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WAGES, MONEY, NOTICE TO DEFENDANT OF RIGHT AGAINST (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Circuit Civil Court
P.O. Box 4667
West Palm Beach, FL 33402
NOTICE TO DEFENDANT OF RIGHT AGAINST GARNISHMENT OF
WAGES, MONEY,
AND OTHER PROPERTY
The Writ of Garnishment delivered to you with this Notice means that wages, money, and other property
belonging to you have been garnished to pay a court judgment against you. HOWEVER, YOU MAY
BE ABLE TO KEEP OR RECOVER YOUR WAGES, MONEY, OR PROPERTY. READ THIS
NOTICE CAREFULLY.
State and federal laws provide that certain wages, money, and property, even if deposited in a bank,
savings and loan, or credit union, may not be taken to pay certain types of court judgments. Such wages,
money, and property are exempt from garnishment. The major exemptions are listed below on the form
for Claim of Exemption and Request for Hearing. This list does not include all possible exemptions. You
should consult a lawyer for specific advice.
TO KEEP YOUR WAGES, MONEY, AND OTHER PROPERTY FROM BEING GARNISHED, OR
TO GET BACK ANYTHING ALREADY TAKEN, YOU MUST COMPLETE A FORM FOR CLAIM
OF EXEMPTION AND REQUEST FOR HEARING AS SET FORTH BELOW AND HAVE THE
FORM NOTARIZED. YOU MUST F IL E THE FORM WITH THE CLERK’S OFFICE WITHIN
20 DAYS AFTER THE DATE YOU RECEIVE THIS NOTICE OR YOU MAY LOSE
IMPORTANT RIGHTS. YOU MUST ALSO MAIL OR DELIVER A COPY OF THIS FORM TO
THE PLAINTIFF AND THE GARNISHEE AT THE ADDRESSES LISTED ON THE WRIT OF
GARNISHMENT.
If you request a hearing, it will be held as soon as possible after your request is received by the court. The
plaintiff or the plaintiff’s attorney must file any objection within 8 business days if you hand delivered to
the plaintiff or the plaintiff’s attorney a copy of the form for Claim of Exemption and Request for Hearing
or, alternatively, 14 business days if you mailed a copy of the form for claim and request to the plaintiff or
the plaintiff’s attorney. If the plaintiff or the plaintiff’s attorney files an objection to your Claim of
Exemption and Request for Hearing, the clerk will notify you and the other parties of the time and date of
the hearing. You may attend the hearing with or without an attorney. If the plaintiff or the plaintiff’s
attorney fails to file an objection, no hearing is required, the writ of garnishment will be dissolved and
your wages, money, or property will be released.
YOU SHOULD FILE THE FORM FOR CLAIM OF EXEMPTION IMMEDIATELY TO KEEP YOUR
WAGES, MONEY, OR PROPERTY FROM BEING APPLIED TO THE COURT JUDGMENT. THE
CLERK CANNOT GIVE YOU LEGAL ADVICE. IF YOU NEED LEGAL ASSISTANCE YOU
SHOULD SEE A LAWYER. IF YOU CANNOT AFFORD A PRIVATE LAWYER, LEGAL
SERVICES MAY BE AVAILABLE. CONTACT YOUR LOCAL BAR ASSOCIATION OR ASK
THE CLERK’S OFFICE ABOUT ANY LEGAL SERVICES PROGRAM IN YOUR AREA.
Claim of Exemption and Request for Hearing (F.S. 77.041) (01/21)
County Civil Court
P.O. Box 3406
West Palm Beach, FL 33402
IN THE COUNTY/CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
IN AND FOR PALM BEACH COUNTY, FLORIDA
Case No:
-vs-
Plaintiff(s)
Defendant(s)
Garnishee
CLAIM OF EXEMPTION AND REQUEST FOR
HEARING PURSUANT TO F.S. 77.041
I claim exemptions from garnishment under the following categories as checked:
1. Head of family wages. (You must check a. or b. below.)
a. I provide more than one-half of the support for a child or other dependent and have
net earnings of $750 or less per week.
b. I provide more than one-half of the support for a child or other dependent, have net
earnings of more than $750 per week, but have not agreed in writing to have my wages
garnished.
2. Social Security benefits.
3. Supplemental Security Income benefits.
4. Public assistance (welfare).
5. Workers’ Compensation.
6. Reemployment assistance or unemployment compensation.
7. Veterans’ benefits.
8. Retirement or profit-sharing benefits or pension money.
9. Life insurance benefits or cash surrender value of a life insurance policy or proceeds of
annuity contract.
10. Disability income benefits.
11. Prepaid College Trust Fund or Medical Savings Account.
12. Other exemptions as provided by law.
(explain)
Claim of Exemption and Request for Hearing
(F.S. 77.041) (01/21), Page 1 of 2
I request a hearing to decide the validity of my claim. Notice of the hearing should be
given to me at:
Address:
Telephone number:
I CERTIFY UNDER OATH AND PENALTY OF PERJURY that a copy of this CLAIM OF
EXEMPTION AND REQUEST FOR HEARING has been furnished by ( ) United States mail or
( ) e-mail or ( ) hand delivery on {date}____________________________________________.
I FURTHER CERTIFY UNDER OATH AND PENALTY OF PERJURY that the statements
made in this request are true to the best of my knowledge and belief.
{Name and Address of Plaintiff or Plaintiff’s attorney and of Garnishee or Garnishee’s attorney to whom
this document was furnished}
Name: _________________________________
Address: _____________
_____________
City, State, Zip: ______________
_______________________
Fax Number: ____________________________
Name: ______________
______________________
Address: ____________
______________
City, State, Zip: _____________
_________________________
Fax Number: ____________________________
Date
Defendant’s signature
STATE OF FLORIDA
COUNTY OF PALM BEA
CH
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online
notarization, this day of , , by
[Notary Seal]
Notary Public or Deputy Clerk
Name typed, printed, or stamped
My Commission Expires:
Personally Known OR Produced Identification
Type of Identification Produced:
Claim of Exemption and Request for Hearing
(F.S. 77.041) (01/21), Page 2 of 2
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WAGES, MONEY, NOTICE TO DEFENDANT OF RIGHT AGAINST (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Completed 5 July 2021

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