........
		........
		........
	
13.15	7.
	........
		........
		........
	
13.16	8.
	........
		........
		........
	
13.17	9.
	........
		........
		........
	
13.18	10.
	........
		........
		........
	
13.19				TOTAL OF COLUMN I
	$ ........
	
13.20 	Column G. Look at Column D and Column F. Enter the smaller amount of the two here 
13.21 	in Column G.
13.22 	Column H. Enter any amount claimed by you that would lower the amount of earnings 
13.23 	that will go to the debtor. Things like:
13.24 	(i) a setoff,
13.25 	(ii) a defense,
13.26 	(iii) a lien,
13.27 	(iv) a claim, or
13.28 	(v) any amount claimed by any other person as an exemption or adverse interest.
13.29 	Note: You must describe your claim(s) and the claims of others, if known, in the spaces 
13.30 	after this worksheet.
13.31 	Enter zero in Column H if there are no claims by you or others which would lower the 
13.32 	amount of earnings owed to the debtor.
14.1 	Note: Any debt that happened within 10 days before you got the first levy on a debt 
14.2 	may not be set off against the earnings that are affected by this levy. Any wage assignment 
14.3 	made by the debtor within 10 days before you got the first levy on a debt is void. Wage 
14.4 	assignment is when a debtor voluntarily agrees to money being taken out of their earnings.
14.5 	Column I. Subtract the amount in Column H from the amount in Column G and enter 
14.6 	here. This is the amount of earnings that go to the creditor.
14.7 	*If you entered any amount in Column H for any payday(s) payday, you must describe 
14.8 	those claims below either your claims, or the claims of others. It doesn't matter if they are 
14.9 	your claims, or the claims of others. For amounts claimed claims by others, you must both 
14.10 	state list the names and addresses of such persons each, and the nature of describe their 
14.11 	claim claims, if known you know.
14.12 	........
14.13 	........
14.14 	........
14.15 	........
14.16 	Earnings Worksheet Affirmation
14.17 	I, ................. (person signing Affirmation), am the third party party/employer or I am 
14.18 	authorized by the third party party/employer to complete this earnings disclosure worksheet,
14.19 	and have done so truthfully and to the best of my knowledge.

14.20			........
	
14.21			Signature
	
14.22	Dated: ........
	........
	(...) ........
	
14.23		Title
	Phone Number

14.24	Date: ........
		
14.25	Third Party's Name: ........
		
14.26	Third Party's Signature: ........
		
14.27	Phone: ........
	Fax: ........
		
14.28	Email: ........

14.29 	Sec. 3. Minnesota Statutes 2024, section 550.143, subdivision 2, is amended to read:
14.30 		Subd. 2.Disclosure form. Along with the writ of execution, the notice, instructions, 
14.31 	and the exemption notice described in subdivision 3, the sheriff shall serve upon the financial 
14.32 	institution an execution disclosure form which must be substantially in the following form:

15.1	STATE OF MINNESOTA
		DISTRICT COURT
	
15.2	COUNTY OF ........
		........JUDICIAL DISTRICT
	
15.3	........(Judgment Creditor)
			
15.4	against
		FINANCIAL INSTITUTIONS
	
15.5	........(Judgment Debtor)
		EXECUTION
	
15.6	and
		DISCLOSURE
	
15.7	........(Third Party)

15.8	State of Minnesota
		District Court
	
15.9	County of: ........
		Judicial District: ........
	
15.10			Court File Number: ........
	
15.11			Case Type: ........
	
15.12	Creditor's full name
			
15.13	........
		Execution Disclosure
	
15.14	against
			
15.15	Debtor's full name
			
15.16	........
			
15.17	and
			
15.18	Third Party (bank, employer, or other)
			
15.19	........
			
15.20 	This form is called a "Non-Earnings Disclosure" or "Disclosure." It is being sent to you 
15.21 	because you might be holding property that belongs to the debtor, or you might owe money 
15.22 	to the debtor.
15.23 	You are the "third party" or "garnishee." The "debtor" is the person who owes money. 
15.24 	The debtor is also called the "judgment debtor." The creditor is the person the debtor owes 
15.25 	money to. The creditor is also called the "judgment creditor." The debtor owes 
15.26 	$....................... to the creditor.
15.27 	You must list any money or property you owe the debtor on the lines below and sign 
15.28 	the affirmation. Write "none" on the line if that is your answer. You must then return this 
15.29 	disclosure to the creditor (or the creditor's lawyer) within 20 days after you got it.
15.30 	On the ..... day of ............., ......., the time of service of execution herein, there was due 
15.31 	and owing the judgment debtor from the third party the following:
15.32 	Fill in the date you got this disclosure:
15.33 	..................... (month) ..................... (day), .......................... (year)
15.34 	On the date you got this disclosure, you owed the debtor:
16.1 	(1) Money. Enter on the line below any amounts due and owing the judgment debtor, 
16.2 	except earnings, from the third party. Write down the amount of money you owe the debtor 
16.3 	(except earnings).
16.4 	........
16.5 	(2) Property. Write a short description of any personal property, instruments, or papers 
16.6 	belonging to the debtor that you have in your possession. List the monetary value of each 
16.7 	thing.
16.8 	........
16.9 	(2) (3) Setoff. Enter on the line below the amount of any setoff, defense, lien, or claim 
16.10 	which the third party claims against the amount set forth on line (1). State the facts by which 
16.11 	such setoff, defense, lien, or claim is claimed. (Any indebtedness to a third party incurred 
16.12 	by the judgment debtor within ten days prior to the receipt of the first execution levy on a 
16.13 	debt is void as to the judgment creditor.) If you claim a setoff, defense, lien, or claim against 
16.14 	the amount on lines (1) and (2) above, enter that amount on the line below. State the facts 
16.15 	about your claim. Note: Any payment the debtor makes to the garnishee within the 10 days 
16.16 	before they get the first garnishment order on that debt can't be used to lower the amount 
16.17 	that is being garnished.
16.18 	........
16.19 	(3) (4) Exemption. Enter any amounts or property that the debtor claims is exempt on 
16.20 	the line below any amounts or property claimed by the judgment debtor to be exempt from 
16.21 	execution.
16.22 	........
16.23 	(4) (5) Adverse Interest. Enter on the line below any amounts claimed by other persons 
16.24 	by reason of ownership or interest in the judgment of the debtor's property that other people 
16.25 	claim they own or have interest in.
16.26 	........
16.27 	(5) (6) Enter on the line below the total of lines (2), (3), and (4) (3), (4), and (5) on the 
16.28 	line below.
16.29 	........
16.30 	(6) (7) Enter on the line below the difference obtained (never less than zero) when line 
16.31 	(5) (6) is subtracted from the amount on line sum of lines (1) and (2) on the line below.
16.32 	........
17.1 	(7) Enter on the line below (8) Figure out 110 percent of the amount of the judgment
17.2 	creditor's claim which remains is still unpaid. Enter it on the line below.
17.3 	........
17.4 	(8) Enter on the line below the lesser of line (6) and line (7). You are hereby instructed 
17.5 	to remit this amount only if it is $10 or more.
17.6 	(9) Look at (7) and (8). Put the smaller number on the line below. Hold this amount only 
17.7 	if it is $10 or more.
17.8 	........
17.9 	AFFIRMATION
17.10 	I, ....................... (person signing Affirmation), am the third party garnishee or I am 
17.11 	authorized by the third party garnishee to complete this nonearnings non-earnings
17.12 	garnishment disclosure, and have done so truthfully and to the best of my knowledge.

17.13	Dated: ........
		........
	
17.14			Signature
	
17.15			........
	
17.16			Title
	
17.17			........
	
17.18			Telephone Number

17.19	Date: ........
		
17.20	Name: ........
		
17.21	Signature: ........
		
17.22	Title: ........
		
17.23	Phone: ........
	Email: ........

17.24 	Sec. 4. Minnesota Statutes 2024, section 550.143, subdivision 3a, is amended to read:
17.25 		Subd. 3a.Form of notice. The notice required by subdivision 3 must be provided as a 
17.26 	separate form and must be substantially in the following form:

17.27	STATE OF MINNESOTA
		DISTRICT COURT
	
17.28	COUNTY OF ........
		........JUDICIAL DISTRICT
	
17.29	........(Creditor)
			
17.30	........(Debtor)
			
17.31	........(Financial institution)

18.1	State of Minnesota
		District Court
	
18.2	County of: ........
		Judicial District: ........
	
18.3			Court File Number: ........
	
18.4			Case Type: ........
	
18.5	Creditor's full name
			
18.6	........
		Notice of Levied Funds
	
18.7	Debtor's full name
			
18.8	........
			
18.9	Third Party (bank, employer, or other)
			
18.10	........
			
18.11 	IMPORTANT NOTICE
18.12 	YOUR FUNDS HAVE BEEN LEVIED
18.13 	Money in Your Account Has Been Frozen
18.14 	The creditor has frozen money in your account at your financial institution bank.
18.15 	Your account balance is $.......
18.16 	The amount being held is $.......
18.17 	The amount being held will be is frozen for 14 days from the date of this notice.
18.18 	Some of your money in your account may be protected (the legal word is exempt). 
18.19 	You may be able to get it sooner than 14 days if you act quickly and follow the 
18.20 	instructions on the next page.
18.21 	The attached exemption form lists some different sources of ways money in your account 
18.22 	that may be protected. If your money is comes from one or more of these sources a benefit 
18.23 	on this list, place put a check on the line on the form next to the sources of your money in 
18.24 	the box next to it. If it is from one of these sources, The creditor cannot can't take it.
18.25 	BUT, if you want the bank to unfreeze your money, you must follow the instructions 
18.26 	and return the exemption form and with copies of your bank statements from the last 
18.27 	60 daysto have the bank unfreeze your money. Instructions and the form are attached. If 
18.28 	you do not don't follow the instructions, your financial institution will give bank gives the 
18.29 	money to the Sheriff your creditor. If your creditor gets an order from the court or writ of 
18.30 	execution, your bank gives the money to them. If that happens and it your money is protected, 
18.31 	you can still get it back from the creditor later, but that is not as easy to do as filling in the 
18.32 	form now. But filling out the form now is easiest.
18.33 	See next pages for instructions and the exemption form.
19.1 	See the attached Exemption Form Instructions and Exemption Form for your next steps.

19.2 	Sec. 5. Minnesota Statutes 2024, section 550.143, subdivision 3b, is amended to read:
19.3 		Subd. 3b.Form of instructions. The instructions required by this section must be in a 
19.4 	separate form and must be substantially in the following form:
19.5 	Exemption Form Instructions
19.6 	Note: The creditor is who you owe the money to. You are the debtor.
19.7 	1. Fill out both of the attached exemption forms in this packet.
19.8 	If you check one of the lines, you should also give proof. Use proof that shows show
19.9 	that some or all of the money in your account is from one or more of the protected sources.
19.10 	This might be letters or account statements. Creditors may ask for a hearing if they question 
19.11 	your exemptions.
19.12 	To avoid a hearing:
19.13 	(i) Case numbers should be added to the form.
19.14 	(ii) Copies of documents should be sent with the form.
19.15 	Notice: You must send to the creditor's attorney (or to the creditor, if no attorney) copies 
19.16 	of your bank statements for the past 60 days before the levy garnishment. Send them to the 
19.17 	creditor's lawyer (or to the creditor, if there isn't a lawyer). Keep a copy of your bank 
19.18 	statements in case there are questions about your claim. If you do not don't send bank 
19.19 	statements to the creditor's attorney lawyer (or to the creditor, if no attorney) bank statements
19.20 	along with your exemption claim, the financial institution may release give your money to 
19.21 	the Sheriff creditor. They would do this once the creditor gives them a court order saying 
19.22 	they have to turn over the funds.
19.23 	2. Sign the exemption forms. Make one a copy to keep for yourself.
19.24 	3. Mail or deliver the other copies of the form by (insert date).
19.25 	Both Copies Must Be Mailed or Delivered the Same Day.
19.26 	One copy of the form and the copies of your bank statements go to:
19.27 	........
19.28 	(Insert name of creditor or creditor's attorney)
19.29 	........
19.30 	(Insert address of creditor or creditor's attorney)
20.1 	One copy goes to:
20.2 	........
20.3 	(Insert name of bank)
20.4 	........
20.5 	(Insert address of bank)

20.6	Creditor's Name: ........
		
20.7	(or creditor's lawyer's name)

20.8	Street Address: ........
		
20.9	City/State/Zip: ........
		
20.10	Phone: ........
	Fax: ........
		
20.11	Email: ........
		
20.12 	One copy goes to:

20.13	Bank's Name: ........

20.14	Street Address: ........
		
20.15	City/State/Zip: ........
		
20.16	Phone: ........
	Fax: ........
		
20.17	Email: ........
		
20.18 	How The Process Works
20.19 	If You Do Not Don't Send in the Exemption Form and Bank Statements:
20.20 	14 days after the date of this letter some or all of your money may be turned over to the 
20.21 	creditor or to the sheriff. This happens once they get an order from the court telling the bank 
20.22 	to do this.
20.23 	If You Do Send in the Exemption Form and Bank Statements:
20.24 	Any money that is NOT protected can be turned over to the sheriff creditor once they 
20.25 	get an order from the court.
20.26 	If the Creditor Does Not Object to Your Claimed Exemptions:
20.27 	The financial institution will bank should unfreeze your money six 6 business days after 
20.28 	the institution gets they get your completed form. If they don't, ask the creditor or the 
20.29 	creditor's lawyer to send a release letter to the bank.
20.30 	If the Creditor Objects to Your Claimed Exemptions:
21.1 	The money you have said is protected on the form will be is held by the bank. The 
21.2 	creditor has six 6 business days to object (disagree) and ask the court to hold a hearing. You 
21.3 	will receive get a Notice of Objection and a Notice of Hearing.
21.4 	The financial institution will hold bank holds the money until a court decides whether
21.5 	if your money is protected or not. Some reasons a creditor may object are because you did 
21.6 	not didn't send copies of your bank statements or other proof of the benefits you received
21.7 	got. Be sure to include these when you send your exemption form.
21.8 	You may want to talk to a lawyer for advice about this process. If you are low income 
21.9 	you can call Legal Aid statewide at 1(877) 696-6529.
21.10 	PENALTIES:
21.11 	Warnings and Fines
21.12 	If you claim that your money is protected and a court decides you made that claim in 
21.13 	bad faith, the court they can order you to pay costs, actual damages, attorney lawyer fees, 
21.14 	and an additional amount of a fine up to $100. Bad faith is when someone does something 
21.15 	wrong on purpose. For example, it may be bad faith if you claim you receive get government 
21.16 	benefits that and you do not receive don't.
21.17 	If the creditor made a bad faith objection to your claim that your money is protected, 
21.18 	the court can order them to pay costs, actual damages, attorney lawyer fees, and an additional 
21.19 	amount of a fine up to $100.

21.20 	Sec. 6. Minnesota Statutes 2024, section 550.143, subdivision 3c, is amended to read:
21.21 		Subd. 3c.Form of exemption form. The exemption form required by this subdivision 
21.22 	must be sent as a separate form and must be in substantially the following form:

21.23	STATE OF MINNESOTA
		DISTRICT COURT
	
21.24	COUNTY OF ........
		........JUDICIAL DISTRICT
	
21.25	........(Creditor)
			
21.26	........(Debtor)
			
21.27	........(Financial institution)

21.28	State of Minnesota
		District Court
	
21.29	County of: ........
		Judicial District: ........
	
21.30			Court File Number: ........
	
21.31			Case Type: ........
	
21.32	Creditor's full name
			
21.33	........
		Exemption Form
	
22.1	against
			
22.2	Debtor's full name
			
22.3	........
			
22.4	Bank's name
			
22.5	........
			
22.6 	EXEMPTION FORM

22.7	A.
	How Much Money is Protected (Exempt)
	
22.8	........
	I claim ALL of the money being frozen by the bank is protected.
	
22.9	........
	I claim SOME of the money is protected. The amount I claim is protected is $.......
	
22.10	B.
	Why The Money is Protected
	
22.11
22.12		My money is protected because I get it from one or more of the following places: 
(Check all that apply)
	
22.13		Earnings (Wages)
	
22.14		ALL or SOME of my wages may be protected.
	
22.1522.16	........
	Some of my wages are protected because they were only deposited in my account 
in the last 20 days.
	
22.17
22.18		For wages that were deposited in your account within the last 20 days, the amount 
protected is whichever is more:
	
22.19		(i) 75% or more of your wages (after taxes are taken out), or
	
22.20
22.21		(ii) The current minimum wage times 40 per week. You can find the current minimum 
wage here: https://www.dli.mn.gov/minwage.
	
22.22		All of my wages are protected because:
	
22.23	........
	I get government benefits (a list of government benefits is on the next page)
	
22.24	........
	I am getting other assistance based on need
	
22.25	........
	I have gotten government benefits in the last 6 months
	
22.26	........
	I was in jail or prison in the last 6 months
	
22.27
22.28
22.29
22.30		If you check one of these 4 boxes, your wages are only protected for 60 days after 
they are deposited in your account. You MUST send the creditor copies of bank 
statements that show what was in your account for the 60 days right before the 
bank froze your money.
	
22.31	........
	Government benefits
	
22.32
22.33		Government benefits include, but are not limited to, the following can include many 
things. For example:
	
22.34		MFIP - Minnesota Family Investment Program,
	
22.35		MFIP Diversionary Work Program,
	
22.36		Work participation cash benefit,
	
22.37		GA - General Assistance,
	
22.38		EA - emergency assistance,
	
22.39		MA - medical assistance,
	
22.40		EGA - emergency general assistance,
	
23.1		MSA - Minnesota Supplemental Aid,
	
23.2		MSA-EA - MSA Emergency Assistance,
	
23.3		Supplemental Nutrition Assistance Program (SNAP),
	
23.4		SSI - Supplemental Security Income,
	
23.5		MinnesotaCare,
	
23.6		Medicare Part B premium payments,
	
23.7		Medicare Part D extra help,
	
23.8		Energy or fuel assistance.
	
23.9		(i) MFIP - Minnesota Family Investment Program
	
23.10		(ii) DWP - MFIP Diversionary Work Program
	
23.11		(iii) SNAP - Supplemental Nutrition Assistance Program
	
23.12		(iv) GA - General Assistance
	
23.13		(v) EGA - Emergency General Assistance
	
23.14		(vi) MSA - Minnesota Supplemental Aid
	
23.15		(vii) MSA-EA - MSA Emergency Assistance
	
23.16		(viii) EA - Emergency Assistance
	
23.17		(ix) Energy or Fuel Assistance
	
23.18		(x) Work Participation Cash Benefit
	
23.19		(xi) MA - Medical Assistance
	
23.20		(xii) MinnesotaCare
	
23.21		(xiii) Medicare Part B - Premium Payments help
	
23.22		(xiv) Medicare Part D - Extra
	
23.23		(xv) SSI - Supplemental Security Income
	
23.24
23.25		(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), MN Working family 
credit
	
23.26		(xvii) Renter's Refund (also called Renter's Property Tax Credit)
	
23.27	LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT
	
23.28	........
	
23.29		List the case number and county for every box you checked:
	
23.30		Case Number: ........ County: ........
	
23.31		Case Number: ........ County: ........
	
23.32		Case Number: ........ County: ........
	
23.33		County: ........
	
23.34		Government benefits also include:
	
23.35	........
	Social Security benefits
	
23.36	........
	Unemployment benefits
	
23.37	........
	Workers' compensation
	
23.38	........
	Veterans Veterans' benefits
	
24.1
24.2
24.3		If you receive get any of these government benefits, include copies of any documents 
you have that show you receive Social Security, unemployment, workers' 
compensation, or veterans benefits get them.
	
24.4	........
	Other assistance based on need
	
24.5	........
	I get other assistance based on need that is not on the list. It comes from: ........
	
24.6		........
	
24.7		Make sure you include copies of any documents that show this.
	
24.8 	You may have assistance based on need from another source that is not on the list. If you 
24.9 	do, check this box, and fill in the source of your money on the line below:
24.10 	Source:........
24.11 	Include copies of any documents you have that show the source of this money.

24.12	EARNINGS
	
24.13		ALL or SOME of your earnings (wages) may also be protected.
	
24.14	........
	All of your earnings (wages) are protected if:
	
24.15	........
	You get government benefits (see list of government benefits)
	
24.16	........
	You currently receive other assistance based on need
	
24.17	........
	You have received government benefits in the last six months
	
24.18	........
	You were in jail or prison in the last six months
	
24.19
24.20
24.21
24.22		If 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.
	
24.23	........
	Some of your earnings (wages) are protected.
	
24.24
24.25
24.26		If 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:
	
24.27		75 percent of your wages (after taxes are taken out); or
	
24.28		(insert the sum of the current federal minimum wage) multiplied by 40.
	
24.29	C.
	Other Exempt Protected Funds
	
24.30
24.31		The money from the following these things are also completely protected after they 
are deposited in your my account.
	
24.32	........
	Child support
	
24.3324.34	........
	An accident, disability, or retirementA retirement, disability, or accident pension 
or annuity
	
24.35	........
	Earnings of my child who is under 18 years of age
	
24.36	........
	Payments to you me from a life insurance policy
	
24.37	........
	Earnings of your child who is under 18 years of age
	
24.38	........
	Child support
	
24.3924.40
25.1
25.2	........
	Money paid to you me from a claim for damage or destruction of property. Property 
includes household goods, farm tools or machinery, tools for your my job, business 
equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, 
furniture, or appliances.
	
25.3	........
	Death benefits paid to you me
	
25.4 	I give my permission to any agency that has given me cash benefits to give information 
25.5 	about my benefits to the above-named creditor, or its attorney named above or to the creditor's 
25.6 	lawyer. The information will ONLY concern whether be if I get benefits or not assistance, 
25.7 	or whether if I have gotten them assistance in the past six 6 months. If I was an inmate in 
25.8 	the last 6 months, I give my permission to the correctional institution to tell the creditor 
25.9 	named above or the creditor's lawyer that I was an inmate there.
25.10 	If I was an inmate in the last six months, I give my permission to the correctional 
25.11 	institution to tell the above-named creditor that I was an inmate there.
25.12 	You must sign and send this form and send it back to the creditor's Attorney lawyer
25.13 	(or to the creditor, if there is no attorney lawyer) and the bank. Remember to include 
25.14 	a copy of your bank statements for the past 60 days. Fill in the blanks below and go 
25.15 	back to the instructions to make sure you do did it correctly.
25.16 	I have mailed or delivered a copy of this form to: the creditor's lawyer (or to the creditor, 
25.17 	if there is no lawyer) at the address listed below.
25.18 	........
25.19 	(Insert name of creditor or creditor's attorney)
25.20 	........
25.21 	(Insert address of creditor or creditor's attorney)

25.22	Creditor's Signature: ........
		
25.23	(or creditor's lawyer's signature)

25.24	Creditor's Name: ........
		
25.25	(or creditor's lawyer's name)

25.26	Street Address: ........
		
25.27	City/State/Zip: ........
		
25.28	Phone: ........
	Fax: ........
		
25.29	Email: ........
		
25.30 	I have also mailed or delivered a copy of this exemption form to my bank at the address 
25.31 	listed in the instructions. below:

25.32	DATED: ........
	........
	
25.33		DEBTOR
	
26.1		........
	
26.2		DEBTOR ADDRESS
	
26.3		........
	
26.4		DEBTOR TELEPHONE NUMBER

26.5	Bank's Name: ........

26.6	Street Address: ........
		
26.7	City/State/Zip: ........
		
26.8	Phone: ........
	Fax: ........
		
26.9	Email: ........

26.10	Date: ........
		
26.11	Debtor's Signature: ........
		
26.12	Debtor's Name: ........
		
26.13	Street Address: ........
		
26.14	City/State/Zip: ........
		
26.15	Phone: ........
		
26.16	Email: ........

26.17 	Sec. 7. Minnesota Statutes 2024, section 551.05, subdivision 1b, is amended to read:
26.18 		Subd. 1b.Form of notice. The notice must be a separate form and must be substantially 
26.19 	in the following form:

26.20	STATE OF MINNESOTA
			DISTRICT COURT
	
26.21	COUNTY OF ........
			........JUDICIAL DISTRICT
	
26.22	........
	(Creditor)
				
26.23	........
	(Debtor)
				
26.2526.24
	........
	(Financial 
institution)

26.26	State of Minnesota
		District Court
	
26.27	County of: ........
		Judicial District: ........
	
26.28			Court File Number: ........
	
26.29			Case Type: ........
	
26.30	Creditor's full name:
			
26.31	........
			
26.32	Debtor's full name:
			
26.33	........
			
26.34	Third Party (bank, employer, or other):
			
26.35	........
			
27.1 	IMPORTANT NOTICE
27.2 	YOUR FUNDS HAVE BEEN LEVIED
27.3 	Money in Your Account Has Been Frozen
27.4 	The creditor has frozen money in your account at your financial institution bank.
27.5 	Your account balance is $.......
27.6 	The amount being held is $.......
27.7 	The amount being held will be is frozen for 14 days from the date of this notice.
27.8 	Some of your money in your account may be protected (the legal word is exempt). You 
27.9 	may be able to get it sooner than 14 days if you act quickly and follow the instructions 
27.10 	on the next page.
27.11 	The attached exemption form lists some different sources of ways money in your account 
27.12 	that may be protected. If your money is from one or more of these sources, place a check 
27.13 	on the line on the form next to the sources of your money. If it is from one of these sources, 
27.14 	the Creditor cannot take it comes from a benefit on this list, put a check on the line next to 
27.15 	it. The creditor can't take it.
27.16 	BUT, if you want the bank to unfreeze your money, you must follow the instructions and 
27.17 	return the exemption form and with copies of your bank statements from the last 60 
27.18 	days to have the bank unfreeze your money. Instructions and the form are attached. If you 
27.19 	do not don't follow the instructions, your financial institution will give bank gives the money 
27.20 	to the your creditor. If your creditor gets an order from the court or writ of execution, your 
27.21 	bank gives the money to them. If that happens and it your money is protected, you can still 
27.22 	get it back from the creditor later, but that is not as easy to do as filling in the form now.
27.23 	But filling out the form now is easiest.
27.24 	See next pages for instructions and the exemption form.

27.25 	Sec. 8. Minnesota Statutes 2024, section 551.05, subdivision 1c, is amended to read:
27.26 		Subd. 1c.Form of instructions. The instructions required must be in a separate form 
27.27 	and must be substantially in the following form:
27.28 	INSTRUCTIONS
27.29 	Note: The creditor is who you owe the money to. You are the debtor.
27.30 	1. Fill out both of the attached exemption forms in this packet.
28.1 	If you check one of the lines, you should also give proof that shows that some or all of 
28.2 	the money in your account is from one or more of the protected sources. Creditors 
28.3 	may ask for a hearing if they question your exemptions. To avoid a hearing:
28.4 	Case numbers should be added to the form. Copies of documents should be sent 
28.5 	with the form.
28.6 	If you check one of the lines, you should also give proof. Use proof that shows that some 
28.7 	or all of the money in your account is from one or more of the protected sources. This might 
28.8 	be letters or account statements. Creditors may ask for a hearing if they question your 
28.9 	exemptions.
28.10 	To avoid a hearing:
28.11 	(i) Case numbers should be added to the form.
28.12 	(ii) Copies of documents should be sent with the form.
28.13 	Notice: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO THE 
28.14 	CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS FOR 
28.15 	THE PAST 60 DAYS BEFORE THE LEVY. Keep a copy of your bank statements in 
28.16 	case there are questions about your claim. If you do not send to the creditor's attorney 
28.17 	(or to the creditor, if no attorney) bank statements with your exemption claim, the 
28.18 	financial institution may release your money to the creditor.
28.19 	Notice: You must send copies of your bank statements for the past 60 days before the 
28.20 	garnishment. Send them to the creditor (or to the creditor's lawyer). Keep a copy of your 
28.21 	bank statements in case there are questions about your claim. If you don't send bank 
28.22 	statements to the creditor (or to the creditor's lawyer) along with your exemption claim, the 
28.23 	financial institution may give your money to the creditor. They would do this once the 
28.24 	creditor gives them  a court order saying they have to turn over the funds.
28.25 	2. Sign the exemption forms. Make one copy to keep for yourself.
28.26 	3. Mail or deliver the other copies of the form by (insert date).
28.27 	Both Copies Must Be Mailed or Delivered the Same Day.
28.28 	One copy of the form and the copies of your bank statements go to:

28.29	Creditor's Name: ........
	
28.30	(Insert name of creditor or creditor's attorney) (or creditor's lawyer's name)
	
28.31	Street Address: ........
	
28.32	(Insert address of creditor or creditor's attorney) City/State/Zip: ........
	
29.1	Phone: ........
	Fax: ........
	
29.2	Email: ........
	
29.3 	One copy goes to:

29.4	Bank's Name: ........
		
29.5	(Insert name of bank) Street Address: ........
		
29.6	City/State/Zip: ........
		
29.7	(Insert address of bank) Phone: ........
	Fax: ........
	
29.8	Email: ........
		
29.9 	How The Process Works
29.10 	If You Do Not Don't Send in the Exemption Form and Bank Statements:
29.11 	14 days after the date of this letter some or all of your money may be turned over to the 
29.12 	creditor pursuant to Minnesota statute. This happens once they get an order from the court 
29.13 	telling the bank to do this.
29.14 	If You Do Send in the Exemption Form and Bank Statements:
29.15 	Any money that is NOT protected can be turned over to the creditor once they get an order 
29.16 	from the court.
29.17 	If the Creditor Does Not Object to Your Claimed Exemptions:
29.18 	The financial institution will unfreeze your money six business days after the institution 
29.19 	gets your completed form. The bank should unfreeze your money 6 business days after they 
29.20 	get your completed form. If they don't, ask the creditor or the creditor's lawyer to send a 
29.21 	release letter to the bank.
29.22 	If the Creditor Objects to Your Claimed Exemptions:
29.23 	The money you have said is protected on the form will be is held by the bank. The creditor 
29.24 	has six 6 business days to object (disagree) and ask the court to hold a hearing. You will 
29.25 	receive get a Notice of Objection and a Notice of Hearing.
29.26 	The financial institution will hold bank holds the money until a court decides whether if
29.27 	your money is protected or not. Some reasons a creditor may object are because you did 
29.28 	not didn't send copies of your bank statements or other proof of the benefits you received
29.29 	got. Be sure to include these when you send your exemption form.
29.30 	You may want to talk to a lawyer for advice about this process. If you are low income you 
29.31 	can call Legal Aid statewide at 1(877) 696-6529.
29.32 	PENALTIES Warnings and Fines:
30.1 	If you claim that your money is protected and a court decides you made that claim in bad 
30.2 	faith, the court they can order you to pay costs, actual damages, attorney lawyer fees, and 
30.3 	an additional amount of a fine up to $100. Bad faith is when someone does something wrong 
30.4 	on purpose. For example, it may be bad faith if you claim you receive get government 
30.5 	benefits that you do not receive and you don't.
30.6 	If the creditor made a bad faith objection to your claim that your money is protected, the 
30.7 	court can order them to pay costs, actual damages, attorney lawyer fees, and an additional 
30.8 	amount of a fine up to $100.

30.9 	Sec. 9. Minnesota Statutes 2024, section 551.05, subdivision 1d, is amended to read:
30.10 		Subd. 1d.Form of exemption form. The exemption form required by this subdivision 
30.11 	must be a separate form and must be in substantially the following form:

30.12	STATE OF MINNESOTA
			DISTRICT COURT
	
30.13	COUNTY OF ........
			........JUDICIAL DISTRICT
	
30.14	........
	(Creditor)
				
30.15	........
	(Debtor)
				
30.1730.16
	........
	(Financial 
institution)

30.18	State of Minnesota
		District Court
	
30.19	County of: ........
		Judicial District: ........
	
30.20			Court File Number: ........
	
30.21			Case Type: ........
	
30.22	Creditor's full name:
			
30.23	........
		Exemption Form
	
30.24	against
			
30.25	Debtor's full name:
			
30.26	........
			
30.27	Bank's name:
			
30.28	........
			
30.29 	EXEMPTION FORM

30.30	A.
	How Much Money Is Protected (exempt)
	
30.31	........
	... I claim ALL of the money being frozen by the bank is protected.
	
30.32	........
	... I claim SOME of the money is protected. The amount I claim is protected is $........
	
30.33	B.
	Why The Money Is Protected
	
30.34
30.35		My money is protected because I get it from one or more of the following places: 
(Check all that apply)
	
31.1		Earnings (Wages)
		
31.2		ALL or SOME of my wages may be protected.
		
31.3
31.4		... Some of my wages are protected because they were only deposited in my 
account in the last 20 days.
		
31.5
31.6		For wages that were deposited in your account within the last 20 days, the amount 
protected is whichever is more:
		
31.7		(i) 75% of your wages or more (after taxes are taken out), or
		
31.8
31.9		(ii) The current minimum wage times 40 per week. You can find the current 
minimum wage here: https://www.dli.mn.gov/minwage.
		
31.10		All of my wages are protected because:
		
31.11		... I get government benefits (a list of government benefits is on the next page)
		
31.12		... I am getting other assistance based on need
		
31.13		... I have gotten government benefits in the last 6 months
		
31.14		... I was in jail or prison in the last 6 months
		
31.15
31.16
31.17
31.18		If you check one of these 4 boxes, your wages are only protected for 60 days 
after they are deposited in your account. You MUST send the creditor copies 
of bank statements that show what was in your account for the 60 days right 
before the bank froze your money.
		
31.19	........
	Government benefits
	
31.20
31.21		Government benefits can include, but are not limited to, the following many things. 
For example:
	
31.22		MFIP - Minnesota family investment program,
	
31.23		MFIP Diversionary Work Program,
	
31.24		Work participation cash benefit,
	
31.25		GA - general assistance,
	
31.26		EA - emergency assistance,
	
31.27		MA - medical assistance,
	
31.28		EGA - emergency general assistance,
	
31.29		MSA - Minnesota supplemental aid,
	
31.30		MSA-EA - MSA emergency assistance,
	
31.31		Supplemental Nutrition Assistance Program (SNAP),
	
31.32		SSI - Supplemental Security Income,
	
31.33		MinnesotaCare,
	
31.34		Medicare Part B premium payments,
	
31.35		Medicare Part D extra help,
	
31.36		Energy or fuel assistance.
	
31.37	LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT
	
31.38	........
	
31.39	LIST THE CASE NUMBER AND COUNTY
	
31.40		Case Number: ........
	
32.1		County: ........
	
32.2		Government benefits also include:
	
32.3	........
	Social Security benefits
	
32.4	........
	Unemployment benefits
	
32.5	........
	Workers' compensation
	
32.6	........
	Veterans benefits
	
32.7
32.8
32.9		If 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.
	
32.10	........
	Other assistance based on need
	
32.11 	You may have assistance based on need from another source that is not on the list. If you 
32.12 	do, check this box, and fill in the source of your money on the line below:
32.13 	Source:........
32.14 	Include copies of any documents you have that show the source of this money.

32.15	EARNINGS
	
32.16		ALL or SOME of your earnings (wages) may also be protected.
	
32.17	........
	All of your earnings (wages) are protected if:
	
32.18	........
	You get government benefits (see list of government benefits)
	
32.19	........
	You currently receive other assistance based on need
	
32.20	........
	You have received government benefits in the last six months
	
32.21	........
	You were in jail or prison in the last six months
	
32.22
32.23
32.24
32.25		If 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.
	
32.26	........
	Some of your earnings (wages) are protected.
	
32.27
32.28
32.29		If 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:
	
32.30		75 percent of your wages (after taxes are taken out); or
	
32.31		(insert the sum of the current federal minimum wage) multiplied by 40.
	
32.32		OTHER EXEMPT FUNDS
	
32.33
32.34		The money from the following are also completely protected after they are deposited 
in your account.
	
32.35	........
	An accident, disability, or retirement pension or annuity
	
32.36	........
	Payments to you from a life insurance policy
	
32.37	........
	Earnings of your child who is under 18 years of age
	
32.38	........
	Child support
	
33.133.2
33.3
33.4	........
	Money paid to you from a claim for damage or destruction of property Property 
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.
	
33.5	........
	Death benefits paid to you

33.6		(i) MFIP - Minnesota Family Investment Program
	
33.7		(ii) DWP - MFIP Diversionary Work Program
	
33.8		(iii) SNAP - Supplemental Nutrition Assistance Program
	
33.9		(iv) GA - General Assistance
	
33.10		(v) EGA - Emergency General Assistance
	
33.11		(vi) MSA - Minnesota Supplemental Aid
	
33.12		(vii) MSA-EA - MSA Emergency Assistance
	
33.13		(viii) EA - Emergency Assistance
	
33.14		(ix) Energy or Fuel Assistance
	
33.15		(x) Work Participation Cash Benefit
	
33.16		(xi) MA - Medical Assistance
	
33.17		(xii) MinnesotaCare
	
33.18		(xiii) Medicare Part B - Premium Payments help
	
33.19		(xiv) Medicare Part D - Extra
	
33.20		(xv) SSI - Supplemental Security Income
	
33.21
33.22		(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
Family Credit
	
33.23		(xvii) Renter's Refund (also called Renter's Property Tax Credit)

33.24
33.25	List the case number and county for every 
box you checked:
		
33.26	Case Number: ........
	County: ........
	
33.27	Case Number: ........
	County: ........
	
33.28	Case Number: ........
	County: ........
	
33.29	Government benefits also include:
		
33.30	... Social Security benefits
		
33.31	... Unemployment benefits
		
33.32	... Workers' compensation
		
33.33	... Veterans' benefits
		
33.34 	If you get any of these government benefits, include copies of any documents that show 
33.35 	you get them.
33.36 	... I get other assistance based on need  that is not on the list. It comes from:
33.37 	........
34.1 	Make sure you include copies of any documents that show this.

34.2	C.
	Other Protected Funds
	
34.3
34.4		The money from these things are also completely protected after they are deposited 
in my account.
	
34.5		... Child Support
	
34.6		... A retirement, disability, or accident pension or annuity
	
34.7		... Earnings of my child who is under 18 years of age
	
34.8		... Payments to me from a life insurance policy
	
34.934.10
34.11
34.12
		... Money paid to me from a claim for damage or destruction of property. Property 
includes household goods, farm tools or machinery, tools for my job, business 
equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, 
furniture, or appliances.
	
34.13		... Death benefits paid to me
	
34.14 	I give my permission to any agency that has given me cash benefits to give information 
34.15 	about my benefits to the above-named creditor, or its attorney creditor named above or to 
34.16 	the creditor's lawyer. The information will ONLY concern whether I get benefits or not, or 
34.17 	whether I have gotten them in the past six months be if I get assistance, or if I have gotten 
34.18 	assistance in the past 6 months.If I was an inmate in the last six 6 months, I give my 
34.19 	permission to the correctional institution to tell the above-named creditor named above or 
34.20 	the creditor's lawyer that I was an inmate there.
34.21 	YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S 
34.22 	ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. 
34.23 	REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR THE 
34.24 	PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE 
34.25 	INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.
34.26 	You must sign this form and send it back to the creditor's lawyer (or to the creditor, 
34.27 	if there is no lawyer) and the bank. Remember to include a copy of your bank 
34.28 	statements for the past 60 days. Fill in the blanks below and go back to the instructions 
34.29 	to make sure you did it correctly.
34.30 	I have mailed or delivered a copy of this form to: the creditor (or creditor's lawyer) at 
34.31 	the address listed below.

34.32	Creditor's Signature: ........
	
34.33	(Insert name of creditor or creditor's attorney lawyer's signature)
	
34.34	Creditor's Name: ........
	
34.35	(Insert address of creditor or creditor's attorney lawyer's name)

35.1	Street Address: ........
		
35.2	City/State/Zip: ........
		
35.3	Phone: ........
	Fax: ........
	
35.4	Email: ........
		
35.5 	I have also mailed or delivered a copy of this exemption form to my bank at the address 
35.6 	listed in the instructions. below:

35.7	DATED: ........
	........
	
35.8		DEBTOR
	
35.9		........
	
35.10		DEBTOR ADDRESS
	
35.11		........
	
35.12		DEBTOR TELEPHONE NUMBER

35.13	Bank's Name: ........
		
35.14	Street Address: ........
		
35.15	City/State/Zip: ........
		
35.16	Phone: ........
	Fax: ........
		
35.17	Email: ........

35.18	Date: ........
		
35.19	Debtor's Signature: ........
		
35.20	Debtor's Name: ........
		
35.21	Street Address: ........
		
35.22	City/State/Zip: ........
		
35.23	Phone: ........
		
35.24	Email: ........

35.25 	Sec. 10. Minnesota Statutes 2024, section 551.06, subdivision 6, is amended to read:
35.26 		Subd. 6.Earnings exemption notice. Before the first levy on earnings, the attorney for 
35.27 	the judgment creditor shall serve upon the judgment debtor no less than ten days before the 
35.28 	service of the writ of execution, a notice that the writ of execution may be served on the 
35.29 	judgment debtor's employer. The notice must: (1) be substantially in the form set forth 
35.30 	below; (2) be served personally, in the manner of a summons and complaint, or by first 
35.31 	class mail to the last known address of the judgment debtor; (3) inform the judgment debtor 
35.32 	that an execution levy may be served on the judgment debtor's employer in ten days, and 
35.33 	that the judgment debtor may, within that time, cause to be served on the judgment creditor's 
35.34 	attorney a signed statement under penalties of perjury asserting an entitlement to an 
35.35 	exemption from execution; (4) inform the judgment debtor of the earnings exemptions 
36.1 	contained in section 550.37, subdivision 14; and (5) advise the judgment debtor of the relief 
36.2 	set forth in this chapter to which the judgment debtor may be entitled if a judgment creditor 
36.3 	in bad faith disregards a valid claim and the fee, costs, and penalty that may be assessed 
36.4 	against a judgment debtor who in bad faith falsely claims an exemption or in bad faith takes 
36.5 	action to frustrate the execution process. The notice requirement of this subdivision does 
36.6 	not apply to a levy on earnings being held by an employer pursuant to a garnishment 
36.7 	summons served in compliance with chapter 571.
36.8 	The ten-day notice informing a judgment debtor that a writ of execution may be used 
36.9 	to levy the earnings of an individual must be substantially in the following form:

36.10	STATE OF MINNESOTA
			DISTRICT COURT
	
36.11	COUNTY OF ........
			........JUDICIAL DISTRICT
	
36.12	........
	(Judgment Creditor)
				
36.13	against
						
36.14					EXECUTION EXEMPTION
	
36.15					NOTICE AND NOTICE OF
	
36.16	........
	(Judgment Debtor)
		INTENT TO LEVY ON EARNINGS
	
36.17	and
				WITHIN TEN DAYS
	
36.18	........
	(Third Party)
				
36.19 	PLEASE TAKE NOTICE that A levy may be served upon your employer or other third 
36.20 	parties, without any further court proceedings or notice to you, ten days or more from the 
36.21 	date hereof. Your earnings are completely exempt from execution levy if you are now a 
36.22 	recipient of relief based on need, if you have been a recipient of relief within the last six 
36.23 	months, or if you have been an inmate of a correctional institution in the last six months.
36.24 	Relief based on need includes the Minnesota Family Investment Program (MFIP), 
36.25 	Emergency Assistance (EA), Work First Program, Medical Assistance (MA), General 
36.26 	Assistance (GA), Emergency General Assistance (EGA), Minnesota Supplemental Aid 
36.27 	(MSA), MSA Emergency Assistance (MSA-EA), Supplemental Security Income (SSI), and 
36.28 	Energy Assistance.
36.29 	If you wish to claim an exemption, you should fill out the appropriate form below, sign 
36.30 	it, and send it to the judgment creditor's attorney.
36.31 	You may wish to contact the attorney for the judgment creditor in order to arrange for 
36.32 	a settlement of the debt or contact an attorney to advise you about exemptions or other 
36.33 	rights.

37.1	State of Minnesota
	District Court
	
37.2	County of: ........
	Judicial District: ........
	
37.3		Court File Number: ........
	
37.4		Case Type: ........
	
37.5	Creditor's full name:
		
37.6	........
	Execution Exemption Notice and Notice of
	
37.7	against
	Intent to Levy on Earnings
	
37.8	Debtor's full name:
		
37.9	........
		
37.10	and
		
37.11	Third Party (bank, employer, or other):
		
37.12	........
		
37.13 	Notice: A levy may be served on your employer or other third parties. A levy means that 
37.14 	part of your earnings can be taken to pay off debts that you owe. This can happen in 
37.15 	10 days or more after you get this notice. This can happen without any other court action 
37.16 	or notice to you. But some of your money may be protected.
37.17 	Your earnings cannot be taken if:
37.18 	(i) you are getting government assistance based on need,
37.19 	(ii) you got any government assistance based on need in the last 6 months, or
37.20 	(iii) you were an inmate of a correctional institution in the last 6 months.
37.21 	These are called exemptions. Your money is NOT protected unless you fill out the 
37.22 	Exemption Claim Notice attached and send it back to the creditor or the creditor's 
37.23 	lawyer. If you are not sure if you have any exemptions, talk to a lawyer.
37.24 	You can also contact the creditor or their lawyer to talk about a settlement of the debt.

37.25		Examples of government assistance based on need:
	
37.26		(i) MFIP - Minnesota Family Investment Program
	
37.27		(ii) DWP - MFIP Diversionary Work Program
	
37.28		(iii) SNAP - Supplemental Nutrition Assistance Program
	
37.29		(iv) GA - General Assistance
	
37.30		(v) EGA - Emergency General Assistance
	
37.31		(vi) MSA - Minnesota Supplemental Aid
	
37.32		(vii) MSA-EA - MSA Emergency Assistance
	
37.33		(viii) EA - Emergency Assistance
	
37.34		(ix) Energy or Fuel Assistance
	
38.1		(x) Work Participation Cash Benefit
	
38.2		(xi) MA - Medical Assistance
	
38.3		(xii) MinnesotaCare
	
38.4		(xiii) Medicare Part B - Premium Payments help
	
38.5		(xiv) Medicare Part D - Extra
	
38.6		(xv) SSI - Supplemental Security Income
	
38.7
38.8		(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
Family Credit
	
38.9		(xvii) Renter's Refund (also called Renter's Property Tax Credit)
	
38.10 	PENALTIES Warnings and Fines
38.11 	(1) Be advised that even if you claim an exemption, an execution levy may still be served 
38.12 	on your employer. If your earnings are levied on after you claim an exemption, you may 
38.13 	petition the court for a determination of your exemption. If the court finds that the 
38.14 	judgment creditor disregarded your claim of exemption in bad faith, you will be entitled 
38.15 	to costs, reasonable attorney fees, actual damages, and an amount not to exceed $100.
38.16 	Even if you claim an exemption, a levy may still be served on your employer. If they 
38.17 	take money from you after you claim an exemption, you may ask the court to review 
38.18 	your exemption. If the court finds that the creditor ignored your claim of exemption in 
38.19 	bad faith, you are entitled to costs, reasonable lawyer fees, actual damages, and a fine 
38.20 	up to $100. Bad faith is when someone does something wrong on purpose.
38.21 	(2) HOWEVER, BE WARNED if you claim an exemption, the judgment creditor can 
38.22 	also petition the court for a determination of your exemption, and if the court finds that 
38.23 	you claimed an exemption in bad faith, you will be assessed costs and reasonable 
38.24 	attorney's fees plus an amount not to exceed $100. BUT if you claim an exemption, the 
38.25 	creditor can also ask the court to review your exemption. If the court finds that you 
38.26 	claimed an exemption in bad faith, you are charged costs and reasonable lawyer fees, 
38.27 	and a fine up to $100.
38.28 	(3) If after receipt of this notice, you in bad faith take action to frustrate the execution 
38.29 	levy, thus requiring the judgment creditor to petition the court to resolve the problem, 
38.30 	you will be liable to the judgment creditor for costs and reasonable attorney's fees plus 
38.31 	an amount not to exceed $100. If you get this notice, then do something in bad faith to 
38.32 	try to block or stop the levy and the creditor has to take you to court because of it, you 
38.33 	will have to pay the creditor's costs, and reasonable lawyer's fees, and a fine up to $100.

38.34	DATED: ........
		........
	
38.35			(Attorney for Judgment Creditor)
	
39.1			........
	
39.2			Address
	
39.3			........
	
39.4			Telephone

39.5	Date: ........
		
39.6	Creditor's Signature: ........
		
39.7	(or creditor's lawyer's signature)
		
39.8	Creditor's Name: ........
		
39.9	(or creditor's lawyer's name)
		
39.10	Street Address: ........
		
39.11	City/State/Zip: ........
		
39.12	Phone: ........
	Fax: ........
	
39.13	Email: ........
		
39.14 	JUDGMENT DEBTOR'S EXEMPTION CLAIM NOTICE
39.15 	Debtor's Exemption Claim Notice
39.16 	I hereby claim that my earnings are exempt from execution because: (check all that 
39.17 	apply)
39.18 	(1) ... I am presently a recipient of reliefgetting government assistance based on need. 
39.19 	(Specify State the program, case number if you know it, and the county from which 
39.20 	relief is being received you got it from.)

39.21	........
	........
	........
	
39.22	Program
	Case Number (if known)
	County

39.23	Program: ........
	Case #: ........
	County: ........
	
39.24	Program: ........
	Case #: ........
	County: ........
	
39.25	Program: ........
	Case #: ........
	County: ........
	
39.26 	(2) ... I am not now receiving relief getting assistance based on need right now, but I 
39.27 	have received relief did get government assistance based on need within the last six 6
39.28 	months. (Specify State the program, case number if you know it, and the county from 
39.29 	which relief has been received you got it from.)

39.30	........
	........
	........
	
39.31	Program
	Case Number (if known)
	County

39.32	Program: ........
	Case #: ........
	County: ........
	
39.33	Program: ........
	Case #: ........
	County: ........
	
39.34	Program: ........
	Case #: ........
	County: ........
	
40.1 	(3) ... I have been was an inmate of a correctional institution within the last six 6 months. 
40.2 	(Specify State the correctional institution and location.)

40.3	........
	........
	
40.4	Correctional Institution........
	Location........
	
40.5 	I hereby authorize any agency that has distributed relief to me or any correctional 
40.6 	institution in which I was an inmate to disclose to the above-named judgment creditor or 
40.7 	the judgment creditor's attorney only whether or not I am or have been a recipient of relief 
40.8 	based on need or an inmate of a correctional institution within the last six months. I have 
40.9 	mailed or delivered a copy of this form to the creditor or creditor's attorney.

40.10	DATE: ........
		........
	
40.11			Judgment Debtor
	
40.12			........
	
40.13			Address
	
40.14 	I give my permission to any agency listed above to give information about my benefits to 
40.15 	the creditor named above, or to the creditor's lawyer. The information will ONLY be if I 
40.16 	get assistance, or if I have gotten assistance in the past 6 months. If I was an inmate in the 
40.17 	last 6 months, I give my permission to the correctional institution to tell the creditor named 
40.18 	above or the creditor's lawyer that I was an inmate there.

40.19	Date: ........
		
40.20	Debtor's Signature: ........
		
40.21	Debtor's Name: ........
		
40.22	Street Address: ........
		
40.23	City/State/Zip: ........
		
40.24	Phone: ........
		
40.25	Email: ........

40.26 	Sec. 11. Minnesota Statutes 2024, section 551.06, subdivision 9, is amended to read:
40.27 		Subd. 9.Notice of levy on earnings, disclosure, and worksheet. The attorney for the 
40.28 	judgment creditor shall serve upon the judgment debtor's employer a notice of levy on 
40.29 	earnings and an execution earnings disclosure form and an earnings disclosure worksheet 
40.30 	with the writ of execution, that must be substantially in the form set forth below.

40.31	STATE OF MINNESOTA
			DISTRICT COURT
	
40.32	COUNTY OF ........
			........JUDICIAL DISTRICT
	
40.33						FILE NO. ........
	
40.34	........
	(Judgment Creditor)
				
41.1	against
				NOTICE OF LEVY ON
	
41.2					EARNINGS AND DISCLOSURE
	
41.3	........
	(Judgment Debtor)
				
41.4	and
						
41.5	........
	(Third Party)
				
41.6 	PLEASE TAKE NOTICE that pursuant to Minnesota Statutes, sections 551.04 and 
41.7 	551.06, the undersigned, as attorney for the judgment creditor, hereby makes demand and 
41.8 	levies execution upon all earnings due and owing by you (up to $10,000) to the judgment 
41.9 	debtor for the amount of the judgment specified below. A copy of the writ of execution 
41.10 	issued by the court is enclosed. The unpaid judgment balance is $.....
41.11 	This levy attaches all unpaid nonexempt disposable earnings owing or to be owed by 
41.12 	you and earned or to be earned by the judgment debtor before and within the pay period in 
41.13 	which the writ of execution is served and within all subsequent pay periods whose paydays 
41.14 	occur within the 90 days after the service of this levy.
41.15 	In responding to this levy, you are to complete the attached disclosure form and worksheet 
41.16 	and mail it to the undersigned attorney for the judgment creditor, together with your check 
41.17 	payable to the above-named judgment creditor, for the nonexempt amount owed by you to 
41.18 	the judgment debtor or for which you are obligated to the judgment debtor, within the time 
41.19 	limits set forth in the aforementioned statutes.

41.20		........
	
41.21		Attorney for the Judgment Creditor
	
41.22		........
	
41.23		........
	
41.24		........
	
41.25		Address
	
41.26		(...) ........
	
41.27		Phone Number
	
41.28 	DISCLOSURE
41.29 	DEFINITIONS
41.30 	"EARNINGS": For the purpose of execution, "earnings" means compensation paid or 
41.31 	payable to an employee for personal services or compensation paid or payable to the producer 
41.32 	for the sale of agricultural products; milk or milk products; or fruit or other horticultural 
41.33 	products produced when the producer is operating a family farm, a family farm corporation, 
41.34 	or an authorized farm corporation, as defined in section 500.24, subdivision 2, whether 
42.1 	denominated as wages, salary, commission, bonus, or otherwise, and includes periodic 
42.2 	payments pursuant to a pension or retirement.
42.3 	"DISPOSABLE EARNINGS": Means that part of the earnings of an individual remaining 
42.4 	after the deduction from those earnings of amounts required by law to be withheld. (Amounts 
42.5 	required by law to be withheld do not include items such as health insurance, charitable 
42.6 	contributions, or other voluntary wage deductions.)
42.7 	"PAYDAY": For the purpose of execution, "payday(s)" means the date(s) upon which 
42.8 	the employer pays earnings to the judgment debtor in the ordinary course of business. If 
42.9 	the judgment debtor has no regular payday, payday(s) means the 15th and the last day of 
42.10 	each month.

42.11	State of Minnesota
		District Court
	
42.12	County of: ........
		Judicial District: ........
	
42.13			Court File Number: ........
	
42.14			Case Type: ........
	
42.15	Creditor's full name:
			
42.1742.16
	........
		Notice of Levy on Earnings for 
Non-Child Support Judgements
	
42.18	against
			
42.19	Debtor's full name:
			
42.20	........
			
42.21	and
			
42.22	Third Party (Debtor's Employer):
			
42.23	........
			
42.24 	To the employer:
42.25 	An employee of yours owes a judgment (money) to a creditor. The creditor's lawyer is 
42.26 	starting a levy on the earnings you owe the employee. A levy means that you might have 
42.27 	to hold part of the employee's earnings and send it to the creditor. By law, you have to do 
42.28 	this. The limit on the levy is $10,000. A copy of the writ of execution from the court is 
42.29 	enclosed. The amount of the judgment is $........
42.30 	The levy applies to "nonexempt disposable earnings" that you owe the employee. There are 
42.31 	definitions and instructions below on how to calculate the amount, if any, you have to hold. 
42.32 	The levy starts with the pay period when you got this levy. It continues for all pay periods 
42.33 	in the 90 days after you got this levy.
43.1 	You must complete the attached disclosure form and worksheet. Then mail it to the lawyer 
43.2 	listed below. If any money is owed under the levy, you must also send a check payable to 
43.3 	the creditor listed above. Follow the steps and the deadlines explained below.

43.4	Creditor's Name: ........
		
43.5	Creditor's Lawyer's Name: ........
		
43.6	Street Address: ........
		
43.7	City/State/Zip: ........
		
43.8	Phone: ........
	Fax: ........
	
43.9	Email: ........

43.10	State of Minnesota
		District Court
	
43.11	County of: ........
		Judicial District: ........
	
43.12			Court File Number: ........
	
43.13			Case Type: ........
	
43.14	Creditor's full name:
			
43.1643.15
	........
		Earnings Disclosure and Worksheet 
For Non-Child Support Judgements
	
43.17	against
			
43.18	Debtor's full name:
			
43.19	........
			
43.20	and
			
43.21	Third Party (Debtor's Employer):
			
43.22	........
			
43.23 	This form is called an "Earnings Execution Disclosure" or "Disclosure." It is for the employer 
43.24 	to fill out. The "debtor" is the person who owes money. The debtor gets a copy of this form 
43.25 	for their own information.
43.26 	The employer is the "third party." The debtor is also called a "judgment debtor." If the debtor 
43.27 	asks how the calculations in this document were made, the employer must provide 
43.28 	information about it.
43.29 	Definitions
43.30 	"Earnings": what is paid or payable to an employee, independent contractor, or 
43.31 	self-employed person for personal services (a job). Also called compensation. Compensation 
43.32 	can be wages, salary, commission, bonuses, payments, profit-sharing distributions, severance 
43.33 	payment, fees, or other. It includes periodic payments from a pension or retirement. It can 
43.34 	also be compensation paid or payable to a producer for the sale of agricultural products. 
43.35 	This can be things like milk or milk products, or fruit or other horticultural products. Or 
44.1 	things produced in the operation of a family farm, a family farm corporation, or an authorized 
44.2 	farm corporation. This is defined in Minnesota Statutes, section 500.24, subdivision 2.
44.3 	"Disposable Earnings": the part of a person's earnings that are left after subtracting 
44.4 	the amounts required by law to be withheld. Note: Amounts required by law to be withheld 
44.5 	do not include things like health insurance, charitable contributions, or other voluntary wage 
44.6 	deductions.
44.7 	"Payday": the date when the employer pays earnings to the debtor for doing their job. 
44.8 	If the debtor has no regular payday, then "payday" means the 15th and the last day of each 
44.9 	month.
44.10 	THE THIRD PARTY/EMPLOYER MUST ANSWER THE FOLLOWING 
44.11 	QUESTIONS:
44.12 	1. Do you now owe, or within 90 days from the date the execution levy was served on 
44.13 	you, will you or may you owe money to the judgment debtor for earnings? Right now, do 
44.14 	you owe money to the debtor for earnings?

44.15	Yes .....
	No .....
		
44.16 	2. Does the judgment debtor earn more than $... per week? (This amount is the greater 
44.17 	of $9.50 per hour of the federal minimum wage per week.) Within 90 days from the date 
44.18 	you were served with the levy, will you or may you owe money to the debtor for earnings?

44.19	Yes .....
	No .....
		
44.20 	3. Does the debtor earn more than the current Minnesota or federal minimum wage per 
44.21 	week? (use the number that is more)

44.22	Yes .....
	No .....
		
44.23 	INSTRUCTIONS FOR COMPLETING THE
44.24 	EARNINGS DISCLOSURE
44.25 	A. If your answer to either question 1 or 2 is "No," then you must sign the affirmation 
44.26 	on page 2 and return this disclosure to the judgment creditor's attorney within 20 days after 
44.27 	it was served on you, and you do not need to answer the remaining questions. If you answer 
44.28 	"No" to question 1, 2, or 3, you don't need to answer the rest of the questions. You don't 
44.29 	have to do the Earnings Disclosure Worksheet. Sign the Earnings Disclosure Affirmation 
44.30 	below and return this disclosure form to the sheriff. You must return it within 20 days after 
44.31 	it was served on you.
45.1 	B.If your answers to both questions 1 and 2 are "Yes," you must complete this form 
45.2 	and the Earnings Disclosure Worksheet as follows: If you answer "Yes" to question 1 or 2, 
45.3 	and "Yes" to question 3, sign the Earnings Disclosure Affirmation below. You must return 
45.4 	it to the sheriff within 20 days. You must also fill out the rest of this form. Read the 
45.5 	instructions for the Earnings Disclosure Worksheet.
45.6 	For each payday that falls within 90 days from the date the execution levy was served 
45.7 	on you, YOU MUST calculate the amount of earnings to be retained by completing steps 
45.8 	3 through 11 on page 2, and enter the amounts on the Earnings Disclosure Worksheet. 
45.9 	UPON REQUEST, THE EMPLOYER MUST PROVIDE THE DEBTOR WITH 
45.10 	INFORMATION AS TO HOW THE CALCULATIONS REQUIRED BY THIS 
45.11 	DISCLOSURE WERE MADE.
45.12 	Each payday, you must retain the amount of earnings listed in column I on the Earnings 
45.13 	Disclosure Worksheet.
45.14 	You must pay the attached earnings and return this Earnings Disclosure Form and the 
45.15 	Earnings Disclosure Worksheet to the judgment creditor's attorney and deliver a copy 
45.16 	to the judgment debtor within ten days after the last payday that falls within the 90-day 
45.17 	period.
45.18 	If the judgment is wholly satisfied or if the judgment debtor's employment ends before 
45.19 	the expiration of the 90-day period, your disclosure and remittance should be made 
45.20 	within ten days after the last payday for which earnings were attached.
45.21 	For steps 3 through 11, "columns" refers to columns on the Earnings Disclosure Worksheet.

45.22	3.
	COLUMN A.
		Enter the date of judgment debtor's payday.
	
45.23	4.
	COLUMN B.
		Enter judgment debtor's gross earnings for each payday.
	
45.2445.25	5.
	COLUMN C.
		Enter judgment debtor's disposable earnings for each 
payday.
	
45.2645.27	6.
	COLUMN D.
		Enter 25 percent of disposable earnings. (Multiply 
Column C by .25.)
	
45.2845.29
45.30
45.31
45.32
45.33
45.34
45.35	7.
	COLUMN E.
		Enter here the greater of 40 times $9.50 or 40 times the 
hourly federal minimum wage ($.......) times the number 
of work weeks included in each payday. (Note: If a pay 
period includes days in excess of whole work weeks, 
the additional days should be counted as a fraction of a 
work week equal to the number of workdays in excess 
of a whole work week divided by the number of 
workdays in a normal work week.)
	
45.3645.37	8.
	COLUMN F.
		Subtract the amount in Column E from the amount in 
Column C, and enter here.
	
45.3845.39	9.
	COLUMN G.
		Enter here the lesser of the amount in Column D and 
the amount in Column F.
	
46.146.2
46.3
46.4
46.5
46.6
46.7
46.8
46.946.10
46.11
	10.
	COLUMN H.
		Enter here any amount claimed by you as a setoff, 
defense, lien, or claim, or any amount claimed by any 
other person as an exemption or adverse interest which 
would reduce the amount of earnings owing to the 
judgment debtor. (Note: Any indebtedness to you 
incurred within ten days prior to your receipt of the first 
execution levy on a debt may not be set off against the 
earnings otherwise subject to this levy. Any wage 
assignment made by the judgment debtor within ten 
days prior to your receipt of the first execution levy on 
a debt is void.)
	
46.12
46.13
46.14
46.15				You must also describe your claim(s) and the claims of 
others, if known, in the space provided below the 
worksheet and state the name(s) and address(es) of these 
persons.
	
46.16
46.17
46.18				Enter zero in Column H if there are no claims by you 
or others which would reduce the amount of earnings 
owing to the judgment debtor.
	
46.1946.20
46.21
46.22
46.23
46.24	11.
	COLUMN I.
		Subtract the amount in Column H from the amount in 
Column G and enter here. This is the amount of earnings 
that you must retain for the payday for which the 
calculations were made. The total of all amounts entered 
in Column I is the amount to be remitted to the attorney 
for the judgment creditor.
	
46.25 	Earnings Disclosure Affirmation
46.26 	I, ................... (person signing Affirmation), am the third party/employer or I am 
46.27 	authorized by the third party/employer to complete this earnings disclosure, and have done 
46.28 	so truthfully and to the best of my knowledge.

46.29	Dated: ........
		........
	
46.30			Signature
	
46.31			........
	
46.32			Title
	
46.33			........
	
46.34			Telephone Number
	
46.35 	EARNINGS DISCLOSURE WORKSHEET
46.36 	...................
46.37 	Judgment Debtor's Name

46.38	Date: ........
		
46.39	Third Party's Name: ........
		
46.40	Third Party's Signature: ........
		
46.41	Phone: ........
	Fax: ........
		
46.42	Email: ........
		
47.1 	Instructions for Completing the Earnings Disclosure Worksheet
47.2 	For each payday that falls within 90 days from the date the levy was served on you, you 
47.3 	must calculate the amount of earnings to be withheld. Enter the amounts on the Earnings 
47.4 	Disclosure Worksheet.
47.5 	You must:
47.6 	1. Withhold the amount of earnings listed in column I on the Earnings Disclosure 
47.7 	Worksheet each payday.
47.8 	2. After 90 days, return this Earnings Disclosure Worksheet to the sheriff. Include all 
47.9 	the money withheld. Sign the Affirmation at the end of the worksheet before returning.
47.10 	3. Deliver a copy of the disclosure and worksheet to the debtor within 10 days after the 
47.11 	last payday that falls within the 90-day period.
47.12 	If the debt (judgment) is fully paid off or if the debtor's job ends before the 90-day period 
47.13 	is over, you need to do the last disclosure and withholdings within 10 days of their last 
47.14 	payday that you withheld money.
47.15 	Calculating Percentage of Disposable Earnings
47.16 	Note to Creditor: You must fill out this chart before sending this form to the employer. 
47.17 	Use the current minimum wage found online at: https://www.dli.mn.gov/minwage.
47.18 	Minimum Wage = $MW/hour.

47.2047.19
		if the weekly gross earnings are:
	then this percentage of the disposable 
earnings are withheld:
		
47.21		Less than [40 X MW]
	0%
		
47.22		[40 X MW + .01] to [60 X MW]
	10%
		
47.23		[60 X MW + .01] to [80 X MW]
	15%
		
47.24		[80 X MW + .01] or more
	25%
		
47.25 	Employer: Use this creditor's calculation chart to know what percentage of earnings 
47.26 	should be withheld.
47.27 	Earnings Disclosure Worksheet

47.28	........
		
47.29	Debtor's Name

47.30	A
			B
		C
	
47.3147.32	Payday Date
		Gross Earnings
		Disposable 
Earnings

48.1	1.
	........
		$........
		$........
	
48.2	2.
	........
		........
		........
	
48.3	3.
	........
		........
		........
	
48.4	4.
	........
		........
		........
	
48.5	5.
	........
		........
		........
	
48.6	6.
	........
		........
		........
	
48.7	7.
	........
		........
		........
	
48.8	8.
	........
		........
		........
	
48.9	9.
	........
		........
		........
	
48.10	10.
	........
		........
		........
	
48.11 	Column A. Enter the debtor's payday.
48.12 	Column B. Enter the debtor's gross earnings for each payday.
48.13 	Column C. Enter the debtor's disposable earnings for each payday.

48.14	D
			E
		F
	
48.15
48.16
48.17
48.18	25% of withholding 
of Column C
(Use the creditor's 
calculation chart)
		Greater of 40 X 
$9.50 or 40 X
MN or Fed. 
Min. Wage
		Column C 
minus Column E
	
48.19	1.
	........
		........
		........
	
48.20	2.
	........
		........
		........
	
48.21	3.
	........
		........
		........
	
48.22	4.
	........
		........
		........
	
48.23	5.
	........
		........
		........
	
48.24	6.
	........
		........
		........
	
48.25	7.
	........
		........
		........
	
48.26	8.
	........
		........
		........
	
48.27	9.
	........
		........
		........
	
48.28	10.
	........
		........
		........
	
48.29 	Column D. Enter the percentage of disposable earnings that will be withheld. Get this 
48.30 	number from the creditor's calculation chart.
48.31 	Column E. Calculate 40 times the current Minnesota minimum wage (or 40 times the 
48.32 	current federal minimum wage) times the number of work weeks in each payday. Enter the 
48.33 	bigger number here. Note: If a payday has extra days that are more than a full work week, 
48.34 	count those extra days as part of a work week. Do this by dividing the number of extra 
48.35 	workdays by the number of workdays in a normal week.
49.1 	Column F. Subtract the amount in Column E from the amount in Column C and enter 
49.2 	here.

49.3	G
			H
		I
	
49.6
49.749.4
49.5
	Lesser of Column D 
and Column F
		Setoff, Lien, 
Adverse 
Interest, or 
Other Claims
		Column G 
minus Column 
H
	
49.8	1.
	........
		........
		........
	
49.9	2.
	........
		........
		........
	
49.10	3.
	........
		........
		........
	
49.11	4.
	........
		........
		........
	
49.12	5.
	........
		........
		........
	
49.13	6.
	........
		........
		........
	
49.14	7.
	........
		........
		........
	
49.15	8.
	........
		........
		........
	
49.16	9.
	........
		........
		........
	
49.17	10.
	........
		........
		........
	
49.18				TOTAL OF COLUMN I
	$........
	
49.19 	Column G. Look at column D and column F. Enter the smaller amount of the two here 
49.20 	in column G.
49.21 	Column H. Enter any amount claimed by you that would lower the amount of earnings 
49.22 	that will go to the debtor. Things like:
49.23 	(i) a setoff,
49.24 	(ii) a defense,
49.25 	(iii) a lien,
49.26 	(iv) a claim, or
49.27 	(v) any amount claimed by any other person as an exemption or adverse interest.
49.28 	Note: You must describe your claim(s) and the claims of others, if known, in the spaces 
49.29 	after this worksheet.
49.30 	Enter zero in column H if there are no claims by you or others which would lower the 
49.31 	amount of earnings owed to the debtor.
49.32 	Note: Any debt that happened within 10 days before you got the first levy on a debt 
49.33 	may not be set off against the earnings that are affected by this levy. Any wage assignment 
50.1 	made by the debtor within 10 days before you got the first levy on a debt is void. Wage 
50.2 	assignment is when a debtor voluntarily agrees to money being taken out of their earnings.
50.3 	Column I. Subtract the amount in column H from the amount in column G and enter 
50.4 	here. This is the amount of earnings that go to the creditor.
50.5 	*If you entered any amount in Column H for any payday(s), you must describe below 
50.6 	either your claims, or the claims of others. For amounts claimed by others, you must both 
50.7 	state the names and addresses of these persons, and the nature of their claim, if known.
50.8 	payday, describe those claims below. It doesn't matter if they are your claims, or the claims 
50.9 	of others. For claims by others, list the names and addresses of each, and describe their 
50.10 	claims, if you know.
50.11 	........
50.12 	........
50.13 	........
50.14 	........
50.15 	Earnings Worksheet Affirmation
50.16 	I, ................. (person signing Affirmation), am the third party/employer or I am authorized 
50.17 	by the third party/employer to complete this earnings disclosure worksheet, and have done 
50.18 	so truthfully and to the best of my knowledge.

50.19			........
	
50.20			Title
	
50.21	Dated: ........
	........
	(...) ........
	
50.22		Signature
	Phone Number

50.23	Date: ........
		
50.24	Third Party's Name: ........
		
50.25	Third Party's Signature: ........
		
50.26	Phone: ........
	Fax: ........
		
50.27	Email: ........

50.28 	Sec. 12. Minnesota Statutes 2024, section 571.72, subdivision 8, is amended to read:
50.29 		Subd. 8.Exemption notice. In every garnishment where the debtor is a natural person, 
50.30 	the debtor shall be provided with a garnishment exemption notice. If the creditor is garnishing 
50.31 	earnings, the earnings exemption notice provided in section 571.924 must be served ten or 
50.32 	more days before the service of the first garnishment summons. If the creditor is garnishing 
51.1 	funds in a financial institution, the exemption notice provided in section 571.912 must be 
51.2 	served with the garnishment summons. In all other cases, the exemption notice must be in 
51.3 	the following form and served on the debtor with a copy of the garnishment summons.

51.4	STATE OF MINNESOTA
		DISTRICT COURT
	
51.5	COUNTY OF ........
		........JUDICIAL DISTRICT
	
51.6	........(Creditor)
			
51.7	against
			
51.8	........(Debtor)
		EXEMPTION NOTICE
	
51.9	and
			
51.10	........(Garnishee)

51.11	State of Minnesota
		District Court
	
51.12	County of: ........
		Judicial District: ........
	
51.13			Court File Number: ........
	
51.14			Case Type: ........
	
51.15	Creditor's full name
			
51.16	........
		Exemption Notice
	
51.17	against
			
51.18	Debtor's full name
			
51.19	........
			
51.20	and
			
51.21	Third Party (bank, employer, or other)
			
51.22	........
			
51.23 	A Garnishment Summons is being served upon on you. This means a creditor with a court 
51.24 	judgment against you wants to take some of your money or property to pay the judgment. 
51.25 	Some of your property may be exempt and cannot can't be garnished taken. 'Exempt' means 
51.26 	protected. The following is a list of some of the more common exemptions. It is not a 
51.27 	complete and is subject to list. For full details and dollar amounts set by law see section 
51.28 	550.37 of the Minnesota Statutes and other state and federal laws. The dollar amounts 
51.29 	contained in this list are subject to the provisions of section 550.37, subdivision 4a, at the 
51.30 	time of garnishment. If you have questions about an exemption, you should obtain contact 
51.31 	a lawyer for legal advice.
51.32 	These things you or your family might have are protected:
51.33 	(1) a homestead or the proceeds from the sale of a homestead equity in your home, or 
51.34 	money from recently selling your home - up to $510,000 total;
51.35 	(2)(i) all clothing, one watch, utensils, and foodstuffs;
52.1 	(ii) household furniture, household appliances, phonographs, radios, and computers, 
52.2 	tablets, televisions up to a total current value of $5,850;, printers, cell phones, smart phones, 
52.3 	and other consumer electronics up to $12,150 in all; and
52.4 	(iii) jewelry - total value can't be more than $3,308;
52.5 	(3) a manufactured (mobile) home used as your home you live in;
52.6 	(4) one motor vehicle currently worth less than $2,600 after deducting any security 
52.7 	interest;, counting only the amount you have paid off:
52.8 	(i) $10,000;
52.9 	(ii) $12,500 if it is necessary for your business, trade, or profession;
52.10 	(iii) $25,000 if used by or to help someone with a disability that makes it hard to walk; 
52.11 	or
52.12 	(iv) $100,000 if designed or modified for someone with a disability that makes it hard 
52.13 	to walk;
52.14 	(5) farm machinery used by an individual principally engaged in farming, or if your 
52.15 	main business is farming. Tools, machines, or office furniture used in your business or trade. 
52.16 	This exemption is limited to - the total value can't be more than $13,000;
52.17 	(6) relief based on need. This includes:
52.18 	(i) MFIP - Minnesota Family Investment Program (MFIP) and Work First Program;
52.19 	(ii) DWP - MFIP Diversionary Work Program;
52.20 	(ii) Medical Assistance (MA);
52.21 	(iii) SNAP - Supplemental Nutrition Assistance Program;
52.22 	(iii) (iv) GA - General Assistance (GA);
52.23 	(iv) (v) EGA - Emergency General Assistance (EGA);
52.24 	(v) (vi) MSA - Minnesota Supplemental Aid (MSA);
52.25 	(vi) MSA-Emergency (vii) MSA-EA - MSA Emergency Assistance (MSA-EA);
52.26 	(vii) Supplemental Security Income (SSI);
52.27 	(viii) Energy Assistance; and
52.28 	(ix) (viii) EA - Emergency Assistance (EA);
52.29 	(ix) Energy or Fuel Assistance;
53.1 	(x) Work Participation Cash Benefit;
53.2 	(xi) MA - Medical Assistance;
53.3 	(xii) MinnesotaCare;
53.4 	(xiii) Medicare Part B - Premium Payments help;
53.5 	(xiv) Medicare Part D - Extra;
53.6 	(xv) SSI - Supplemental Security Income;
53.7 	(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
53.8 	Family Credit; and
53.9 	(xvii) Renter's Refund (also called Renter's Property Tax Credit);
53.10 	(7) wages. 100% is protected if you get government assistance based on need. Otherwise, 
53.11 	between 75-100% is protected depending on how much you earn;
53.12 	(8) retirement benefits - the total interest under all plans and contracts can't be more than 
53.13 	$81,000;
53.14 	(7) (9) Social Security benefits;
53.15 	(8) (10) unemployment benefits, workers' compensation, or veteran's veterans' benefits;
53.16 	(9) an accident, disability, or retirement (11) a retirement, disability, or accident pension 
53.17 	or annuity;
53.18 	(10) (12) life insurance proceeds that are not more than $54,000;
53.19 	(11) (13) earnings of your minor child; and
53.20 	(12) (14) money from a claim for damage or destruction of exempt property (such as - 
53.21 	like household goods, farm tools, business equipment, a manufactured (mobile) home, or 
53.22 	a car). car;
53.23 	(15) sacred possessions - like the Bible, Torah, Qur'an, prayer rug, and other religious 
53.24 	items. Total value can't be more than $2,000;
53.25 	(16) personal library - total value can't be more than $750;
53.26 	(17) musical instruments - total value can't be more than $2,000;
53.27 	(18) family pets - current value can't be more than $1,000;
53.28 	(19) a seat or pew in any house or place of public worship and a lot in any burial ground;
54.1 	(20) tools you need to work in your business or profession - the total value can't be more 
54.2 	than $13,500;
54.3 	(21) household tools and equipment - things like hand and power tools, snow removal 
54.4 	equipment, lawnmowers, and more. Total value can't be more than $3,000; and
54.5 	(22) health savings accounts, medical savings accounts - the total value can't be more 
54.6 	than $25,000.

54.7 	Sec. 13. Minnesota Statutes 2024, section 571.72, subdivision 10, is amended to read:
54.8 		Subd. 10.Exemption notice for prejudgment garnishment.
 54.9 	Exemption Notice
54.10 	Important Notice: A garnishment summons may be served on your employer, bank, 
54.11 	or other third parties. This can happen without any further court proceeding or notice to 
54.12 	you. See the attached Notice of Intent to Garnish for more information.
54.13 	The following money and wages Some of your money in your account may be 
54.14 	protected (the legal word is exempt) from garnishment:.
54.15 	1. Financial institutions/bank
54.16 	Some of the money in your account may be protected because you receive government 
54.17 	benefits from one or more of the following places:
54.18 	Earnings (Wages)
54.19 	ALL or SOME of my wages may be protected.
54.20 	... Some of my wages are protected because they were only deposited in my account in 
54.21 	the last 20 days.
54.22 	For wages that were deposited in your account within the last 20 days, the amount protected 
54.23 	is whichever is more:
54.24 	(i) 75 percent of your wages or more (after taxes are taken out), or
54.25 	(ii) The current minimum wage times 40 per week. You can find the current minimum 
54.26 	wage here: https://www.dli.mn.gov/minwage.
54.27 	All of my wages are protected because:
54.28 	... I get government benefits (a list of government benefits is on the next page)
54.29 	... I am getting other assistance based on need
55.1 	... I have gotten government benefits in the last 6 months
55.2 	... I was in jail or prison in the last 6 months
55.3 	If you check one of these four boxes, your wages are only protected for 60 days after they 
55.4 	are deposited in your account. You MUST send the creditor copies of bank statements
55.5 	that show what was in your account for the 60 days right before the bank froze your 
55.6 	money.
55.7 	Government Benefits
55.8 	Government benefits can include many things. For example:
55.9 	... MFIP - Minnesota Family Investment Program,
55.10 	... DWP - MFIP Diversionary Work Program,
55.11 	Work participation cash benefit,
55.12 	... SNAP - Supplemental Nutrition Assistance Program
55.13 	... GA - General Assistance,
55.14 	... EGA - Emergency General Assistance
55.15 	... MSA - Minnesota Supplemental Aid
55.16 	... MSA-EA - MSA Emergency Assistance
55.17 	... EA - Emergency Assistance,
55.18 	... Energy or Fuel Assistance
55.19 	... Work Participation Cash Benefit
55.20 	... MA - Medical Assistance,
55.21 	EGA - emergency general assistance or county crisis funds,
55.22 	MSA - Minnesota supplemental aid,
55.23 	MSA-EA - MSA emergency assistance,
55.24 	Supplemental Nutrition Assistance Program (SNAP),
55.25 	SSI - Supplemental Security Income,
55.26 	... MinnesotaCare,
55.27 	... Medicare Part B - Premium Payments, help
55.28 	... Medicare Part D - Extra help,
56.1 	... SSI - Supplemental Security Income
56.2 	Energy or fuel assistance,
56.3 	... Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working Family 
56.4 	Credit
56.5 	... Renter's Refund (also called Renter's Property Tax Credit)
56.6 	List the case number and county for every box you checked:

56.7	Case Number: ........
	County: ........
	
56.8	Case Number: ........
	County: ........
	
56.9	Case Number: ........
	County: ........
	
56.10 	Government benefits also include:
56.11 	... Social Security benefits,
56.12 	... Unemployment benefits,
56.13 	... Workers' compensation,
56.14 	Veterans ... Veterans' benefits.
56.15 	Sending the creditor's attorney (or creditor, if no attorney) a copy of BANK 
56.16 	STATEMENTS that show what was in your account for the past 60 days may give the 
56.17 	creditor enough information about your exemption claim to avoid a garnishment.
56.18 	2. Earnings
56.19 	All or some of your earnings may be completely protected from garnishment if:
56.20 	All of your earnings (wages) may be protected if:
56.21 	You get government benefits (see list of government benefits)
56.22 	You currently receive other assistance based on need
56.23 	You have received government benefits in the last six months
56.24 	You were in jail or prison in the last six months
56.25 	Your wages are only protected for 60 days after they are deposited in your account so 
56.26 	it would be helpful if you immediately send the undersigned creditor a copy of BANK 
56.27 	STATEMENTS that show what was in your account for the past 60 days.
56.28 	Some of your earnings (wages) may be protected if:
57.1 	If all of your earnings are not exempt, some of your earnings may still be protected for 
57.2 	20 days after they were deposited in your account. The amount protected is the larger amount 
57.3 	of:
57.4 	75 percent of your wages (after taxes are taken out); or
57.5 	(insert the sum of the current federal minimum wage) multiplied by 40.
57.6 	If you get any of these government benefits, include copies of any documents that show 
57.7 	you get them.
57.8 	... I get other assistance based on need that is not on the list. It comes from:........
57.9 	........
57.10 	Make sure you include copies of any documents that show this.
57.11 	Other Protected Funds
57.12 	The money from the following these things are also exempt for 20 days completely 
57.13 	protected after they are deposited in your my account.
57.14 	... Child Support
57.15 	An accident, disability, or retirement ... A retirement, disability, or accident pension 
57.16 	or annuity
57.17 	Payments to you from a life insurance policy
57.18 	... Earnings of your my child who is under 18 years of age
57.19 	... Payments to me from a life insurance policy
57.20 	Child support
57.21 	... Money paid to you me from a claim for damage or destruction of property. Property 
57.22 	includes household goods, farm tools or machinery, tools for your my job, business 
57.23 	equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, 
57.24 	or appliances.
57.25 	... Death benefits paid to you. me
57.26 	You WILL BE ABLE TO can claim these exemptions when you RECEIVE get a 
57.27 	notice. You will get the notice at least ten 10 days BEFORE a wage garnishment. BUT if 
57.28 	the creditor garnishes your bank account, you will not won't get the notice until AFTER the 
57.29 	account has been frozen. If you believe the money in your bank account or your wages are 
57.30 	exempt, YOU SHOULD IMMEDIATELY contact the person below right away. YOU 
58.1 	SHOULD Tell them why you think your account or wages are exempt to see if you can 
58.2 	avoid garnishment.

58.3	Creditor ........
	
58.4	Creditor Address ........
	
58.5	Creditor telephone number ........

58.6	Creditor's Name: ........
		
58.7	(or creditor's lawyer's name)
		
58.8	Street Address: ........
		
58.9	City/State/Zip: ........
		
58.10	Phone: ........
	Fax: ........
		
58.11	Email: ........

58.12 	Sec. 14. Minnesota Statutes 2024, section 571.74, is amended to read:
58.13 	571.74 GARNISHMENT SUMMONS AND NOTICE TO DEBTOR.
58.14 	The garnishment summons and notice to debtor must be substantially in the following 
58.15 	form. The notice to debtor must be in no smaller than 14-point type.

58.16	GARNISHMENT SUMMONS
	
58.17	STATE OF MINNESOTA
		DISTRICT COURT
	
58.18	COUNTY OF ........
		........ JUDICIAL DISTRICT
	
58.19	........ (Creditor)
			
58.20	........ (Debtor)
		UNPAID BALANCE ........
	
58.21	........ (Debtor's Address)
		Date of Entry
	
58.2258.23	........ (Garnishee)
		of Judgment (or) Subject to Minnesota 
Statutes, section 571.71, clause (2)

58.24	State of Minnesota
		District Court
	
58.25	County of: ........
		Judicial District: ........
	
58.26			Court File Number: ........
	
58.27			Case Type: ........
	
58.28	Creditor's full name
			
58.29	........
		Garnishment Summons
	
58.30	and
			
58.31	Debtor's full name
			
58.32	........
			
58.33	Third Party (bank, employer, or other)
			
58.34	........
			
58.35	Unpaid Balance: ........
			
59.1 	GARNISHMENT SUMMONS
59.2 	The State of Minnesota
59.3 	To the Garnishee Third Party (garnishee) named above:
59.4 	You are hereby summoned and required to serve upon the creditor's attorney (or the 
59.5 	creditor if not represented by an attorney) and on the debtor within 20 days after service of 
59.6 	this garnishment summons upon you, a written disclosure, of the nonexempt indebtedness, 
59.7 	money, or other property due or belonging to the debtor and owing by you or in your 
59.8 	possession or under your control and answers to all written interrogatories that are served 
59.9 	with the garnishment summons. However, if the garnishment is on earnings and the debtor 
59.10 	has garnishable earnings, you shall serve the completed disclosure form on the creditor's 
59.11 	attorney, or the creditor if not represented by an attorney, within ten days of the last payday 
59.12 	to occur within the 90 days after the date of the service of this garnishment summons. 
59.13 	"Payday" means the day which you pay earnings in the ordinary course of business. If the 
59.14 	debtor has no regular paydays, "payday" means the 15th day and the last day of each month.
59.15 	Your disclosure need not exceed 110 percent of the amount of the creditor's claim that 
59.16 	remains unpaid.
59.17 	You shall retain garnishable earnings, other indebtedness, money, or other property in 
59.18 	your possession in an amount not to exceed 110 percent of the creditor's claim until such 
59.19 	time as the creditor causes a writ of execution to be served upon you, until the debtor 
59.20 	authorizes you in writing to release the property to the creditor, or until the expiration of 
59.21 	...... days from the date of service of this garnishment summons upon you, at which time 
59.22 	you shall return the disposable earnings, other indebtedness, money, or other property to 
59.23 	the debtor.
59.24 	A court has ordered that you must serve a written statement to the creditor (or to the 
59.25 	creditor's lawyer). You must do this within 20 days after you get this notice. Your written 
59.26 	statement should include any money, or other property of the debtor that you have or owe 
59.27 	to them. It should also include answers to any questions that are in this summons.
59.28 	But, if the garnishment is on earnings and the debtor has earnings that can be garnished, 
59.29 	fill out the completed disclosure form. Then serve it on the creditor (or the creditor's lawyer). 
59.30 	It must be served within 10 days of the last payday within the 90 days after the date you 
59.31 	got this summons. If the debtor has no regular paydays, "payday" means the 15th day and 
59.32 	the last day of each month.
60.1 	You don't have to disclose more than 110% of the unpaid amount that is owed to the 
60.2 	creditor. Keep earnings that can be garnished, other indebtedness, money, or other property 
60.3 	in your possession in an amount not to exceed 110 percent of the creditor's claim. Keep this 
60.4 	until:
60.5 	(i) the creditor has a writ of execution served on you;
60.6 	(ii) the debtor gives you permission in writing to release the property to the creditor; or
60.7 	(iii) it's been ... days from the day you got this garnishment summons.
60.8 	Then you give the debtor back the disposable earnings, other indebtedness, money, or other 
60.9 	property.
60.10 	Earnings
60.11 	In the event If you are summoned as a garnishee because you owe "earnings" (as defined 
60.12 	on the Earnings Garnishment Disclosure form attached to this Garnishment Summons, if 
60.13 	applicable) to the debtor, then you are required to must serve upon the creditor's attorney, 
60.14 	or the creditor if not represented by an attorney, a written an Earnings Disclosure Form 
60.15 	within on the creditor (or the creditor's lawyer). The Earnings Disclosure Form must be in 
60.16 	writing and must be served in the time limit set forth above. "Earnings" are defined on the 
60.17 	Earnings Garnishment Disclosure Form attached to this Garnishment Summons.
60.18 	In the case of earnings, you are further required to retain in your possession must keep
60.19 	all unpaid, nonexempt disposable earnings owed or to be owed by you and earned or to be 
60.20 	earned that you owe or will owe to the debtor within during the pay period in which when
60.21 	this garnishment summons notice is served and within all subsequent pay periods whose 
60.22 	paydays (defined above) occur within the 90 days after the date of service of this garnishment 
60.23 	summons delivered and for all pay periods within 90 days after this notice is served.
60.24 	Any assignment of earnings made by the debtor to any party within ten days before the 
60.25 	receipt of the first garnishment on a debt is void. Any indebtedness to you incurred by the 
60.26 	debtor within the ten days before the receipt of the first garnishment on a debt may not be 
60.27 	set off against amounts otherwise subject to the garnishment.
60.28 	Any transfer of earnings made by the debtor to someone else within 10 days before the 
60.29 	first garnishment notice is invalid. Any debt the debtor owes you from within those 10 days 
60.30 	can't be used to lower the amount that can be garnished.
60.31 	You are prohibited By law from discharging or disciplining you can't fire or discipline
60.32 	the debtor because the debtor's their earnings have been subject to garnishment.
61.1 	This Garnishment Summons includes:
61.2 	(check applicable box the boxes that apply)

61.3	........
		Earnings garnishment (see attached Earnings Disclosure Form)
		
61.4	........
		Nonearnings garnishment (see attached Nonearnings Disclosure Form)
		
61.561.6	........
		Both Earnings and Nonearnings garnishment (see both attached Earnings and 
Nonearnings Disclosure Form)
		
61.7 	Notice to Debtor
61.8 	You are being served copies of a Garnishment Summons, Earnings Garnishment 
61.9 	Disclosure Form, Nonwage Garnishment Disclosure Form, Garnishment Exemption Notices 
61.10 	and/or written Interrogatories (strike out if not applicable),. Copies of which are hereby 
61.11 	served on you, were served upon the Garnishee by delivering copies these same documents 
61.12 	were also delivered to the Garnishee. The Garnishee was paid $15.

61.13	Dated: ........
		........
		
61.14			Attorney for Creditor (or creditor)
		
61.15			........
		
61.16			........
		
61.17			........
		
61.18			Address
		
61.19			........
		
61.20			Telephone
		
61.21			........
		
61.22			Attorney I.D. No

61.23	Date: ........
		
61.24	Creditor's Signature: ........
		
61.25	(or creditor's lawyer's signature)
		
61.26	Creditor's Name: ........
		
61.27	(or creditor's lawyer's name)
		
61.28	Street Address: ........
		
61.29	City/State/Zip: ........
		
61.30	Phone: ........
	Fax: ........
		
61.31	Email: ........

61.32 	Sec. 15. Minnesota Statutes 2024, section 571.75, subdivision 2, is amended to read:
61.33 		Subd. 2.Contents of disclosure. The disclosure must state:
62.1 	(a) If an earnings garnishment disclosure, the amount of disposable earnings earned by 
62.2 	the debtor within the debtor's pay periods as specified in section 571.921.
62.3 	(b) If a nonearnings garnishment disclosure, a description of any personal property or 
62.4 	any instrument or papers relating to this property belonging to the judgment debtor or in 
62.5 	which the debtor is interested or other indebtedness of the garnishee to the debtor.
62.6 	(c) If the garnishee asserts any setoff, defense, claim, or lien on disposable earnings, 
62.7 	other indebtedness, money, or property, the garnishee shall disclose the amount and the 
62.8 	facts concerning the same.
62.9 	(d) Whether the debtor asserts any exemption, or any other objection, known to the 
62.10 	garnishee against the right of the creditor to garnish the disposable earnings, other 
62.11 	indebtedness, money, or property disclosed.
62.12 	(e) If other persons assert claims to any disposable earnings, other indebtedness, money, 
62.13 	or property disclosed, the garnishee shall disclose the names and addresses of these claimants 
62.14 	and, so far as known by the garnishee, the nature of their claims.
62.15 	(f) The garnishment disclosure forms and earnings disclosure worksheet must be the 
62.16 	same or substantially similar to the following forms. If the garnishment affects earnings of 
62.17 	the debtor, the creditor shall use the earnings garnishment disclosure form. If the garnishment 
62.18 	affects any indebtedness, money, or property of the debtor, other than earnings, the creditor 
62.19 	shall use the nonearnings garnishment disclosure form. Nothing contained in this paragraph 
62.20 	limits the simultaneous use of the earnings and nonearnings garnishment disclosure forms.
62.21 	EARNINGS DISCLOSURE FORM AND WORKSHEET

62.22	STATE OF MINNESOTA
		DISTRICT COURT
	
62.23	COUNTY OF ........
		........ JUDICIAL DISTRICT
	
62.24	........ (Creditor)
			
62.25	........ (Debtor)
		GARNISHMENT
	
62.26	........ (Garnishee)
		EARNINGS DISCLOSURE

62.27	State of Minnesota
		District Court
	
62.28	County of: ........
		Judicial District: ........
	
62.29			Court File Number: ........
	
62.30			Case Type: ........
	
62.31	Creditor's full name
			
62.32	........
		Garnishment Earnings Disclosure
	
62.33	and
		For Non-Child Support Judgments
	
62.34	Debtor's full name
			
63.1	........
			
63.2	Third Party (bank, employer, or other)
			
63.3	........
			
63.4 	This form is called a "Garnishment Earnings Disclosure" or "Disclosure." It is for the 
63.5 	employer to fill out. The "debtor" is the person who owes money. The debtor gets a copy 
63.6 	of this form for their own information. The debtor is also called a "judgment debtor."
63.7 	The "creditor" is the party owed the money. The creditor is also called a "judgment 
63.8 	creditor."
63.9 	The "employer" is the "third party" or "garnishee." If the debtor asks how the calculations 
63.10 	in this document were made, the employer must provide information about it.
63.11 	Definitions
63.12 	"Earnings": For the purpose of garnishment, "earnings" means compensation what is
63.13 	paid or payable to an employee, independent contractor or self-employed person for personal 
63.14 	services or (a job). Also called compensation. Compensation can be wages, salary, 
63.15 	commission, bonus, payments, profit-sharing distributions, severance payment, fees or 
63.16 	other. It includes periodic payments from a pension or retirement. It can also be compensation
63.17 	paid or payable to the a producer for the sale of agricultural products;. This can be things 
63.18 	like milk or milk products;, or fruit or other horticultural products. Or things produced when 
63.19 	the producer is operating in the operation of a family farm, a family farm corporation, or 
63.20 	an authorized farm corporation, as. This is defined in section 500.24, subdivision 2, whether 
63.21 	denominated as wages, salary, commission, bonus, or otherwise, and includes periodic 
63.22 	payments pursuant to a pension or retirement.
63.23 	"Disposable Earnings": Means that the part of the a person's earnings of an individual 
63.24 	remaining after the deduction from those earnings of that are left after subtracting the
63.25 	amounts required by law to be withheld. (AmountsNote: Amounts required by law to be 
63.26 	withheld do not include items such as things like health insurance, charitable contributions, 
63.27 	or other voluntary wage deductions.)
63.28 	"Payday": For the purpose of garnishment, "payday(s)" means the date(s) upon which
63.29 	the date when the employer pays earnings to the debtor in the ordinary course of business
63.30 	for doing their job. If the debtor has no regular payday, payday(s) then "payday" means the 
63.31 	fifteenth 15th and the last day of each month.
63.32 	The Employer/Garnishee Must Answer The Following Questions:
64.1 	1. Do you Right now owe, or within 90 days from the date the garnishment summons 
64.2 	was served on you, will you or, do you expect to owe money to the debtor for earnings?

64.3		Yes .....
		No .....

64.4		Yes .....
		No .....
		
64.5 	2. Within 90 days from the date you were served with the garnishment, will you or may 
64.6 	you owe money to the debtor for earnings?

64.7		Yes .....
		No .....
		
64.8 	2 3. Does the debtor earn more than $........ per week? (This amount is the greater of 
64.9 	$9.50 per hour or the current Minnesota or federal minimum wage per week.)? (use the 
64.10 	number that is more)

64.11		Yes .....
		No .....

64.12		Yes .....
		No .....
		
64.13 	INSTRUCTIONS FOR COMPLETING THE
64.14 	EARNINGS DISCLOSURE
64.15 	A. If your answer to either question 1 or 2 is "No," then you must sign the affirmation 
64.16 	on Page 2 and return this disclosure to the creditor's attorney (or the creditor if not represented 
64.17 	by an attorney) within 20 days after it was served on you, and you do not need to answer 
64.18 	the remaining questions.
64.19 	B. If your answers to both questions 1 and 2 are "Yes," you must complete this form 
64.20 	and the Earnings Disclosure Worksheet as follows:
64.21 	A. If you answer "No" to question 1, 2, or 3, you don't need to answer the rest of the 
64.22 	questions. You don't have to do the Earnings Disclosure Worksheet. Sign the Earnings 
64.23 	Disclosure Affirmation below and return this disclosure form to the creditor's attorney (or 
64.24 	the creditor if not represented by an attorney). You must return it within 20 days after it 
64.25 	was served on you.
64.26 	B. If you answer "Yes" to question 1 or 2, and "Yes" to question 3, sign the Earnings 
64.27 	Disclosure Affirmation below. You must return it to the creditor's attorney (or the creditor 
64.28 	if not represented by an attorney) within 20 days. You must also fill out the rest of this form. 
64.29 	Read the instructions for the Earnings Disclosure Worksheet.
64.30 	Earnings Disclosure Affirmation
65.1 	I, ........................ (person signing Affirmation), am the third party/employer or I am 
65.2 	authorized by the third party/employer to complete this earnings disclosure and have done 
65.3 	so truthfully and to the best of my knowledge.

65.4	Date: ........
		
65.5	Signature of Third Party/Employer:
		
65.6	........
		
65.7	Title: ........
		
65.8	Phone: ........
		
65.9 	Instructions for Completing the Earnings Disclosure Worksheet
65.10 	For each payday that falls within 90 days from the date the garnishment summons was 
65.11 	served on you, you must calculate the amount of earnings to be retained by completing 
65.12 	Steps 3 through 11, and enter the amounts on the Earnings Disclosure Worksheet. UPON 
65.13 	REQUEST, THE EMPLOYER MUST PROVIDE THE DEBTOR WITH 
65.14 	INFORMATION AS TO HOW THE CALCULATIONS REQUIRED BY THIS 
65.15 	DISCLOSURE WERE MADE. withheld. Enter the amounts on the Earnings Disclosure 
65.16 	Worksheet.
65.17 	Each payday, you must retain the amount of earnings listed in Column I on the Earnings 
65.18 	Disclosure Worksheet.
65.19 	You must return this Earnings Disclosure Form and the Earnings Disclosure Worksheet 
65.20 	to the creditor's attorney (or the creditor if not represented by an attorney) and deliver 
65.21 	a copy to the debtor within ten days after the last payday that falls within the 90-day 
65.22 	period.
65.23 	If the claim is wholly satisfied or if the debtor's employment ends before the expiration 
65.24 	of the 90-day period, your disclosure should be made within ten days after the last payday 
65.25 	for which earnings were attached.
65.26 	For Steps 3 through 11, "Columns" refers to columns on the Earnings Disclosure Worksheet.

65.27	3.
	COLUMN A.
		Enter the date of debtor's payday.
	
65.28	4.
	COLUMN B.
		Enter debtor's gross earnings for each payday.
	
65.29	5.
	COLUMN C.
		Enter debtor's disposable earnings for each payday.
	
65.3065.31	6.
	COLUMN D.
		Enter 25 percent of disposable earnings. (Multiply 
Column C by .25.)
	
65.3265.33
65.34
65.35
65.36
66.1
66.2
66.3	7.
	COLUMN E.
		Enter here the greater of 40 times $9.50 or 40 times the 
hourly federal minimum wage ($..........) times the 
number of work weeks included in each payday. (Note: 
If a pay period includes days in excess of whole work 
weeks, the additional days should be counted as a 
fraction of a work week equal to the number of 
workdays in excess of a whole work week divided by 
the number of workdays in a normal work week.)
	
66.466.5	8.
	COLUMN F.
		Subtract the amount in Column E from the amount in 
Column C, and enter here.
	
66.666.7	9.
	COLUMN G.
		Enter here the lesser of the amount in Column D and 
the amount in Column F.
	
66.866.966.10
66.11
66.12
66.13
66.14
66.15
66.16
66.17
66.18
	10.
	COLUMN H.
		Enter here any amount claimed by you as a setoff, 
defense, lien, or claim, or any amount claimed by any 
other person as an exemption or adverse interest which 
would reduce the amount of earnings owing to the 
debtor. (Note: Any indebtedness to you incurred by the 
debtor within the ten days before the receipt of the first 
garnishment on a debt may not be set off against 
amounts otherwise subject to the garnishment. Any 
assignment of earnings made by the debtor to any party 
within ten days before the receipt of the first 
garnishment on a debt is void.)
	
66.19
66.20
66.21
66.22				You must also describe your claim(s) and the claims of 
others, if known, in the space provided below the 
worksheet and state the name(s) and address(es) of these 
persons.
	
66.23
66.24
66.25				Enter zero in Column H if there are no claims by you 
or others which would reduce the amount of earnings 
owing to the debtor.
	
66.2666.27
66.28
66.29	11.
	COLUMN I.
		Subtract the amount in Column H from the amount in 
Column G and enter here. This is the amount of earnings 
that you must retain for the payday for which the 
calculations were made.
	
66.30 	AFFIRMATION
66.31 	I, ...................... (person signing Affirmation), am the garnishee or I am authorized by 
66.32 	the garnishee to complete this earnings disclosure, and have done so truthfully and to the 
66.33 	best of my knowledge.

66.34	Dated: ........
		........
	
66.35			Signature
	
66.36			........
	
66.37			Title
	
66.38			........
	
66.39			Telephone Number
	
66.40 	EARNINGS DISCLOSURE WORKSHEET
66.41 	.............................
66.42 	Debtor's Name
67.1 	You must:
67.2 	1. Withhold the amount of earnings listed in column I on the Earnings Disclosure 
67.3 	Worksheet each payday.
67.4 	2. After 90 days, return this Earnings Disclosure Worksheet to the creditor's attorney 
67.5 	(or the creditor if not represented by an attorney). Include all the money withheld. Sign the 
67.6 	Affirmation at the end of the worksheet before returning.
67.7 	3. Deliver a copy of the disclosure and worksheet to the debtor within 10 days after the 
67.8 	last payday that falls within the 90-day period.
67.9 	If the debt (judgment) is fully paid off or if the debtor's job ends before the 90-day period 
67.10 	is over, you need to do the last disclosure and withholdings within 10 days of their last 
67.11 	payday that you withheld money.
67.12 	Calculating Percentage of Disposable Earnings
67.13 	Note to Creditor: You must fill out this chart before sending this form to the employer. 
67.14 	Use the current minimum wage found online at: https://www.dli.mn.gov/minwage.
67.15 	Minimum Wage = $MW/hour.

67.1767.16
		if the weekly gross earnings are:
	then this percentage of the disposable 
earnings are withheld:
		
67.18		Less than [40 X MW]
	0%
		
67.19		[40 X MW + .01] to [60 X MW]
	10%
		
67.20		[60 X MW + .01] to [80 X MW]
	15%
		
67.21		[80 X MW + .01] or more
	25%
		
67.22 	Employer: Use this creditor's calculation chart to know what percentage of earnings 
67.23 	should be withheld.
67.24 	Earnings Disclosure Worksheet

67.25	........
		
67.26	Debtor's Name

67.27	A
			B
		C
	
67.2867.29	Payday Date
		Gross Earnings
		Disposable 
Earnings
	
67.30	1.
	........
		$........
		$........
	
67.31	2.
	........
		........
		........
	
67.32	3.
	........
		........
		........
	
67.33	4.
	........
		........
		........
	
68.1	5.
	........
		........
		........
	
68.2	6.
	........
		........
		........
	
68.3	7.
	........
		........
		........
	
68.4	8.
	........
		........
		........
	
68.5	9.
	........
		........
		........
	
68.6	10.
	........
		........
		........
	
68.7 	Column A. Enter the debtor's payday.
68.8 	Column B. Enter the debtor's gross earnings for each payday.
68.9 	Column C. Enter the debtor's disposable earnings for each payday.

68.10	D
			E
		F
	
68.11
68.12
68.13
68.14	25% of withholding 
of Column C
(Use the creditor's 
calculation chart)
		Greater of 40 X 
$9.50 or 40 X
MN or Fed. Min. 
Wage
		Column C minus 
Column E

68.15	1.
	........
		........
		........
	
68.16	2.
	........
		........
		........
	
68.17	3.
	........
		........
		........
	
68.18	4.
	........
		........
		........
	
68.19	5.
	........
		........
		........
	
68.20	6.
	........
		........
		........
	
68.21	7.
	........
		........
		........
	
68.22	8.
	........
		........
		........
	
68.23	9.
	........
		........
		........
	
68.24	10.
	........
		........
		........
	
68.25 	Column D. Enter the percentage of disposable earnings that will be withheld. Get this 
68.26 	number from the creditor's calculation chart.
68.27 	Column E. Calculate 40 times the current Minnesota minimum wage (or 40 times the 
68.28 	current federal minimum wage) times the number of work weeks in each payday. Enter the 
68.29 	bigger number here. Note: If a payday has extra days that are more than a full work week, 
68.30 	count those extra days as part of a work week. Do this by dividing the number of extra 
68.31 	workdays by the number of workdays in a normal week.
68.32 	Column F. Subtract the amount in column E from the amount in column C and enter 
68.33 	here.

69.1	G
			H
		I
	
69.3
69.469.2
	Lesser of Column D 
and Column F
		Setoff, Lien, 
Adverse Interest, 
or Other Claims
		Column G minus 
Column H

69.5	1.
	........
		........
		........
	
69.6	2.
	........
		........
		........
	
69.7	3.
	........
		........
		........
	
69.8	4.
	........
		........
		........
	
69.9	5.
	........
		........
		........
	
69.10	6.
	........
		........
		........
	
69.11	7.
	........
		........
		........
	
69.12	8.
	........
		........
		........
	
69.13	9.
	........
		........
		........
	
69.14	10.
	........
		........
		........
	
69.15				Total of Column I=
	$ ........
	
69.16 	Column G. Look at column D and column F. Enter the smaller amount of the two here 
69.17 	in column G.
69.18 	Column H. Enter any amount claimed by you that would lower the amount of earnings 
69.19 	that will go to the debtor. Things like:
69.20 	(i) a setoff,
69.21 	(ii) a defense,
69.22 	(iii) a lien,
69.23 	(iv) a claim, or
69.24 	(v) any amount claimed by any other person as an exemption or adverse interest.
69.25 	Note: You must describe your claim(s) and the claims of others, if known, in the spaces 
69.26 	after this worksheet.
69.27 	Enter zero in column H if there are no claims by you or others which would lower the 
69.28 	amount of earnings owed to the debtor.
69.29 	Note: Any debt that happened within 10 days before you got the first garnishment on a 
69.30 	debt may not be set off against the earnings that are affected by this garnishment. Any wage 
69.31 	assignment made by the debtor within 10 days before you got the first garnishment on a 
69.32 	debt is void. Wage assignment is when a debtor voluntarily agrees to money being taken 
69.33 	out of their earnings.
70.1 	Column I. Subtract the amount in column H from the amount in column G and enter 
70.2 	here. This is the amount of earnings that go to the creditor.
70.3 	*If you entered any amount in Column H for any payday(s), you must payday, describe 
70.4 	those claims below either. It doesn't matter if they are your claims, or the claims of others. 
70.5 	For amounts claimed claims by others you must both state, list the names and addresses of 
70.6 	these persons each, and the nature of describe their claim claims, if known you know.
70.7 	........
70.8 	........
70.9 	........
70.10 	AFFIRMATION
70.11 	Earnings Worksheet Affirmation
70.12 	I, ........................ (person signing Affirmation), am the third party party/employer or I 
70.13 	am authorized by the third party party/employer to complete this earnings disclosure 
70.14 	worksheet, and have done so truthfully and to the best of my knowledge.

70.15	Dated: ........
		
70.16	Signature ........
		
70.17	Title ........
		
70.18	Telephone Number (....) ........

70.19	Date: ........
		
70.20	Third Party's Name: ........
		
70.21	Third Party's Signature: ........
		
70.22	Phone: ........
	Fax: ........
		
70.23	Email: ........
		
70.24 	EARNINGS DISCLOSURE FORM AND WORKSHEET
70.25 	FOR CHILD SUPPORT DEBTOR

70.26	STATE OF MINNESOTA
		DISTRICT COURT
	
70.27	COUNTY OF ........
		........ JUDICIAL DISTRICT
	
70.28	........ (Creditor)
			
70.29	........ (Debtor)
		GARNISHMENT
	
70.30	........ (Garnishee)
		EARNINGS DISCLOSURE
	
70.31 	DEFINITIONS
71.1 	"EARNINGS": For the purpose of execution, "earnings" means compensation paid or 
71.2 	payable to an employee for personal services or compensation paid or payable to the producer 
71.3 	for the sale of agricultural products; milk or milk products; or fruit or other horticultural 
71.4 	products produced when the producer is operating a family farm, a family farm corporation, 
71.5 	or an authorized farm corporation, as defined in section 500.24, subdivision 2, whether 
71.6 	denominated as wages, salary, commission, bonus, or otherwise, and includes periodic 
71.7 	payments pursuant to a pension or retirement, workers' compensation, or unemployment 
71.8 	benefits.
71.9 	"DISPOSABLE EARNINGS": Means that part of the earnings of an individual remaining 
71.10 	after the deduction from those earnings of amounts required by law to be withheld. (Amounts 
71.11 	required by law to be withheld do not include items such as health insurance, charitable 
71.12 	contributions, or other voluntary wage deductions.)
71.13 	"PAYDAY": For the purpose of execution, "payday(s)" means the date(s) upon which 
71.14 	the employer pays earnings to the debtor in the ordinary course of business. If the judgment 
71.15 	debtor has no regular payday, payday(s) means the 15th and the last day of each month.
71.16 	THE GARNISHEE MUST ANSWER THE FOLLOWING QUESTION:
71.17 	(1) Do you now owe, or within 90 days from the date the execution levy was served on 
71.18 	you, will you or may you owe money to the debtor for earnings?

71.19		Yes ........
		No ........
		
71.20 	INSTRUCTIONS FOR COMPLETING THE
71.21 	EARNINGS DISCLOSURE
71.22 	A. If your answer to question 1 is "No," then you must sign the affirmation below and 
71.23 	return this disclosure to the creditor's attorney (or the creditor if not represented by an 
71.24 	attorney) within 20 days after it was served on you, and you do not need to answer the 
71.25 	remaining questions.
71.26 	B. If your answer to question 1 is "Yes," you must complete this form and the Earnings 
71.27 	Disclosure Worksheet as follows:
71.28 	For each payday that falls within 90 days from the date the garnishment summons was 
71.29 	served on you, YOU MUST calculate the amount of earnings to be retained by completing 
71.30 	steps 2 through 8 on page 2, and enter the amounts on the Earnings Disclosure Worksheet. 
71.31 	UPON REQUEST, THE EMPLOYER MUST PROVIDE THE DEBTOR WITH 
71.32 	INFORMATION AS TO HOW THE CALCULATIONS REQUIRED BY THIS 
71.33 	DISCLOSURE WERE MADE.
72.1 	Each payday, you must retain the amount of earnings listed in column G on the Earnings 
72.2 	Disclosure Worksheet.
72.3 	You must pay the attached earnings and return this earnings disclosure form and the 
72.4 	Earnings Disclosure Worksheet to the creditor's attorney (or the creditor if not represented 
72.5 	by an attorney) and deliver a copy to the debtor within ten days after the last payday 
72.6 	that falls within the 90-day period. If the claim is wholly satisfied or if the debtor's 
72.7 	employment ends before the expiration of the 90-day period, your disclosure should be 
72.8 	made within ten days after the last payday for which earnings were attached.
72.9 	For steps 2 through 8, "columns" refers to columns on the Earnings Disclosure Worksheet.
72.10 	(2) COLUMN A. Enter the date of debtor's payday.
72.11 	(3) COLUMN B. Enter debtor's gross earnings for each payday.
72.12 	(4) COLUMN C. Enter debtor's disposable earnings for each payday.
72.13 	(5) COLUMN D. Enter either 50, 55, 60, or 65 percent of disposable earnings, based 
72.14 	on which of the following descriptions fits the child support judgment debtor:
72.15 	(a) 50 percent of the judgment debtor's disposable income, if the judgment debtor is 
72.16 	supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks 
72.17 	to be calculated to the beginning of the work week in which the execution levy is received);
72.18 	(b) 55 percent of the judgment debtor's disposable income, if the judgment debtor is 
72.19 	supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks 
72.20 	to be calculated to the beginning of the work week in which the execution levy is received);
72.21 	(c) 60 percent of the judgment debtor's disposable income, if the judgment debtor is not 
72.22 	supporting a spouse or dependent child and the judgment is 12 weeks old or less (12 weeks 
72.23 	to be calculated to the beginning of the work week in which the execution levy is received); 
72.24 	or
72.25 	(d) 65 percent of the judgment debtor's disposable income, if the judgment debtor is not 
72.26 	supporting a spouse or dependent child, and the judgment is over 12 weeks old (12 weeks 
72.27 	to be calculated to the beginning of the work week in which the execution levy is received). 
72.28 	(Multiply column C by .50, .55, .60, or .65, as appropriate.)
72.29 	(6) COLUMN E. Enter here any amount claimed by you as a setoff, defense, lien, or 
72.30 	claim, or any amount claimed by any other person as an exemption or adverse interest that 
72.31 	would reduce the amount of earnings owing to the debtor. (Note: Any assignment of earnings 
72.32 	made by the debtor to any party within ten days before the receipt of the first garnishment 
73.1 	on a debt is void. Any indebtedness to you incurred by the debtor within the ten days before 
73.2 	the receipt of the first garnishment on a debt may not be set off against amounts otherwise 
73.3 	subject to the garnishment.)
73.4 	You must also describe your claim(s) and the claims of others, if known, in the space 
73.5 	provided below the worksheet and state the name(s) and address(es) of these persons.
73.6 	Enter zero in column E if there are no claims by you or others that would reduce the 
73.7 	amount of earnings owing to the judgment debtor.
73.8 	(7) COLUMN F. Subtract the amount in column E from the amount in column D and 
73.9 	enter here. This is the amount of earnings that you must remit for the payday for which the 
73.10 	calculations were made.
73.11 	AFFIRMATION
73.12 	I, ................... (person signing Affirmation), am the garnishee or I am authorized by the 
73.13 	garnishee to complete this earnings disclosure, and have done so truthfully and to the best 
73.14 	of my knowledge.

73.15	Dated: ........
		........
		
73.16			Signature
		
73.17			........
		
73.18			Title
		
73.19			........
		
73.20			Telephone Number
		
73.21
73.22	EARNINGS DISCLOSURE 
WORKSHEET
		........
		
73.23			Debtor's Name

73.24	A
			B
		C
	
73.2573.26	Payday Date
		Gross Earnings
		Disposable 
Earnings
	
73.27	1.
	........
		$........
		$........
	
73.28	2.
	........
		........
		........
	
73.29	3.
	........
		........
		........
	
73.30	4.
	........
		........
		........
	
73.31	5.
	........
		........
		........
	
73.32	6.
	........
		........
		........
	
73.33	7.
	........
		........
		........
	
73.34	8.
	........
		........
		........
	
74.1	9.
	........
		........
		........
	
74.2	10.
	........
		........
		........

74.3	D
			E
		F
	
74.4
74.574.6	Either 50, 55, 60, or 
65% of Column C
		Setoff, Lien, 
Adverse Interest, 
or Other Claims
		Column D minus 
Column E
	
74.7	1.
	........
		........
		........
	
74.8	2.
	........
		........
		........
	
74.9	3.
	........
		........
		........
	
74.10	4.
	........
		........
		........
	
74.11	5.
	........
		........
		........
	
74.12	6.
	........
		........
		........
	
74.13	7.
	........
		........
		........
	
74.14	8.
	........
		........
		........
	
74.15	9.
	........
		........
		........
	
74.16	10.
	........
		........
		........
	
74.17				TOTAL OF COLUMN F $........
	
74.18 	*If you entered any amount in column E for any payday(s), you must describe below 
74.19 	either your claims, or the claims of others. For amounts claimed by others, you must both 
74.20 	state the names and addresses of such persons, and the nature of their claim, if known.
74.21 	........
74.22 	........
74.23 	........
74.24 	AFFIRMATION
74.25 	I, ................. (person signing Affirmation), am the third party or I am authorized by the 
74.26 	third party to complete this earnings disclosure worksheet, and have done so truthfully and 
74.27 	to the best of my knowledge.

74.28			........
	
74.29			Signature
	
74.30	Dated: ........
	........
	(....) ........
	
74.31		Title
	Phone Number
	
74.32 	NONEARNINGS DISCLOSURE FORM

74.33	STATE OF MINNESOTA
		DISTRICT COURT
	
74.34	COUNTY OF ........
		........ JUDICIAL DISTRICT
	
75.1	........ (Creditor)
			
75.2	against
			
75.3	........ (Debtor)
		NONEARNINGS DISCLOSURE
	
75.4	and
			
75.5	........ (Garnishee)
			
75.6 	On the ......... day of .............., ............, the time of service of garnishment summons 
75.7 	herein, there was due and owing the debtor from the garnishee the following:

75.8	State of Minnesota
		District Court
	
75.9	County of: ........
		Judicial District: ........
	
75.10			Court File Number: ........
	
75.11			Case Type: ........
	
75.12	Creditor's full name
			
75.13	........
		Non-Earnings Disclosure
	
75.14	against
		For Non-Child Support Judgments
	
75.15	Debtor's full name
			
75.16	........
			
75.17	and
			
75.18	Third Party (bank, employer, or other)
			
75.19	........
			
75.20 	This form is called a "Non-Earnings Disclosure" or "Disclosure." It is being sent to you 
75.21 	because you might be holding property that belongs to the debtor, or you might owe money 
75.22 	to the debtor.
75.23 	You are the "third party" or "garnishee." The "debtor" is the person who owes money. 
75.24 	The debtor is also called the "judgment debtor." The "creditor" is the person the debtor owes 
75.25 	money to. The creditor is also called the "judgment creditor." The debtor owes $.................. 
75.26 	to the creditor.
75.27 	You must list any money or property you owe the debtor on the lines below and sign 
75.28 	the affirmation. Write "none" on the line if that is your answer. You must then return this 
75.29 	disclosure to the creditor (or the creditor's lawyer) within 20 days after you got it.
75.30 	Fill in the date you got this disclosure:

75.31	........ (month)
	........ (day),
	........ (year)
		
75.32 	On the date you got this disclosure, you owed the debtor:
76.1 	(1) Money. Enter on the line below any amounts due and owing the debtor, except 
76.2 	earnings, from the garnishee Write down the amount of money you owe the debtor (except 
76.3 	earnings).
76.4 	........
76.5 	(2) Property. Describe on the line below Write a short description of any personal 
76.6 	property, instruments, or papers belonging to the debtor and in the possession of the garnishee
76.7 	that you have in your possession. List the monetary value of each thing.
76.8 	........
76.9 	(3) Setoff. Enter on the line below the amount of any If you claim a setoff, defense, lien, 
76.10 	or claim which the garnishee claims against the amount set forth on lines (1) and (2) above
76.11 	enter that amount on the line below. State the facts by which the setoff, defense, lien, or
76.12 	about your claim is claimed. (Any indebtedness to a garnishee incurred by the debtor within 
76.13 	the ten days before the receipt of the first garnishment on a debt may not be set off against 
76.14 	amounts otherwise subject to the garnishment.)Note: Any payment the debtor makes to 
76.15 	the garnishee within the 10 days before they get the first garnishment order on that debt 
76.16 	can't be used to lower the amount that is being garnished.
76.17 	........
76.18 	(4) Exemption. Enter on the line below any amounts or property claimed by the debtor 
76.19 	to be exempt from execution that the debtor claims is exempt on the line below.
76.20 	........
76.21 	(5) Adverse Interest. Enter on the line below any amounts claimed by other persons by 
76.22 	reason of ownership or interest in the debtor's property of the debtor's property that other 
76.23 	people claim they own or have interest in.
76.24 	........
76.25 	(6) Enter on the line below the total of lines (3), (4), and (5) on the line below.
76.26 	........
76.27 	(7) Enter on the line below the difference obtained (never less than zero) when line (6) 
76.28 	is subtracted from the sum of lines (1) and (2) on the line below.
76.29 	........
76.30 	(8) Enter on the line below Figure out 110 percent of the amount of the creditor's claim 
76.31 	which remains is still unpaid. Enter it on the line below.
77.1 	........
77.2 	(9) Enter on the line below the lesser of line Look at (7) and line (8). Retain Put the 
77.3 	smaller number on the line below. Hold this amount only if it is $10 or more.
77.4 	........
77.5 	AFFIRMATION
77.6 	I, .......................... (person signing Affirmation), am the garnishee or I am authorized 
77.7 	by the garnishee to complete this nonearnings garnishment disclosure, and. I have done so 
77.8 	truthfully and to the best of my knowledge.

77.9	Dated: ........
		........
		
77.10			Signature
		
77.11			........
		
77.12			Title
		
77.13			........
		
77.14			Telephone Number

77.15	Date: ........
		
77.16	Name: ........
		
77.17	Signature: ........
		
77.18	Title: ........
		
77.19	Phone: ........
	Email: ........

77.20 	Sec. 16. Minnesota Statutes 2024, section 571.912, is amended to read:
77.21 	571.912 FORM OF NOTICE, INSTRUCTIONS, AND EXEMPTION NOTICE.
77.22 		Subdivision 1.Form of notice. The notice, instructions, and exemption notice informing 
77.23 	a debtor that a garnishment summons has been used to attach funds of the debtor to satisfy 
77.24 	a claim must be a separate notice and must be substantially in the following form:

77.25	STATE OF MINNESOTA
		DISTRICT COURT
	
77.26	COUNTY OF ........
		........JUDICIAL DISTRICT
	
77.27	........(Creditor)
			
77.28	........(Debtor)
			
77.29	........(Financial institution)

77.30	State of Minnesota
		District Court
	
77.31	County of: ........
		Judicial District: ........
	
77.32			Court File Number: ........
	
77.33			Case Type: ........
	
78.1	Creditor's full name
			
78.2	........
			
78.3	Debtor's full name
			
78.4	........
			
78.5	Third Party (bank, employer, or other)
			
78.6	........
			
78.7 	Important Notice
78.8 	YOUR FUNDS HAVE BEEN GARNISHED
78.9 	Money in Your Account Has Been Frozen
78.10 	The Creditor has frozen money in your account at your financial institution bank.
78.11 	Your account balance is $.......
78.12 	The amount being held is $.......
78.13 	The amount being held will be is frozen for 14 days from the date of this notice.
78.14 	Some of your money in your account may be protected (the legal word is exempt). 
78.15 	You may be able to get it sooner than 14 days if you act quickly and follow the 
78.16 	instructions on the next page.
78.17 	The attached exemption form lists some different sources of ways money in your account 
78.18 	that may be protected. If your money is comes from one or more of these sources, place a 
78.19 	benefit on the list, put a check on the line on the form next to the sources of your money. 
78.20 	If it is from one of these sources, next to it. The creditor cannot can't take it.
78.21 	BUT, if you want the bank to unfreeze your money, you must follow the instructions 
78.22 	and return the exemption form and with copies of your bank statements from the last 
78.23 	60 daysto have the bank unfreeze your money. Instructions and the form are attached. If 
78.24 	you do not don't follow the instructions or your Creditor gets an order from the court or writ 
78.25 	of execution, your financial institution will give bank gives the money to your creditor. If 
78.26 	your creditor gets an order from the court or writ of execution, your bank gives the money 
78.27 	to them. If that happens and it your money is protected, you can still get it back from the 
78.28 	creditor later,. But that is not as easy to do as filling in out the form now is easiest.
78.29 	See next pages for instructions and the exemption form.
78.30 		Subd. 2.Form of instructions. The instructions required must be in a separate form 
78.31 	and must be substantially in the following form:
78.32 	Instructions
79.1 	Note: The creditor is who you owe the money to. You are the debtor.
79.2 	1. Fill out both of the attached exemption forms in this packet.
79.3 	If you check one of the lines, you should also give proof. Use proof that shows show
79.4 	that some or all of the money in your account is from one or more of the protected sources. 
79.5 	This might be letters or account statements. Creditors may ask for a hearing if they question 
79.6 	your exemptions.
79.7 	To avoid a hearing:
79.8 	(i) Case numbers should be added to the form.
79.9 	(ii) Copies of documents should be sent with the form.
79.10 	Notice: You must send to the creditor's attorney (or to the creditor, if no attorney) copies 
79.11 	of your bank statements for the past 60 days before the garnishment. Send them to the 
79.12 	creditor (or to the creditor's lawyer). Keep a copy of your bank statements in case there are 
79.13 	questions about your claim. If you do not don't send bank statements to the creditor's attorney 
79.14 	(or to the creditor, if no attorney) bank statements creditor (or to the creditor's lawyer) along
79.15 	with your exemption claim, the financial institution may release give your money to the 
79.16 	creditor. They would do this once the creditor gives the financial institution them a court 
79.17 	order directing it saying they have to turn over the funds.
79.18 	2. Sign the exemption forms. Make one a copy to keep for yourself.
79.19 	3. Mail or deliver the other copies of the form by (insert date).
79.20 	Both Copies Must Be Mailed or Delivered the Same Day.
79.21 	One copy of the form and the copies of your bank statements go to:

79.22	........
	
79.23	(Insert name of creditor or creditor's attorney)
	
79.24	........
	
79.25	(Insert address of creditor or creditor's attorney)

79.26	Creditor's Name: ........
		
79.27	(or creditor's lawyer's name)
		
79.28	Street Address: ........
		
79.29	City/State/Zip: ........
		
79.30	Phone: ........
	Fax: ........
		
79.31	Email: ........
		
79.32 	One copy goes to:

80.1	........
	
80.2	(Insert name of bank)
	
80.3	........
	
80.4	(Insert address of bank)

80.5	Bank's Name: ........
		
80.6	Street Address: ........
		
80.7	City/State/Zip: ........
		
80.8	Phone: ........
	Fax: ........
		
80.9	Email: ........
		
80.10 	How The Process Works
80.11 	If You Do Not Don't Send in the Exemption Form and Bank Statements:
80.12 	14 days after the date of this letter some or all of your money may be turned over to the 
80.13 	creditor. This happens once they get an order from the court telling the financial institution
80.14 	bank to do this.
80.15 	If You Do Send in the Exemption Form and Bank Statements:
80.16 	Any money that is NOT protected can be turned over to the creditor once they get an 
80.17 	order from the court.
80.18 	If the Creditor Does Not Object to Your Claimed Exemptions:
80.19 	The financial institution will bank should unfreeze your money six 6 business days after 
80.20 	the institution gets they get your completed form. If they don't, ask the creditor or the 
80.21 	creditor's lawyer to send a release letter to the bank.
80.22 	If the Creditor Objects to Your Claimed Exemptions:
80.23 	The money you have said is protected on the form will be is held by the bank. The 
80.24 	creditor has six 6 business days to object (disagree) and ask the court to hold a hearing. You 
80.25 	will receive get a Notice of Objection and a Notice of Hearing.
80.26 	The financial institution will hold bank holds the money until a court decides whether
80.27 	if your money is protected or not. Some reasons a creditor may object are because you did 
80.28 	not didn't send copies of your bank statements or other proof of the benefits you received
80.29 	got. Be sure to include these when you send your exemption form.
80.30 	You may want to talk to a lawyer for advice about this process. If you are low income 
80.31 	you can call Legal Aid statewide at 1(877) 696-6529.
80.32 	PENALTIES:
81.1 	Warnings and Fines
81.2 	If you claim that your money is protected and a court decides you made that claim in 
81.3 	bad faith, the court they can order you to pay costs, actual damages, attorney lawyer fees, 
81.4 	and an additional amount of a fine up to $100. Bad faith is when someone does something 
81.5 	wrong on purpose. For example, it may be bad faith if you claim you receive get government 
81.6 	benefits that you do not receive and you don't.
81.7 	If the creditor made a bad faith objection to your claim that your money is protected, 
81.8 	the court can order them to pay costs, actual damages, attorney lawyer fees, and an additional 
81.9 	amount of a fine up to $100.
81.10 		Subd. 3.Exemption notice. The exemption notice must be a separate form and must 
81.11 	be in substantially the following form:

81.12	STATE OF MINNESOTA
		DISTRICT COURT
	
81.13	COUNTY OF ........
		........JUDICIAL DISTRICT
	
81.14	........(Creditor)
			
81.15	........(Debtor)
			
81.16	........(Financial institution)

81.17	State of Minnesota
		District Court
	
81.18	County of: ........
		Judicial District: ........
	
81.19			Court File Number: ........
	
81.20			Case Type: ........
	
81.21	Creditor's full name
			
81.22	........
		Exemption Form
	
81.23	vs.
			
81.24	Debtor's full name
			
81.25	........
			
81.26	Bank's name
			
81.27	........
			
81.28 	EXEMPTION FORM

81.29	A.
		How Much Money is Protected (exempt)
	
81.30	........
		... I claim ALL of the money being frozen by the bank is protected.
	
81.31	........
		... I claim SOME of the money is protected. The amount I claim is protected is $.......
	
81.32	B.
		Why The Money is Protected
	
81.33
81.34			My money is protected because I get it from one or more of the following places: 
(Check all that apply)
	
81.35			Earnings (Wages)
	
82.1			ALL or SOME of my wages may be protected.
	
82.2
82.3			... Some of my wages are protected because they were only deposited in my account 
in the last 20 days.
	
82.4
82.5			For wages that were deposited in your account within the last 20 days, the amount 
protected is whichever is more:
	
82.6			(i) 75% of your wages or more (after taxes are taken out), or
	
82.7
82.8			(ii) The current minimum wage times 40 per week. You can find the current minimum 
wage here: https://www.dli.mn.gov/minwage.
	
82.9			All of my wages are protected because:
	
82.10			... I get government benefits (a list of government benefits is on the next page)
	
82.11			... I am getting other assistance based on need
	
82.12			... I have gotten government benefits in the last 6 months
	
82.13			... I was in jail or prison in the last 6 months
	
82.14
82.15
82.16
82.17			If you check one of these 4 boxes, your wages are only protected for 60 days after 
they are deposited in your account. You MUST send the creditor copies of bank 
statements that show what was in your account for the 60 days right before the 
bank froze your money.
	
82.18	........
		Government Benefits
	
82.19
82.20			Government benefits can include, but are not limited to, the following many things. 
For example:
	
82.21			... MFIP - Minnesota Family Investment Program,
	
82.22			... DWP - MFIP Diversionary Work Program,
	
82.23			... SNAP - Supplemental Nutrition Assistance Program
	
82.24			Work participation cash benefit,
	
82.25			... GA - General Assistance,
	
82.26			EA - emergency assistance,
	
82.27			MA - medical assistance,
	
82.28			... EGA - Emergency General Assistance,
	
82.29			... MSA - Minnesota Supplemental Aid,
	
82.30			... MSA-EA - MSA Emergency Assistance,
	
82.31			... EA - Emergency Assistance
	
82.32			... Energy or Fuel Assistance
	
82.33			... Work Participation Cash Benefit
	
82.34			... MA - Medical Assistance
	
82.35			Supplemental Nutrition Assistance Program (SNAP),
	
82.36			SSI - Supplemental Security Income,
	
82.37			... MinnesotaCare,
	
82.38			... Medicare Part B - Premium Payments, help
	
82.39			... Medicare Part D - Extra help,
	
82.40			Energy or fuel assistance.
	
83.1			... SSI - Supplemental Security Income
	
83.2
83.3			... Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
Family Credit
	
83.4			... Renter's Refund (also called Renter's Property Tax Credit)
	
83.5	LIST SOURCE(S) OF FUNDING IN YOUR ACCOUNT
	
83.6	........
	
83.7	LIST THE CASE NUMBER AND COUNTY
	
83.8			Case Number: ........
	
83.9			County: ........
	
83.10			Government benefits also include:
	
83.11	........
		Social Security benefits
	
83.12	........
		Unemployment benefits
	
83.13	........
		Workers' compensation
	
83.14	........
		Veterans benefits
	
83.15
83.16
83.17			If 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.
	
83.18	........
		Other assistance based on need
	
83.19 	You may have assistance based on need from another source that is not on the list. If you 
83.20 	do, check this box, and fill in the source of your money on the line below:
83.21 	Source:........
83.22 	Include copies of any documents you have that show the source of this money.

83.23	EARNINGS
	
83.24			ALL or SOME of your earnings (wages) may also be protected.
	
83.25	........
		All of your earnings (wages) are protected if:
	
83.26	........
		You get government benefits (see list of government benefits)
	
83.27	........
		You currently receive other assistance based on need
	
83.28	........
		You have received government benefits in the last six months
	
83.29	........
		You were in jail or prison in the last six months
	
83.30
83.31
83.32
83.33			If 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.
	
83.34	........
		Some of your earnings (wages) are protected.
	
83.35
83.36
83.37			If 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:
	
83.38			75 percent of your wages (after taxes are taken out); or
	
83.39			(insert the sum of the current federal minimum wage) multiplied by 40.
	
84.1			OTHER EXEMPT FUNDS
	
84.2
84.3			The money from the following are also completely protected after they are deposited 
in your account.
	
84.4	........
		An accident, disability, or retirement pension or annuity
	
84.5	........
		Payments to you from a life insurance policy
	
84.6	........
		Earnings of your child who is under 18 years of age
	
84.7	........
		Child support
	
84.884.984.10
84.11
	........
		Money paid to you from a claim for damage or destruction of property Property 
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.
	
84.12	........
		Death benefits paid to you

84.13
84.14	List the case number and county for every 
box you checked:
		
84.15	Case Number: ........
	County: ........
	
84.16	Case Number: ........
	County: ........
	
84.17	Case Number: ........
	County: ........
	
84.18	Government benefits also include:
		
84.19	... Social Security benefits
		
84.20	... Unemployment benefits
		
84.21	... Workers' compensation
		
84.22	... Veterans' benefits
		
84.23 	If you get any of these government benefits, include copies of any documents that show 
84.24 	you get them.
84.25 	... I get other assistance based on need that is not on the list. It comes from: ........
84.26 	........
84.27 	Make sure you include copies of any documents that show this.
84.28 	C. Other Protected Funds
84.29 	The money from these things are also completely protected after they are deposited in 
84.30 	my account.
84.31 	... Child Support
84.32 	... A retirement, disability, or accident pension or annuity
84.33 	... Earnings of my child who is under 18 years of age
84.34 	... Payments to me from a life insurance policy
85.1 	... Money paid to me from a claim for damage or destruction of property. Property 
85.2 	includes household goods, farm tools or machinery, tools for my job, business equipment, 
85.3 	a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, or 
85.4 	appliances
85.5 	... Death benefits paid to me
85.6 	I give my permission to any agency that has given me cash benefits to give information 
85.7 	about my benefits to the above-named creditor, named above or its attorney to the creditor's 
85.8 	lawyer. The information will ONLY concern whether be if I get benefits or not, or whether 
85.9 	I have gotten them assistance, or if I have gotten assistance in the past six 6 months. If I 
85.10 	was an inmate in the last 6 months, I give my permission to the correctional institution to 
85.11 	tell the creditor named above or the creditor's lawyer that I was an inmate there.
85.12 	If I was an inmate in the last six months, I give my permission to the correctional 
85.13 	institution to tell the above-named creditor that I was an inmate there.
85.14 	You must sign this form and send THIS FORM it back to the creditor's 
85.15 	ATTORNEY lawyer (or to the creditor, if there is no ATTORNEY lawyer) and the 
85.16 	bank. Remember to include a copy of your bank statements for the past 60 days. Fill 
85.17 	in the blanks below and go back to the instructions to make sure you do did it correctly.
85.18 	I have mailed or delivered a copy of this form to: the creditor (or to the creditor's lawyer) 
85.19 	at the address listed below.

85.20	........
	
85.21	(Insert name of creditor or creditor's attorney)
	
85.22	........
	
85.23	(Insert address of creditor or creditor's attorney)

85.24	Creditor's Signature: ........
		
85.25	(or creditor's lawyer's signature)
		
85.26	Creditor's Name: ........
		
85.27	(or creditor's lawyer's name)
		
85.28	Street Address: ........
		
85.29	City/State/Zip: ........
		
85.30	Phone: ........
	Fax: ........
		
85.31	Email: ........
		
85.32 	I have also mailed or delivered a copy of this exemption form to my bank at the address 
85.33 	listed in the instructions. below:

86.1	DATED: ........
	........
	
86.2		DEBTOR
	
86.3		........
	
86.4		DEBTOR ADDRESS
	
86.5		........
	
86.6		DEBTOR TELEPHONE NUMBER

86.7	Bank's Name: ........
		
86.8	Street Address: ........
		
86.9	City/State/Zip: ........
		
86.10	Phone: ........
	Fax: ........
		
86.11	Email: ........

86.12	Date: ........
		
86.13	Debtor's Signature: ........
		
86.14	Debtor's Name: ........
		
86.15	Street Address: ........
		
86.16	City/State/Zip: ........
		
86.17	Phone: ........
		
86.18	Email: ........

86.19 	Sec. 17. Minnesota Statutes 2024, section 571.914, subdivision 2, is amended to read:
86.20 		Subd. 2.Form of Notice of Objection and Notice of Hearing.  The Written Objection 
86.21 	and Notice of Hearing must be in substantially the following form:

86.22	STATE OF MINNESOTA
		DISTRICT COURT
	
86.23	COUNTY OF ........
		........JUDICIAL DISTRICT
	
86.24	........(Creditor)
			
86.25	........(Debtor)
		CREDITOR'S NOTICE OF OBJECTION
	
86.26			AND NOTICE OF HEARING ON
	
86.27	........(Garnishee)
		EXEMPTION CLAIM

86.28	........
		
86.29	........
		
86.30	........
		
86.31
86.32	(CREDITOR OR CREDITOR'S 
ATTORNEY)
		
86.33		NOTICE OF HEARING
	
86.34
86.35
86.36		The creditor objects to your exemption claim. 
This hearing is to resolve your exemption 
claim.
	
87.1	Hearing Date:
	........
	
87.2	Time:
	........
	
87.3	Hearing Place:
	........

87.4	State of Minnesota
		District Court
	
87.5	County of: ........
		Judicial District: ........
	
87.6			Court File Number: ........
	
87.7			Case Type: ........
	
87.8	Creditor's full name
			
87.9	........
		Creditor's Notice of Objection and
	
87.10	and
		Notice of Hearing on Exemption Claim
	
87.11	Debtor's full name
			
87.12	........
			
87.13	Third Party (bank, employer, or other)
			
87.14	........
			
87.15 	Hearing Notice
87.16 	The creditor objects to your exemption claim. This hearing is to decide if your exemption 
87.17 	claim is valid.

87.18	The hearing will be at:
			
87.19	Place: ........
	Date: ........
	Time: ........
	
87.20 	The creditor objects to your claim of exemption from garnishment for the following 
87.21 	reason(s):

87.22	........
	
87.23	........
	
87.24	........
	
87.25 	(Note: Bring with you to the hearing all documents and materials supporting your 
87.26 	exemption claim. Failure to do so could delay the court's decision.)
87.27 	If the creditor receives all documents and materials supporting your exemption claim 
87.28 	before the hearing date, the creditor may agree with your claim and you can avoid a hearing.
87.29 	Because a court hearing will be held on your claim that your funds are protected, your 
87.30 	financial institution will retain the funds until it receives an order from the court.
87.31 	Note: Bring all your documents and materials that support your exemption claim 
87.32 	to the hearing. If you don't, the court's decision could be held up.
88.1 	You can send your documents and materials to the creditor before the hearing. If they 
88.2 	review them and agree with your claim, you can avoid a hearing.
88.3 	Because there is a court hearing scheduled about your exemption claim, your bank will 
88.4 	keep your funds until it gets an order from the court.

88.5	Date: ........
		
88.6	Creditor's Signature: ........
		
88.7	(or creditor's lawyer's signature)
		
88.8	Creditor's Name: ........
		
88.9	(or creditor's lawyer's name)
		
88.10	Street Address: ........
		
88.11	City/State/Zip: ........
		
88.12	Phone: ........
	Fax: ........
		
88.13	Email: ........

88.14 	Sec. 18. Minnesota Statutes 2024, section 571.925, is amended to read:
88.15 	571.925 FORM OF NOTICE.
88.16 	The ten-day notice informing a debtor that a garnishment summons may be used to 
88.17 	garnish the earnings of an individual must be substantially in the following form:

88.18	STATE OF MINNESOTA
		DISTRICT COURT
	
88.19	COUNTY OF ........
		........JUDICIAL DISTRICT
	
88.20	........(Creditor)
			
88.21	against
			
88.22			GARNISHMENT EXEMPTION
	
88.23	........(Debtor)
		NOTICE AND NOTICE OF
	
88.24	and
		INTENT TO GARNISH EARNINGS
	
88.25	........(Garnishee)
			
88.26 	PLEASE TAKE NOTICE that a garnishment summons or levy may be served upon 
88.27 	your employer or other third parties, without any further court proceedings or notice to you, 
88.28 	ten days or more from the date hereof. Some or all of your earnings are exempt from 
88.29 	garnishment. If your earnings are garnished, your employer must show you how the amount 
88.30 	that is garnished from your earnings was calculated. You have the right to request a hearing 
88.31 	if you claim the garnishment is incorrect.
88.32 	Your earnings are completely exempt from garnishment if you are now a recipient of 
88.33 	assistance based on need, if you have been a recipient of assistance based on need within 
89.1 	the last six months, or if you have been an inmate of a correctional institution in the last six 
89.2 	months.
89.3 	Assistance based on need includes, but is not limited to:

89.4	State of Minnesota
		District Court
	
89.5	County of: ........
		Judicial District: ........
	
89.6			Court File Number: ........
	
89.7			Case Type: ........
	
89.8	Creditor's full name
			
89.9	........
		Garnishment Exemption Notice and
	
89.10	and
		Notice of Intent to Garnish Earnings
	
89.11	Debtor's full name
			
89.12	........
			
89.13	Third Party (bank, employer, or other)
			
89.14	........
			
89.15 	Notice: A garnishment may be served on your employer or other third parties. 
89.16 	Garnishment means that part of your earnings can be taken to pay off debts that you 
89.17 	owe. This can happen in 10 days or more after you get this notice. This can happen without 
89.18 	any other court action or notice to you. But some of your money may be protected.

89.19		Your earnings cannot be taken if:
		
89.20		(i) you are getting government assistance based on need,
		
89.21		(ii) you got any government assistance based on need in the last 6 months, or
		
89.22		(iii) you were an inmate of a correctional institution in the last 6 months.
		
89.23 	These are called exemptions. Your money is NOT protected unless you fill out the 
89.24 	Exemption Claim Notice attached and send it back to the creditor or the creditor's 
89.25 	lawyer. If you are not sure if you have any exemptions, talk to a lawyer.
89.26 	You can also contact the creditor or their lawyer to talk about a settlement of the debt.
89.27 	Examples of government assistance based on need:

89.28		(i) MFIP - Minnesota Family Investment Program,
	
89.29		(ii) DWP - MFIP Diversionary Work Program,
	
89.30		(iii)  SNAP - Supplemental Nutrition Assistance Program
	
89.31		Work participation cash benefit,
	
89.32		(iv) GA - General Assistance,
	
89.33		EA - emergency assistance,
	
89.34		MA - medical assistance,
	
90.1		(v) EGA - Emergency General Assistance,
	
90.2		(vi) MSA - Minnesota Supplemental Aid,
	
90.3		(vii) MSA-EA - MSA Emergency Assistance,
	
90.4		Supplemental Nutrition Assistance Program (SNAP),
	
90.5		SSI - Supplemental Security Income,
	
90.6		(viii)  EA - Emergency Assistance
	
90.7		(ix)  Energy or Fuel Assistance
	
90.8		(x)  Work Participation Cash Benefit
	
90.9		(xi)  MA - Medical Assistance
	
90.10		(xii) MinnesotaCare,
	
90.11		(xiii) Medicare Part B - Premium Payments, help
	
90.12		(xiv) Medicare Part D - Extra help,
	
90.13		Energy or fuel assistance.
	
90.14		(xv)  SSI - Supplemental Security Income
	
90.15
90.16		(xvi)  Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
Family Credit
	
90.17		(xvii)  Renter's Refund (also called Renter's Property Tax Credit)
	
90.18 	If you wish to claim an exemption, you should fill out the appropriate form below, sign 
90.19 	it, and send it to the creditor's attorney and the garnishee.
90.20 	You may wish to contact the attorney for the creditor in order to arrange for a settlement 
90.21 	of the debt or contact an attorney to advise you about exemptions or other rights.
90.22 	PENALTIES
90.23 	(1) Be advised that even if you claim an exemption, a garnishment summons may still 
90.24 	be served on your employer. If your earnings are garnished after you claim an exemption, 
90.25 	you may petition the court for a determination of your exemption. If the court finds that 
90.26 	the creditor disregarded your claim of exemption in bad faith, you will be entitled to 
90.27 	costs, reasonable attorney fees, actual damages, and an amount not to exceed $100.
90.28 	(2) HOWEVER, BE WARNED if you claim an exemption, the creditor can also petition 
90.29 	the court for a determination of your exemption, and if the court finds that you claimed 
90.30 	an exemption in bad faith, you will be assessed costs and reasonable attorney's fees plus 
90.31 	an amount not to exceed $100.
90.32 	(3) If after receipt of this notice, you in bad faith take action to frustrate the garnishment, 
90.33 	thus requiring the creditor to petition the court to resolve the problem, you will be liable 
90.34 	to the creditor for costs and reasonable attorney's fees plus an amount not to exceed 
90.35 	$100.

91.1	Dated: ........
		........
	
91.2			(Attorney for) Creditor
	
91.3			........
	
91.4			Address
	
91.5			........
	
91.6			Telephone
	
91.7 	Warnings and Fines
91.8 	(1) Even if you claim an exemption, a levy may still be served on your employer. If they 
91.9 	take money from you after you claim an exemption, you may ask the court to review your 
91.10 	exemption. If the court finds that the creditor ignored your claim of exemption in bad faith, 
91.11 	you are entitled to costs, reasonable lawyer fees, actual damages, and a fine up to $100. Bad 
91.12 	faith is when someone does something wrong on purpose.
91.13 	(2) BUT if you claim an exemption, the creditor can also ask the court to review your 
91.14 	exemption. If the court finds that you claimed an exemption in bad faith, you are charged 
91.15 	costs and reasonable lawyer fees, and a fine up to $100.
91.16 	(3) If you get this notice, then do something in bad faith to try to block or stop the levy 
91.17 	and the creditor has to take you to court because of it, you will have to pay the creditor's 
91.18 	costs, and reasonable lawyer's fees, and a fine up to $100.

91.19	Date: ........
		
91.20	Creditor's Signature: ........
		
91.21	(or creditor's lawyer's signature)
		
91.22	Creditor's Name: ........
		
91.23	(or creditor's lawyer's name)
		
91.24	Street Address: ........
		
91.25	City/State/Zip: ........
		
91.26	Phone: ........
	Fax: ........
		
91.27	Email: ........
		
91.28 	DEBTOR'S EXEMPTION CLAIM NOTICE

91.29	State of Minnesota
		District Court
	
91.30	County of: ........
		Judicial District: ........
	
91.31			Court File Number: ........
	
91.32			Case Type: ........
	
91.33	Creditor's full name
			
91.34	........
		Debtor's Exemption
	
91.35	and
		Claim Notice
	
92.1	Debtor's full name
			
92.2	........
			
92.3	and
			
92.4	Third Party (bank, employer, or other)
			
92.5	........
			
92.6 	I hereby claim that my earnings are exempt from this garnishment because: (check all 
92.7 	that apply)
92.8 	(1) I am presently a recipient of relief based on need. (Specify the program, case number, 
92.9 	and the county from which relief is being received.)

92.10	........
	........
	........
	
92.11	Program
	Case Number (if known)
	County
	
92.12 	(2) I am not now receiving relief based on need, but I have received relief based on need 
92.13 	within the last six months. (Specify the program, case number, and the county from 
92.14 	which relief has been received.)

92.15	........
	........
	........
	
92.16	Program
	Case Number (if known)
	County
	
92.17 	(3) I have been an inmate of a correctional institution within the last six months. (Specify 
92.18 	the correctional institution and location.)

92.19	........
		........
	
92.20	Correctional Institution
		Location
	
92.21 	I hereby authorize any agency that has distributed relief to me or any correctional 
92.22 	institution in which I was an inmate to disclose to the above-named creditor or the creditor's 
92.23 	attorney only whether or not I am or have been a recipient of relief based on need or an 
92.24 	inmate of a correctional institution within the last six months. I have mailed or delivered a 
92.25 	copy of this form to the creditor or creditor's attorney.

92.26	........
		........
	
92.27	Date
		Debtor
	
92.28			........
	
92.29			Address
	
92.30			........
	
92.31			Debtor Telephone Number

92.32	STATE OF MINNESOTA
		DISTRICT COURT
	
92.33	COUNTY OF ........
		........JUDICIAL DISTRICT
	
93.1	........(Creditor)
			
93.2	........(Debtor)
			
93.3	........(Financial institution)
			
93.4 	... I am getting government assistance based on need. (State the program, case number 
93.5 	if you know it, and the county you got it from.)

93.6	Program: ........
	Case #: ........
	County: ........
	
93.7	Program: ........
	Case #: ........
	County: ........
	
93.8	Program: ........
	Case #: ........
	County: ........
	
93.9 	... I am not getting assistance based on need right now, but I did get government assistance 
93.10 	based on need within the last 6 months. (State the program, case number if you know it, 
93.11 	and the county you got it from.)

93.12	Program: ........
	Case #: ........
	County: ........
	
93.13	Program: ........
	Case #: ........
	County: ........
	
93.14	Program: ........
	Case #: ........
	County: ........
	
93.15 	... I was an inmate of a correctional institution within the last 6 months. (State the 
93.16 	correctional institution and location.)

93.17	Correctional Institution ........
	Location ........
	
93.18 	I give my permission to any agency listed above to give information about my benefits 
93.19 	to the creditor named above, or to the creditor's lawyer. The information will ONLY be if 
93.20 	I get assistance, or if I have gotten assistance in the past 6 months. If I was an inmate in the 
93.21 	last 6 months, I give my permission to the correctional institution to tell the creditor named 
93.22 	above or the creditor's lawyer that I was an inmate there.
93.23 	Sign and send this form back to the creditor or the creditor's lawyer.
93.24 	Fill in the blanks below.
93.25 	I mailed or delivered a copy of this form to the creditor or to the creditor's lawyer if they 
93.26 	have one, at the address listed below.

93.27	Date: ........
		
93.28	Creditor's Signature: ........
		
93.29	(or creditor's lawyer's signature)
		
93.30	Creditor's Name: ........
		
93.31	(or creditor's lawyer's name)
		
93.32	Street Address: ........
		
93.33	City/State/Zip: ........
		
94.1	Phone: ........
	Fax: ........
		
94.2	Email: ........

94.3	Date: ........
		
94.4	Debtor's Signature: ........
		
94.5	Debtor's Name: ........
		
94.6	Street Address: ........
		
94.7	City/State/Zip: ........
		
94.8	Phone: ........
		
94.9	Email: ........

94.10 	Sec. 19. Minnesota Statutes 2024, section 571.931, subdivision 6, is amended to read:
94.11 		Subd. 6.Notice. The debtor shall be served with a copy of the prejudgment garnishment 
94.12 	order issued pursuant to this section together with a copy of all pleadings and other documents 
94.13 	not previously served, including any affidavits upon which the claimant intends to rely at 
94.14 	the subsequent hearing and a transcript of any oral testimony given at the prejudgment 
94.15 	garnishment hearing upon which the creditor intends to rely and a notice of hearing. Service 
94.16 	must be in the manner prescribed for personal service of a summons unless that service is 
94.17 	impracticable or would be ineffective and the court prescribes an alternative method of 
94.18 	service calculated to provide actual notice to the debtor.
94.19 	The notice of hearing served upon the debtor must be signed by the creditor or the 
94.20 	attorney for the creditor and must be accompanied by an exemption notice. The notice of 
94.21 	hearing must be accompanied by an exemption notice, and both notices must provide, at a 
94.22 	minimum, the following information in substantially the following language:
94.23 	NOTICE OF HEARING
94.24 	Hearing Notice
94.25 	TO: ........
94.26 	(the debtor) (debtor's full name)
94.27 	The (insert the name of court) Court has ordered the prejudgment garnishment of some 
94.28 	of your property in the possession or control of a third party. This is about property that a 
94.29 	third party has or controls. Some of your property may be exempt from seizure and can't 
94.30 	be taken. See the exemption notice below.
94.31 	The Court issued this Order based upon the claim of because (insert name of creditor) 
94.32 	that (insert name of creditor) is claims they are entitled to a court order for garnishment
94.33 	take some of your property to secure your payment of any money judgment that (insert 
95.1 	name of creditor) may later be obtained against you and that immediate action was necessary. 
95.2 	They do this to make sure you pay any money they might win in a future case against you. 
95.3 	They felt immediate action was needed.
95.4 	You have the legal right to challenge (insert name of creditor) claims at a court hearing 
95.5 	before a judge.

95.6	The hearing will be at:
			
95.7	Place: ........
	Date: ........
	Time: ........
	
95.8 	The hearing will be held at the (insert place) on (insert date) at (insert time). You may 
95.9 	attend can go to the court hearing alone or with an attorney a lawyer. After you have 
95.10 	presented your side of the matter, the court will decide You get to tell the court your side 
95.11 	of the issue. Then the court decides what should be done with your property until the lawsuit 
95.12 	against you is finally decided.
95.13 	If you do not attend don't go to this hearing, the court may order garnishment of 
95.14 	your property.
95.15 	Exemption Notice
95.16 	Some of your property may be exempt and cannot be garnished can't be taken. 'Exempt' 
95.17 	means protected. The following is a list of some of the more common exemptions. It is not 
95.18 	a complete and is subject to list. For full details and dollar amounts set by law see section 
95.19 	550.37, and other state and federal laws of the Minnesota Statutes. If you have questions 
95.20 	about an exemption, you should obtain competent contact a lawyer for legal advice.
95.21 	These things you or your family might have are protected:
95.22 	(1) a homestead or the proceeds from the sale of a homestead. equity in your home, or 
95.23 	money from recently selling your home - up to $510,000 total;
95.24 	(2)(i) all clothing, one watch, utensils, and foodstuffs;
95.25 	(ii) household furniture, household appliances, phonographs, radios, and computers, 
95.26 	tablets, televisions up to a total current value of $4,500 at the time of attachment., printers, 
95.27 	cell phones, smart phones, and other consumer electronics up to $12,150 in all; and
95.28 	(iii) jewelry - total value can't be more than $3,308;
95.29 	(3) a manufactured (mobile) home used as your home. you live in;
95.30 	(4) one motor vehicle currently worth less than $2,000 after deducting any security 
95.31 	interest., counting only the amount you have paid off:
96.1 	(i) $10,000;
96.2 	(ii) $12,500 if it is necessary for your business, trade, or profession;
96.3 	(iii) $25,000 if used by or to help someone with a disability that makes it hard to walk; 
96.4 	or
96.5 	(iv) $100,000 if designed or modified for someone with a disability that makes it hard 
96.6 	to walk;
96.7 	(5) farm machinery used by someone principally engaged in farming, or if your main 
96.8 	business is farming. Tools, machines, or office furniture used in your business or trade. This 
96.9 	exemption is limited to $10,000. - the total value can't be more than $13,000;
96.10 	(6) relief based on need. This includes the:
96.11 	(i) MFIP - Minnesota Family Investment Program (MFIP), Emergency Assistance (EA), 
96.12 	Work First Program, Medical Assistance (MA),;
96.13 	(ii) DWP - MFIP Diversionary Work Program;
96.14 	(iii) SNAP - Supplemental Nutrition Assistance Program;
96.15 	(iv) GA - General Assistance (GA),;
96.16 	(v) EGA - Emergency General Assistance (EGA),;
96.17 	(vi) MSA - Minnesota Supplemental Aid (MSA),;
96.18 	(vii) MSA-EA - MSA Emergency Assistance (MSA-EA), Supplemental Security Income 
96.19 	(SSI), and Energy Assistance.;
96.20 	(viii) EA - Emergency Assistance;
96.21 	(ix) Energy or Fuel Assistance;
96.22 	(x) Work Participation Cash Benefit;
96.23 	(xi) MA - Medical Assistance;
96.24 	(xii) MinnesotaCare;
96.25 	(xiii) Medicare Part B - Premium Payments help;
96.26 	(xiv) Medicare Part D - Extra;
96.27 	(xv) SSI - Supplemental Security Income;
96.28 	(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
96.29 	Family Credit; and
97.1 	(xvii) Renter's Refund (also called Renter's Property Tax Credit);
97.2 	(7) wages. 100% is protected if you get government assistance based on need. Otherwise, 
97.3 	between 75-100% is protected depending on how much you earn;
97.4 	(8) retirement benefits - the total interest under all plans and contracts can't be more than 
97.5 	$81,000;
97.6 	(7) (9) Social Security benefits.;
97.7 	(8) (10) unemployment benefits, workers' compensation, or veterans' benefits.;
97.8 	(9) An accident, disability or retirement (11) a retirement, disability, or accident pension 
97.9 	or annuity.;
97.10 	(10) (12) life insurance proceeds. that are not more than $54,000;
97.11 	(11) The (13) earnings of your minor child.;
97.12 	(12) (14) money from a claim for damage or destruction of exempt property (such as - 
97.13 	like household goods, farm tools, business equipment, a manufactured (mobile) home, or 
97.14 	a car). car;
97.15 	(15) sacred possessions - like the Bible, Torah, Qur'an, prayer rug, and other religious 
97.16 	items. Total value can't be more than $2,000;
97.17 	(16) personal library - total value can't be more than $750;
97.18 	(17) musical instruments - total value can't be more than $2,000;
97.19 	(18) family pets - current value can't be more than $1,000;
97.20 	(19) a seat or pew in any house or place of public worship and a lot in any burial ground;
97.21 	(20) tools you need to work in your business or profession - the total value can't be more 
97.22 	than $13,500;
97.23 	(21) household tools and equipment - things like hand and power tools, snow removal 
97.24 	equipment, lawnmowers, and more. Total value can't be more than $3,000; and
97.25 	(22) health savings accounts, medical savings accounts - the total value can't be more 
97.26 	than $25,000.

97.27 	Sec. 20. Minnesota Statutes 2024, section 571.932, subdivision 2, is amended to read:
97.28 		Subd. 2.Service. The creditor's motion to obtain an order of garnishment together with 
97.29 	the creditor's affidavit and notice of hearing must be served in the manner prescribed for 
97.30 	service of a summons in a civil action in district court unless that service is impracticable 
98.1 	or would be ineffective and the court prescribes an alternative method of service calculated 
98.2 	to provide actual notice to the debtor. If the debtor has already appeared in the action, the 
98.3 	motion must be served in the manner prescribed for service of pleadings subsequent to the 
98.4 	summons. The date of the hearing must be fixed in accordance with rule 6 of the Minnesota 
98.5 	Rules of Civil Procedure for the District Courts, unless a different date is fixed by order of 
98.6 	the court.
98.7 	The notice of hearing served upon the debtor shall be signed by the creditor or the 
98.8 	attorney for the creditor and shall provide, at a minimum, the following information in 
98.9 	substantially the following language:
98.10 	NOTICE OF HEARING
98.11 	Hearing Notice
98.12 	TO: ........
98.13 	(the debtor) (debtor's full name)
98.14 	A hearing will be held (insert place) on (insert date) at (insert time) to determine whether 
98.15 	nonexempt property belonging to you will be garnished to secure a judgment that may be 
98.16 	entered against you.
98.17 	There will be a hearing to decide if your nonexempt property will be garnished to help 
98.18 	pay a judgment that may be entered against you.

98.19	The hearing will be at:
			
98.20	Place: ........
	Date: ........
	Time: ........
	
98.21 	You may attend can go to the court hearing alone or with an attorney a lawyer. After 
98.22 	you have presented your side of the matter, the court will decide whether You get to tell 
98.23 	the court your side of the issue. Then the court decides if your property should be garnished 
98.24 	until the lawsuit which has been commenced against you is finally decided.
98.25 	If the court directs the issuance of issues a garnishment summons while during the 
98.26 	lawsuit is pending, you may still can keep the property until the lawsuit is decided if you 
98.27 	file a bond in an amount. The amount of the bond is set by the court.
98.28 	If you DO NOT ATTEND THIS don't go to this hearing, the court may order 
98.29 	garnishment of your nonexempt property TO BE GARNISHED.
98.30 	Exemption Notice
98.31 	Some of your property may be exempt and cannot can't be garnished taken. 'Exempt' 
98.32 	means protected. The following is a list of some of the more common exemptions. It is not 
99.1 	a complete and is subject to list. For full details and dollar amounts set by law see section 
99.2 	550.37, and other state and federal laws of the Minnesota Statutes. The dollar amounts 
99.3 	contained in this list are subject to the provisions of section 550.37, subdivision 4a, at the 
99.4 	time of the garnishment. If you have questions about an exemption, you should obtain 
99.5 	competent contact a lawyer for legal advice.
99.6 	These things you or your family might have are protected:
99.7 	(1) A homestead or the proceeds from the sale of a homestead. equity in your home, or 
99.8 	money from recently selling your home - up to $510,000 total;
99.9 	(2)(i) all clothing, one watch, utensils, and foodstuffs;
99.10 	(ii) household furniture, household appliances, phonographs, radios, and computers, 
99.11 	tablets, televisions up to a total current value of $5,850., printers, cell phones, smart phones, 
99.12 	and other consumer electronics up to $12,150 in all; and
99.13 	(iii) jewelry - total value can't be more than $3,308;
99.14 	(3) a manufactured (mobile) home used as your home. you live in;
99.15 	(4) one motor vehicle currently worth less than $2,600 after deducting any security 
99.16 	interests., counting only the amount you have paid off:
99.17 	(i) $10,000;
99.18 	(ii) $12,500 if it is necessary for your business, trade, or profession;
99.19 	(iii) $25,000 if used by or to help someone with a disability that makes it hard to walk; 
99.20 	or
99.21 	(iv) $100,000 if designed or modified for someone with a disability that makes it hard 
99.22 	to walk;
99.23 	(5) farm machinery used by an individual principally engaged in farming, or if your 
99.24 	main business is farming. Tools, machines, or office furniture used in your business or trade. 
99.25 	This exemption is limited to - the total value can't be more than $13,000.;
99.26 	(6) relief based on need. This includes the:
99.27 	(i) MFIP - Minnesota Family Investment Program (MFIP), Emergency Assistance (EA), 
99.28 	Work First Program, Medical Assistance (MA),;
99.29 	(ii) DWP - MFIP Diversionary Work Program;
99.30 	(iii) SNAP - Supplemental Nutrition Assistance Program;
100.1 	(iv) GA - General Assistance (GA),;
100.2 	(v) EGA - Emergency General Assistance (EGA),;
100.3 	(vi) MSA - Minnesota Supplemental Aid (MSA),;
100.4 	(vii) MSA-EA - MSA Emergency Assistance (MSA-EA), Supplemental Security Income 
100.5 	(SSI), and Energy Assistance.;
100.6 	(viii) EA - Emergency Assistance;
100.7 	(ix) Energy or Fuel Assistance;
100.8 	(x) Work Participation Cash Benefit;
100.9 	(xi) MA - Medical Assistance;
100.10 	(xii) MinnesotaCare;
100.11 	(xiii) Medicare Part B - Premium Payments help;
100.12 	(xiv) Medicare Part D - Extra;
100.13 	(xv) SSI - Supplemental Security Income;
100.14 	(xvi) Tax Credits - federal Earned Income Tax Credit (EITC), Minnesota Working 
100.15 	Family Credit; and
100.16 	(xvii) Renter's Refund (also called Renter's Property Tax Credit);
100.17 	(7) wages. 100% is protected if you get government assistance based on need. Otherwise, 
100.18 	between 75-100% is protected depending on how much you earn;
100.19 	(8) retirement benefits - the total interest under all plans and contracts can't be more than 
100.20 	$81,000;
100.21 	(7) (9) Social Security benefits.;
100.22 	(8) (10) unemployment benefits, workers' compensation, or veterans' benefits.;
100.23 	(9) An accident, disability or retirement (11) a retirement, disability, or accident pension 
100.24 	or annuity.;
100.25 	(10) (12) life insurance proceeds. that are not more than $54,000;
100.26 	(11) The (13) earnings of your minor child.;
100.27 	(12) (14) money from a claim for damage or destruction of exempt property (such as - 
100.28 	like household goods, farm tools, business equipment, a manufactured (mobile) home, or 
100.29 	a car). car;
101.1 	(15) sacred possessions - like the Bible, Torah, Qur'an, prayer rug, and other religious 
101.2 	items. Total value can't be more than $2,000;
101.3 	(16) personal library - total value can't be more than $750;
101.4 	(17) musical instruments - total value can't be more than $2,000;
101.5 	(18) family pets - current value can't be more than $1,000;
101.6 	(19) a seat or pew in any house or place of public worship and a lot in any burial ground;
101.7 	(20) tools you need to work in your business or profession - the total value can't be more 
101.8 	than $13,500;
101.9 	(21) household tools and equipment - things like hand and power tools, snow removal 
101.10 	equipment, lawnmowers, and more. Total value can't be more than $3,000; and
101.11 	(22) health savings accounts, medical savings accounts - the total value can't be more 
101.12 	than $25,000.

101.13 	Sec. 21. IMPLEMENTATION AND COMPLIANCE.
 101.14 	The forms in Minnesota Statutes, chapters 550, 551, and 571, as amended by this act 
101.15 	must be active on the Minnesota courts website and in use by Minnesota courts on June 1, 
101.16 	2025. Notwithstanding Laws 2024, chapter 114, article 3, section 101, the effective date, 
101.17 	garnishments governed by Minnesota Statutes, section 571.922, as amended by Laws 2024, 
101.18 	chapter 114, article 3, section 101, are effective June 1, 2025. The failure to use revised 
101.19 	forms before June 1, 2025, is not a basis for a complaint or violation of a federal statute, 
101.20 	Minnesota Statutes, or the Minnesota Rules of Professional Conduct.

101.21 	Sec. 22. EFFECTIVE DATE.
 101.22 	This act is effective retroactively from January 1, 2025.