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Minnesota Legislature

Office of the Revisor of Statutes

571.912 FORM OF EXEMPTION NOTICE.
The notice informing a debtor that an order for attachment, garnishment summons, or levy
by execution has been used to attach funds of the debtor to satisfy a claim must be substantially in
the following form:
STATE OF MINNESOTA
DISTRICT COURT
COUNTY OF .....
..... JUDICIAL DISTRICT
..... (Creditor)
..... (Debtor)
TO: Debtor
EXEMPTION NOTICE
An order for attachment, garnishment summons, or levy of execution (strike inapplicable
language) has been served on ............ (bank or other financial institution) ............... where you
have an account.
Your account balance is $..................
The amount being held is $.................
However, all or a portion of the funds in your account will normally be exempt from
creditors' claims if they are in one of the following categories:
(1) relief based on need. This includes the Minnesota Family Investment Program (MFIP),
Emergency Assistance (EA), Work First Program, Medical Assistance (MA), General Assistance
(GA), General Assistance Medical Care (GAMC), Emergency General Assistance (EGA),
Minnesota Supplemental Aid (MSA), MSA Emergency Assistance (MSA-EA), Supplemental
Security Income (SSI), and Energy Assistance;
(2) Social Security benefits (Old Age, Survivors, or Disability Insurance);
(3) unemployment benefits, workers' compensation, or veterans' benefits;
(4) an accident, disability, or retirement pension or annuity;
(5) life insurance proceeds;
(6) the earnings of your minor child and any child support paid to you; or
(7) money from a claim for damage or destruction of exempt property (such as household
goods, farm tools, business equipment, a mobile home, or a car).
The following funds are also exempt:
(8) all earnings of a person in category (1);
(9) all earnings of a person who has received relief based on need, or who has been an
inmate of a correctional institution, within the last six months;
(10) 75 percent of every debtor's after tax earnings; and
(11) all of a debtor's after tax earnings below 40 times the federal minimum wage.
TIME LIMIT ON EXEMPTIONS AFTER DEPOSIT IN BANK:
Categories (10) and (11): 20 days
Categories (8) and (9): 60 days
All others: no time limit, as long as funds are traceable to the exempt source. (In tracing
funds, the first-in, first-out method is used. This means money deposited first is spent first.)
The money being sought by the creditor is being held in your account to give you a chance to
claim an exemption.
TO CLAIM AN EXEMPTION:
Fill out, sign, and mail or deliver one copy of the attached exemption claim form to the
institution which sent you this notice and mail or deliver one copy to the creditor's attorney. In
the event that there is no attorney for the creditor, then such notice shall be sent directly to the
creditor. The address for the creditor's attorney or the creditor is set forth below. Both copies
must be mailed or delivered on the same day.
NOTE: You may help resolve your claim faster if you send to the creditor's attorney
written proof or documents that show why your money is exempt. If you have
questions regarding the documents to send as proof of an exemption, call the creditor's
attorney. If you do not send written proof and the creditor's attorney has questions
about your exemption claim, the creditor's attorney may object to your claim which
may result in a further delay in releasing your exempt funds.
If they do not get the exemption claim back from you within 14 days of the date they mailed
or gave it to you, they will be free to turn the money over to the sheriff or the creditor. If you
are going to claim an exemption, do so as soon as possible, because your money may be held
until it is decided.
IF YOU CLAIM AN EXEMPTION:
(1) nonexempt money can be turned over to the creditor or sheriff;
(2) the financial institution will keep holding the money claimed to be exempt; and
(3) seven days after receiving your exemption claim, the financial institution will release the
money to you unless before then it receives an objection to your exemption claim.
IF THE CREDITOR OBJECTS TO YOUR EXEMPTION CLAIM:
The institution will hold the money until a court decides if your exemption claim is valid,
BUT ONLY IF the institution gets a copy of your court motion papers asserting the exemption
WITHIN TEN DAYS after the objection is personally served on you, or within 13 days from the
date the objection is mailed to you. You may wish to consult an attorney at once if the creditor
objects to your exemption claim.
MOTION TO DETERMINE EXEMPTION:
At any time after your funds have been held, you may ask for a court decision on the validity
of your exemption claim by filing a request for hearing which may be obtained at the office
of the court administrator of the above court.
PENALTIES:
If you claim an exemption in bad faith, or if the creditor wrongly objects to an exemption in
bad faith, the court may order the person who acted in bad faith to pay costs, actual damages,
attorney fees, and an additional amount of up to $100.
.....
.....
.....
.....
Name and address of (Attorney for)
Judgment Creditor
EXEMPTION:
(If you claim an exemption complete the following):
(a) Amount of exemption claim.
/ / I claim ALL the funds being held are exempt.
/ / I claim SOME of the funds being held are exempt.
The exempt amount is $............
(b) Basis for exemption.
Of the eleven categories listed above, I am in category number ............ (If more than one
category applies, you may fill in as many as apply.) The source of the exempt funds is the
following:
.....
.....
.....
(If the source is a type of relief based on need, list the case number and county:
case number: ...............;
county: ....................)
I hereby authorize any agency that has distributed relief to me or any correctional institution
in which I was an inmate to disclose to the above named creditor or its attorney only whether or
not I am or have been a recipient of relief based on need or an inmate of a correctional institute
within the last six months.
I have mailed or delivered a copy of the exemption notice to the creditor's attorney at the
address indicated above.
DATED: .....
.....
DEBTOR
.....
DEBTOR ADDRESS
.....
DEBTOR TELEPHONE NUMBER
History: 1990 c 606 art 3 s 24; 1992 c 464 art 1 s 56; 1993 c 156 s 17; 1994 c 488 s 8; 1999
c 107 s 66; 1999 c 159 s 149; 2000 c 343 s 4; 2000 c 405 s 22