On November 20, 2017 a
Request,Application
was filed
involving a dispute between
Osceolasc Llc,
and
Cash, Adam T,
for SMALL CLAIMS
in the District Court of Osceola County.
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IN THE COUNTY COURT, IN
THE NINTH JUDICIAL CIRCUIT
IN AND FOR OSCEOLA COUNTY, FLORIDA
CIVIL DIVISION
CASE NO: 2017-SC-4783 _
OSCEOLASC LLC D.B.A. ST CLOUD se 3 ae
REGIONAL MEDICAL CENTER Se = ma
Plaintiffs), SS Gg RET
-Vs- 3 zi = |“20
ADAM T CASH aoe — 44
Defendant(s), “T2iF =)
and == Paid,
SYNERGY ELECTRICAL SYSTEMS, INC. mT © 428
Garnishee. 47 o Cf
~o —_ / 4
CLAIM FOR EXEMPTION AND REQUEST FOR HEARING
I claim exemptions from garnishment under the following categories as checked:
1. Head of family wages. (You must checka or b below.)
a. I provide more than one-half of the support for a child or other dependent
and have net earnings of.$750.00 or less per week.
x b. I provide more than one-half ofthe support for a child or other dependent,
have net earnings of more than $750.00 per week, but have not agreéd in writing
to have my wages garnished.
2. Social Security benefits. .
3. Supplemental Security Income benefits.
4. Public assistance (welfare).
5. Workers’ compensation.
6. Unemployment Compensation.
7. Veterans’ benefits.
8. Retirement or profit-sharing benefits or pension money.
9. Life Insurance benefits or cash surrender value ofa life insurance policy or
proceeds of annuity contract.
10. Disability income benefits.
il. Prepaid College Trust Fund or Medical Savings Account.
12. Other exemptions as provided by the law.
I request a hearing to decide the:validity of my claim. Notice of the hearing should be given to me at:
Address:
“i a)
Tel. No. Uo d-Y8bH-4hH
The statements made in this request are true to the best of my knowledge and belief.
3
ICERTIFY that] have X___ mailed, hand delivered, or faxed a copy of this Claim of
Exemption and Request for Hearing to the Plaintiff(s) at:
A As PA mich: { 2aqaa
And the Garnishee at: &new y Elecanic. =e
Yon
Date: ei Defendant’s Signature
State of a
County of Lgke
Sworn to and subscribed before me by means of_* physical presence or__ online notarization this G day of
Sy LgelMentification, 2022,by_
Produced bead Adam
. Tcah
Type ofIdentification produced:_f”.Personally
L. Knownlicense.
Deiver's or
|NotaryInformation
TT C—“‘“SC*C*™*C*C*C*C™C™C*~‘*C
My Commission Expires: Clerk of the Circuit Court
a4, 1,2023 -
[ Notary Signature G7 FO" LS = By: | Deputy Clerk
° a —_———
. <<
Fe teik ; +z q cs Cana
ana
nrpappivardiRnassinpeeen yarns
PrintedNang) A itiey, FELICITY PINKSTAFF
358534_2259366_MRH
iBi
eS
MY COMMISSION # GG 331617
EXPIRES: May?, 2023
4
Document Filed Date
July 11, 2022
Case Filing Date
November 20, 2017
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IN THE COUNTY COURT, IN THE NINTH JUDICIAL CIRCUIT IN AND FOR OSCEOLA COUNTY, FLORIDA CIVIL DIVISION CASE NO: 2017-SC-4783 _ OSCEOLASC LLC D.B.A. ST CLOUD se 3 ae REGIONAL MEDICAL CENTER Se = ma Plaintiffs), SS Gg RET -Vs- 3 zi = |“20 ADAM T CASH aoe — 44 Defendant(s), “T2iF =) and == Paid, SYNERGY ELECTRICAL SYSTEMS, INC. mT © 428 Garnishee. 47 o Cf ~o —_ / 4 CLAIM FOR EXEMPTION AND REQUEST FOR HEARING I claim exemptions from garnishment under the following categories as checked: 1. Head of family wages. (You must checka or b below.) a. I provide more than one-half of the support for a child or other dependent and have net earnings of.$750.00 or less per week. x b. I provide more than one-half ofthe support for a child or other dependent, have net earnings of more than $750.00 per week, but have not agreéd in writing to have my wages garnished. 2. Social Security benefits. . 3. Supplemental Security Income benefits. 4. Public assistance (welfare). 5. Workers’ compensation. 6. Unemployment Compensation. 7. Veterans’ benefits. 8. Retirement or profit-sharing benefits or pension money. 9. Life Insurance benefits or cash surrender value ofa life insurance policy or proceeds of annuity contract. 10. Disability income benefits. il. Prepaid College Trust Fund or Medical Savings Account. 12. Other exemptions as provided by the law. I request a hearing to decide the:validity of my claim. Notice of the hearing should be given to me at: Address: “i a) Tel. No. Uo d-Y8bH-4hH The statements made in this request are true to the best of my knowledge and belief. 3 ICERTIFY that] have X___ mailed, hand delivered, or faxed a copy of this Claim of Exemption and Request for Hearing to the Plaintiff(s) at: A As PA mich: { 2aqaa And the Garnishee at: &new y Elecanic. =e Yon Date: ei Defendant’s Signature State of a County of Lgke Sworn to and subscribed before me by means of_* physical presence or__ online notarization this G day of Sy LgelMentification, 2022,by_ Produced bead Adam . Tcah Type ofIdentification produced:_f”.Personally L. Knownlicense. Deiver's or |NotaryInformation TT C—“‘“SC*C*™*C*C*C*C™C™C*~‘*C My Commission Expires: Clerk of the Circuit Court a4, 1,2023 - [ Notary Signature G7 FO" LS = By: | Deputy Clerk ° a —_——— . << Fe teik ; +z q cs Cana ana nrpappivardiRnassinpeeen yarns PrintedNang) A itiey, FELICITY PINKSTAFF 358534_2259366_MRH iBi eS MY COMMISSION # GG 331617 EXPIRES: May?, 2023 4