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Minnesota Legislature

Office of the Revisor of Statutes

571.925 FORM OF NOTICE.
The ten-day notice informing a debtor that a garnishment summons may be used to garnish
the earnings of an individual must be substantially in the following form:
STATE OF MINNESOTA
DISTRICT COURT
COUNTY OF .....
..... JUDICIAL DISTRICT
..... (Creditor)
against
GARNISHMENT EXEMPTION
..... (Debtor)
NOTICE AND NOTICE OF
and
INTENT TO GARNISH EARNINGS
..... (Garnishee)
PLEASE TAKE NOTICE that a garnishment summons or levy may be served upon your
employer or other third parties, without any further court proceedings or notice to you, ten days
or more from the date hereof. Some or all of your earnings are exempt from garnishment. If
your earnings are garnished, your employer must show you how the amount that is garnished
from your earnings was calculated. You have the right to request a hearing if you claim the
garnishment is incorrect.
Your earnings are completely exempt from garnishment if you are now a recipient of relief
based on need, if you have been a recipient of relief within the last six months, or if you have
been an inmate of a correctional institution in the last six months.
Relief based on need 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.
If you wish to claim an exemption, you should fill out the appropriate form below, sign it,
and send it to the creditor's attorney and the garnishee.
You may wish to contact the attorney for the creditor in order to arrange for a settlement of
the debt or contact an attorney to advise you about exemptions or other rights.
PENALTIES
(1) Be advised that even if you claim an exemption, a garnishment summons may still be
served on your employer. If your earnings are garnished after you claim an exemption,
you may petition the court for a determination of your exemption. If the court finds that
the creditor disregarded your claim of exemption in bad faith, you will be entitled to costs,
reasonable attorney fees, actual damages, and an amount not to exceed $100.
(2) HOWEVER, BE WARNED if you claim an exemption, the creditor can also petition
the court for a determination of your exemption, and if the court finds that you claimed an
exemption in bad faith, you will be assessed costs and reasonable attorney's fees plus an
amount not to exceed $100.
(3) If after receipt of this notice, you in bad faith take action to frustrate the garnishment,
thus requiring the creditor to petition the court to resolve the problem, you will be liable to
the creditor for costs and reasonable attorney's fees plus an amount not to exceed $100.
Dated: .....
.....
(Attorney for) Creditor
.....
Address
.....
Telephone
DEBTOR'S EXEMPTION CLAIM NOTICE
I hereby claim that my earnings are exempt from garnishment because:
(1) I am presently a recipient of relief based on need. (Specify the program, case number,
and the county from which relief is being received.)
.....
.....
.....
Program
Case Number (if known)
County
(2) I am not now receiving relief based on need, but I have received relief based on need
within the last six months. (Specify the program, case number, and the county from which
relief has been received.)
.....
.....
.....
Program
Case Number (if known)
County
(3) I have been an inmate of a correctional institution within the last six months. (Specify
the correctional institution and location.)
.....
.....
Correctional Institution
Location
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 the creditor's attorney only
whether or not I am or have been a recipient of relief based on need or an inmate of a correctional
institution within the last six months. I have mailed or delivered a copy of this form to the creditor
or creditor's attorney.
.....
.....
Date
Debtor
.....
Address
.....
Debtor Telephone Number
History: 1986 c 444; 1990 c 606 art 3 s 33; 1999 c 159 s 150; 2000 c 405 s 24