Preview
%
a
WAGE EXECUTION PROCEEDINGS STATE.OF CONNECTICUT mt ey iz
APPLICATION, ORDER, EXECUTION SUPERIOR COURT SE
JO-CV-3 -Rev, 2-15 wwwjud.ct.gov: .
C8. 85 1580, 6-950, 22810, 52.9884, Sua go WAGEEX
29 USC, 208(a)(1) Employer: See Page 2 for Instructions
instructions REE
Judgment Creditor or Attomey Clerk Proper Officer
1. Unless fillny electronically, prepare original and four copies, 1, Issue executlor ing original. 4, Leave one signed copy with’employer,
2. Attach form JD-CV-38 to this form, or Include with execution: 2. Enter cayaun oceed wanton ‘at the bottom of 2, Make return on ‘ned orginal
as one PDF electronic form, ‘section fon page 2. 3. Leave one copy of Modification and Exemption
‘3. Present original and 3 coples to clark of court, 3. Retum ornate ‘and 2 copies if on paper, ‘Claim form (JD-OV-3.a) with employer and fill In
4. Keep one copy for your file, 4, Retaln/scan copy for court fils. "Dato of Service" on form,
Name and malling eddress of Judgment Creditor or Attomey
(To be completed by Judgment Creditor or Attomay) "ADA NOTICE
" 7 el cir err
lcut com
SCHREIBER LAW, LLC with Disabilities Act (ADA), if you need a
53 Stiles Road, Sulte A102 Teasonable accommodation in accordance
with the ‘ADA, contact @:court alerk or an ADA
Salem, NH 03079 cdntact parson fisted at wwwJud.ct. goWADA,
4
“Lyea Bun. [Housing —
FST- cV1960412505
(as) of Judgment Deblor(s)
KARLA-F SANTACRUZLARA
‘7 CHESTNUT ST FL2
GREENWICH, CT 06830-5920
oH) | Stamford. Judicial District 112, oyt St, Stamford. CT. 06905
} i Cred
300 Summit Lake Dr. Sulte 400
falhalla, NY 105952340
S
<
5 Telephone number of employer (ino
g
= 2. Amount of cost < fees
< $102.35
. Total amount of judgment, costs and tees (Add f and 2) Total amount pald (i Hi [5 Total amount unpald (Subtract 4 Fo
$1436.23 $0.00 $1436.23
pplication fee for wage execution (If nof waived by tha cour) | 7. ical id fo flons on this Judgment
$105.00
%, Olhor Court ordared pos\judgmant costs and fees ~ [9. Totaloflines 5,6, 7ande Wa Fy Postjudgment Interest was
$0.00 $1541.23 ordered:by the Court
The above-named Judgment Creditor(s) recovered a judgment against the above-named Judgment Debtor(s), The Judgment Debtor(s) has/have
falled to pay the total amount due on that judgment.
Pursuant to the Connecticut.General Statutes, the Court listed above entered‘an order that the Judgment be paid. by the above-named
Judgment Debtor(s) In the following installment payments:
Theamountof $35.00 ‘was ordered to be paldin -Weekly (weekly, monthly, or other) installment payments, *See Note below
(Note: This Is notthe amount the employer must pay. Employer must pay the amount of execution:calculated on page 2 of this form,
‘The court ordered that installment payments begin on 09/05/19 (commencement date)
The Judgment Debtor(s) failed to comply with the installment Payment Order
Therefore, the Judgment Creditor{s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount
due on tha jutoment shovnt in fine 8 above .
GROSS NEE
On (Hate, Te
70/23 /g__| veoo-as-ue
Execution
To: Any Proper Officer
‘By the authority of the State of Connecticut, you are ordered to cause any wages .due to the Judgment’
Debtor(s), not exceeding the Amount of Executlon calculated on page 2; to be pald tothe Judgment:
Creditor(s) until the Judgment Is‘satisfied, including postjudgment interest as ordered by the-court, If
applicable, plus the application fee(s) and other Court ordered postjudgment costs and fees, and your own
fees or until the execution Is modified or set aside.
| Serve.this execution within:one year of this date, and make retum of service to this courtwithin thirty days
from: sailsfactlan orhie execution.
Page 4 of 2 WAGE EXECUTION PROCEEDINGSImportant Notice To Employer
You are being served with a wage execution, a court order requiring you to witlhold non-exempt wages from:a person employed by you. This execution is being served on you
because your employee, the Judgment Debtor (on page 1), has had a judgment entered agé
the Judgment Creditor (on page 1) and has not made payment of the total amount of the:ju
inst him/her by the:Superior Court requiting him/her to pay Judgment, costs and foes to
idgment plus any costs and fees as shown on page 1,This notice is-to inform you of the
actions you must take in order to comply with the law regarding wage ‘executions. Please read each section carefully.
1.You must notify the employee — Your employee has certain legal rights which
may allow him/her to request the court to change or stop this execution upon his/her
wages. A notice of his/her rights and how to get a hearing in court is attached to the
second copy of the wage execution given fo you by the officer. You must complete
‘your portion of the wage execution and your portion of the exemption and modification
claim form and deliver or mail, postage prepaid, @ copy of these pepers to your
employee immediately so thet your employee can make any claims allowed by law.
Il Execution not effective for 20 days — This execution is not effective until afler
20 days from the day the officer served these papers on you. No money should be
deducted from your employee's wages until the first wages you pay fo your employes
after the 20-day period ends. If your employee elects within the 20-day period to
make a claim fo the court that hishher wages aro partially or totally exempt from
‘execution to pay this judgment or he/she seeks to have'the amount of this execution
changed, wages are-not fo. be withheld from the employee until the court decides the
claims-or determines the rights of your employes In this case, If you are not notified
that your employee has filed papers with the court, the execution isto be enforced
after 20 days from the date of service on you.
Ill. Stay of execution — No earnings claimed to be ‘exempt or subject to a claim for
modification may be withheld from any employee uniil determination of the claim by
the court.
IV. Only one execution issued under section §2-364a of thie General Statutes Is
to be satisfied at a time — You must make deductions from your employee's wages.
and pay over the withheld money against only one execution issued under General
‘Statutes section 52-364a at a time. If you are served with more than one execullon
issued under General Statutes section 52-364a against this employee's wages, the
executions are.to be satisfied in the order In which you até served with them. fInconie
withholdings end voluntary wage deductions for support of a family, if there are any,
‘must be paid before this execution. Family support income withholdings and voluntary
wage deductions are issued an Form JO-FM-1,)
V. Maximum amount deducted — The.maximum amount which can’ be legelly
withheld from your employee's wages is 25% of his/her disposable eamings for each
week, The amount fo be withheld fo pay this execution may be less than 25%, but It
can never-be more. The computations you complete below wil allow you to calculate
the exact amount which should be withheld from this employee's wages.
Unless the court orders that this execution Is to be for a smaller amount, you must
withhold and pay over the maximum amount which you figure out ‘using the
computations below. Your employee tas a right to request the court to reduce the
ariount withheld, but until you receive notice thatthe court has agreed to allow the.
‘amount to be reduced, you must withhold the maximum amount.
Vi. Your duty to comply with this execution — You have-a tegal duly to make
deductions fram your employee's wages and pay any amounts deducted as required
by this execution. IF you do not, legal action may be taken against you. If you aro
found to be In contempt of a court order, you maybe held liable to the Judgment
Creditor for the amounts of wages which you did not withhold from your employee.
Vil. Discipline against your employee — You may not discipline, suspend or
discharge your employee because this wage execution has been served upon you. If
you do untawfully teke action against your employee, you may be liable to pay him all
Of his fost eamings and employment benefits from the time of your action to the time
that thie employee is reinstated. '
‘Tho law allows you to take disciplinary measures against the employee If you are
served with more than 7 wage executions against his/her wages in any calendar year.
Section I. Calculation Of Employee's Disposable Earnings
"Disposable Eamings" means that part of the earnings of an individual
remaining after the deduction from those earnings of amounts to be
withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiation fees, group life
insurance premiums, health insurance premiums, and federal tax levies,
1, Employee's gross compensation per week.
2, Federal income tax Withheld .....ssssseserssersreereresees
3. Federal employment tax.....
4. Normal retirement contribution ......
5, Union dues and initiation fe0S .........sseseseesee
6. Group life insurance premium ...
7. Health insurance premlum..........ssceeee
8. Other federal tax leVICS ...sesesesscsesssssesssssees
9. Total allowable deductions (Add lines 2-8)...
10. Weekly Disposable Eamings (Subtract line 9 from line 1).
Section Il. Calculation Of Employee's Disposable Earnings
To be calculated by employer
A-1. Weekly disposable earings (from line 10 above)
A-2. 25% of disposable earnings for week
B-1, Weekly disposable eamings (from line 10 above)
B2. Forty times the higher of the current federal minimum
hourly wage or state full minimum fair wage.
Amount by which line B-1 exceeds B-2
Courtordered imitation (ifany, fo be entered by clerk)
Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court
ordered limitation set forth below is a lesser amount, in which case the employer must pay that lesser amount)
Column 1
JD-CV-3 Re
15 Page 2
of2
|
|
{
|
|
|EXEMPTION AND MODIFICATION
CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT
devise fev, 115 SUPERIOR COURT
C.G.S. § 31-68(|), 52-212, 52-350a, 2-352b, 52-3612, i |
52-361b, 29 U.S.C. 208(a)(1) www, jud.ct.gov
Name and mailing address of judgment debtor (person who must pay money) or COON
attorney of judgment debtor MXMPEX
(To be completed by judgment creditor (person who money Is pald fo))
= Instructions
To: . To proper officer: Complete Section I! below and
. KARLA F SANTACRUZLARA make service on employer in accordance with the
7 CHESTNUT ST FL2 Instructions on form JD-CV-8.
GREENWICH, CT 06830-5920 Toemployer: Complete Section Il! below and
Immediately deliver to employee.
L _
Section | - Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the
wage execution application (JD-CV-3).
Geographical lame'and address.of court
deal Housing
pitt LJ Session Area Stamford Judicial District, 123 Hoyt St., Stamford CT 06905
Docket number
Cavalry SPV 1, LLC v. KARLA F SANTACRUZLARA FST-CV1960412505
‘Name of judgment deotar (person who must pay money)
KARLA F SANTACRUZLARA
Section Il_- Proper Officer must complete this section
‘Name of proper officer Date of service of wage execution on employer
Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage
Execution form (JD-CV-3) to the judgment debtor (General Statutes section 52-361a(d)).
Section Ill -
Section IV - Notice to judgment debtor (person who. must pay money)
Because a Judgment entered against you, the attached execution has been Issued against wages earned by you from the employer
named above. Beginning twenty (20) days from the Date of Service of Wage Execution on Employer Indicated above, the employer will
remove from your weekly earnings an.amount of money which leaves you with (a) seventy-five percent (75%) of your disposable earnings
OR (b) forty (40) times the higher of the minimum hourly wage set by federal law or state law; whichever Is the larger amount. On page 2 of
this form are the sections of the Connecticut General Statutes. which your employer must follow to figure out (calculate) the weekly amount
that may be taken out-of your wages to agree with the wage execution. If you think that-your employer has not calculated the weekly
‘amount correctly, you should tell your employer.
Your earnings may be exempt from execution (do not have to be taken) — Any wages earned by a person who.gets public
assistance.under an incentive earings or similar program are exempt from (may not be taken from you)’executlon. (Section 52-352b(d) of.
the Connecticut General Statutes).
How to.claim anexemption allowed by law — If you want'to claim that your-earnings are exempt by law from execution you must fill
out and sign’the Claim of Exemption on page 2 of this form and return this exemption and modification clalm form to the ‘Superior Court at
the above address.
When the clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor of the date‘on which the court will
have a hearing to figure out the Issues ralsed by your claim. If this form Is recelved by the court no later than twenty (20) days from the Date
of Service of Wage Execution on Employer indicated above, the employer will not begin withholding (removing) your earnings from your
‘wages until after your claim is figured out by the court. A clalm may also be filed after the twenty (20) day period. No eamings claimed to be
exempt may be withheld from any employee until the claim has been figured out.
Modification of execution — If you have reasonable cause to believe that you have a‘tight to a modification (change) of the wage
exeoution and you want to:ask for a modification (to have less money taken from your wages), you must fill out the Claim for Modification on
page 2 of this form and return this exemption and modification claim form to the Superior Court
at the address listed above.
When the clerk of Superior Court gets this form the clerk will tell you and the judgment da
creditor the date on which the court will have a hearing to figure out the Issues raised by your
claim. If this form Is:received by the court no later than twenty (20).days from the Date of Service
‘of Wage Execution on Employer Indicated above, the employer will not begin withholding your
earnings until after your clalm Is figured out by the court. A claim may also be filed after the twenty
(20) day period. No earnings subject to a claim for modification may be withheld from any
employee until the claim has been figured out.
Setting aside judgment — If the judgment was made against you because you did not
come to court, you may, within four (4) months of the date the court made its Judgment.and upon
belief that you have reasonable cause, ask the court‘to set aside the judgment entered against
you and the case will begin again. A fee will be charged to you for a motion to set aside Judgment.
Page 1 of 2 Exemption and modification claim
i=Resets!Section V - Claim of exemption established by law
|, the Judgment Debtor (person who must pay money), claim and certify under the penalty of false statement that my
earnings.are exempt from execution (do not have to be taken) because:
[get public assistance and earn wages under an incentive earnings or similar program and my earnings
are exempt from execution, or
(1 Other statutory exemption (state exemption and statutory citation)
“Signed (dudgment Debary ee Name and adgress of judgment debtor Telephone number
Section VI - Claim for modification
|, the Judgment Debtor (person who must pay money), ask-for a modification of the wage execution against me because:
New amount requested Describe why you think you should get a modification (have less money taken fram your wages)
/ Per week
Signed (Judgment Debtor) peer | ‘Name and-complete malling address of judgment debtor Telephone number
Section Vii - Agreement to a modification
The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the Wage Execution claimed
ae ee
Section VIII - Notice of hearing on exemption / modification claim
Date of hearing ‘Time of hearing ‘Courtroom:
Mm By the Assistant Clerk
Section IX - Order of court
Itis ordered that:
‘Signed (Judge, Magistrate, Assistant Clerk} - ite signed
. By order of the court
General Statutes
4. The following is the part of section 52-361a(f) of the Connecticut General Statutes which says what part of your wages can be removed by the employer
and given tothe judgment creditor. .
"The maximum part of the aggregate weekly earnings of an Individual which may be subject under this section to levy or other withholding for payment of
a judgment Is the lesser of (1) twenty-five (25) percent of his disposable earnings for that week, or (2) the amount by which his disposable earnings for that
week exoped forty (40) times the higher of (A) the minitnum hourly wage prescribed by seotlon 6(a)(1) of the Fair Labor Standards Act of 1938, 29:U.S.C.
Section 206(a)(4), or (B) the full minimum falr wage established by subsection (1) of section 31-68, in effect at the time the eamings are payable.”
2. The following is the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earnings and which defines ‘What parts.of
your wages which can not be Included In’your total eamings when figuring out (calculating) the weekly amount which Is ‘subject to execution.
“Disposable earnings’ means that part of the eamings of an Individual remaining after the deduction from those eamings of amounts required to be
withheld for payment of federal Income and employment taxes, normal retirement contributions, union dues and initiation fees, group life:Insurance
premiums, health insurance premiums and federal tax levies.”
The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a
reasonable accommodation in accordance with the ADA, contact the clerk at the court named.on page 1 or an ADA
contact person listed at www.jud.ct.gov/ADA/.
JD-GV-3a (back/page 2) Rev. 11-15
Page 2 of 2
Preview
% a WAGE EXECUTION PROCEEDINGS STATE.OF CONNECTICUT mt ey iz APPLICATION, ORDER, EXECUTION SUPERIOR COURT SE JO-CV-3 -Rev, 2-15 wwwjud.ct.gov: . C8. 85 1580, 6-950, 22810, 52.9884, Sua go WAGEEX 29 USC, 208(a)(1) Employer: See Page 2 for Instructions instructions REE Judgment Creditor or Attomey Clerk Proper Officer 1. Unless fillny electronically, prepare original and four copies, 1, Issue executlor ing original. 4, Leave one signed copy with’employer, 2. Attach form JD-CV-38 to this form, or Include with execution: 2. Enter cayaun oceed wanton ‘at the bottom of 2, Make return on ‘ned orginal as one PDF electronic form, ‘section fon page 2. 3. Leave one copy of Modification and Exemption ‘3. Present original and 3 coples to clark of court, 3. Retum ornate ‘and 2 copies if on paper, ‘Claim form (JD-OV-3.a) with employer and fill In 4. Keep one copy for your file, 4, Retaln/scan copy for court fils. "Dato of Service" on form, Name and malling eddress of Judgment Creditor or Attomey (To be completed by Judgment Creditor or Attomay) "ADA NOTICE " 7 el cir err lcut com SCHREIBER LAW, LLC with Disabilities Act (ADA), if you need a 53 Stiles Road, Sulte A102 Teasonable accommodation in accordance with the ‘ADA, contact @:court alerk or an ADA Salem, NH 03079 cdntact parson fisted at wwwJud.ct. goWADA, 4 “Lyea Bun. [Housing — FST- cV1960412505 (as) of Judgment Deblor(s) KARLA-F SANTACRUZLARA ‘7 CHESTNUT ST FL2 GREENWICH, CT 06830-5920 oH) | Stamford. Judicial District 112, oyt St, Stamford. CT. 06905 } i Cred 300 Summit Lake Dr. Sulte 400 falhalla, NY 105952340 S < 5 Telephone number of employer (ino g = 2. Amount of cost < fees < $102.35 . Total amount of judgment, costs and tees (Add f and 2) Total amount pald (i Hi [5 Total amount unpald (Subtract 4 Fo $1436.23 $0.00 $1436.23 pplication fee for wage execution (If nof waived by tha cour) | 7. ical id fo flons on this Judgment $105.00 %, Olhor Court ordared pos\judgmant costs and fees ~ [9. Totaloflines 5,6, 7ande Wa Fy Postjudgment Interest was $0.00 $1541.23 ordered:by the Court The above-named Judgment Creditor(s) recovered a judgment against the above-named Judgment Debtor(s), The Judgment Debtor(s) has/have falled to pay the total amount due on that judgment. Pursuant to the Connecticut.General Statutes, the Court listed above entered‘an order that the Judgment be paid. by the above-named Judgment Debtor(s) In the following installment payments: Theamountof $35.00 ‘was ordered to be paldin -Weekly (weekly, monthly, or other) installment payments, *See Note below (Note: This Is notthe amount the employer must pay. Employer must pay the amount of execution:calculated on page 2 of this form, ‘The court ordered that installment payments begin on 09/05/19 (commencement date) The Judgment Debtor(s) failed to comply with the installment Payment Order Therefore, the Judgment Creditor{s) applies/apply for this execution upon the wages of the Judgment Debtor(s) for the remaining amount due on tha jutoment shovnt in fine 8 above . GROSS NEE On (Hate, Te 70/23 /g__| veoo-as-ue Execution To: Any Proper Officer ‘By the authority of the State of Connecticut, you are ordered to cause any wages .due to the Judgment’ Debtor(s), not exceeding the Amount of Executlon calculated on page 2; to be pald tothe Judgment: Creditor(s) until the Judgment Is‘satisfied, including postjudgment interest as ordered by the-court, If applicable, plus the application fee(s) and other Court ordered postjudgment costs and fees, and your own fees or until the execution Is modified or set aside. | Serve.this execution within:one year of this date, and make retum of service to this courtwithin thirty days from: sailsfactlan orhie execution. Page 4 of 2 WAGE EXECUTION PROCEEDINGSImportant Notice To Employer You are being served with a wage execution, a court order requiring you to witlhold non-exempt wages from:a person employed by you. This execution is being served on you because your employee, the Judgment Debtor (on page 1), has had a judgment entered agé the Judgment Creditor (on page 1) and has not made payment of the total amount of the:ju inst him/her by the:Superior Court requiting him/her to pay Judgment, costs and foes to idgment plus any costs and fees as shown on page 1,This notice is-to inform you of the actions you must take in order to comply with the law regarding wage ‘executions. Please read each section carefully. 1.You must notify the employee — Your employee has certain legal rights which may allow him/her to request the court to change or stop this execution upon his/her wages. A notice of his/her rights and how to get a hearing in court is attached to the second copy of the wage execution given fo you by the officer. You must complete ‘your portion of the wage execution and your portion of the exemption and modification claim form and deliver or mail, postage prepaid, @ copy of these pepers to your employee immediately so thet your employee can make any claims allowed by law. Il Execution not effective for 20 days — This execution is not effective until afler 20 days from the day the officer served these papers on you. No money should be deducted from your employee's wages until the first wages you pay fo your employes after the 20-day period ends. If your employee elects within the 20-day period to make a claim fo the court that hishher wages aro partially or totally exempt from ‘execution to pay this judgment or he/she seeks to have'the amount of this execution changed, wages are-not fo. be withheld from the employee until the court decides the claims-or determines the rights of your employes In this case, If you are not notified that your employee has filed papers with the court, the execution isto be enforced after 20 days from the date of service on you. Ill. Stay of execution — No earnings claimed to be ‘exempt or subject to a claim for modification may be withheld from any employee uniil determination of the claim by the court. IV. Only one execution issued under section §2-364a of thie General Statutes Is to be satisfied at a time — You must make deductions from your employee's wages. and pay over the withheld money against only one execution issued under General ‘Statutes section 52-364a at a time. If you are served with more than one execullon issued under General Statutes section 52-364a against this employee's wages, the executions are.to be satisfied in the order In which you até served with them. fInconie withholdings end voluntary wage deductions for support of a family, if there are any, ‘must be paid before this execution. Family support income withholdings and voluntary wage deductions are issued an Form JO-FM-1,) V. Maximum amount deducted — The.maximum amount which can’ be legelly withheld from your employee's wages is 25% of his/her disposable eamings for each week, The amount fo be withheld fo pay this execution may be less than 25%, but It can never-be more. The computations you complete below wil allow you to calculate the exact amount which should be withheld from this employee's wages. Unless the court orders that this execution Is to be for a smaller amount, you must withhold and pay over the maximum amount which you figure out ‘using the computations below. Your employee tas a right to request the court to reduce the ariount withheld, but until you receive notice thatthe court has agreed to allow the. ‘amount to be reduced, you must withhold the maximum amount. Vi. Your duty to comply with this execution — You have-a tegal duly to make deductions fram your employee's wages and pay any amounts deducted as required by this execution. IF you do not, legal action may be taken against you. If you aro found to be In contempt of a court order, you maybe held liable to the Judgment Creditor for the amounts of wages which you did not withhold from your employee. Vil. Discipline against your employee — You may not discipline, suspend or discharge your employee because this wage execution has been served upon you. If you do untawfully teke action against your employee, you may be liable to pay him all Of his fost eamings and employment benefits from the time of your action to the time that thie employee is reinstated. ' ‘Tho law allows you to take disciplinary measures against the employee If you are served with more than 7 wage executions against his/her wages in any calendar year. Section I. Calculation Of Employee's Disposable Earnings "Disposable Eamings" means that part of the earnings of an individual remaining after the deduction from those earnings of amounts to be withheld for payment of federal income and employment taxes, normal retirement contributions, union dues and initiation fees, group life insurance premiums, health insurance premiums, and federal tax levies, 1, Employee's gross compensation per week. 2, Federal income tax Withheld .....ssssseserssersreereresees 3. Federal employment tax..... 4. Normal retirement contribution ...... 5, Union dues and initiation fe0S .........sseseseesee 6. Group life insurance premium ... 7. Health insurance premlum..........ssceeee 8. Other federal tax leVICS ...sesesesscsesssssesssssees 9. Total allowable deductions (Add lines 2-8)... 10. Weekly Disposable Eamings (Subtract line 9 from line 1). Section Il. Calculation Of Employee's Disposable Earnings To be calculated by employer A-1. Weekly disposable earings (from line 10 above) A-2. 25% of disposable earnings for week B-1, Weekly disposable eamings (from line 10 above) B2. Forty times the higher of the current federal minimum hourly wage or state full minimum fair wage. Amount by which line B-1 exceeds B-2 Courtordered imitation (ifany, fo be entered by clerk) Amount of Execution (Employer must pay the lesser of the two amounts in column 2 unless the court ordered limitation set forth below is a lesser amount, in which case the employer must pay that lesser amount) Column 1 JD-CV-3 Re 15 Page 2 of2 | | { | | |EXEMPTION AND MODIFICATION CLAIM FORM, WAGE EXECUTION STATE OF CONNECTICUT devise fev, 115 SUPERIOR COURT C.G.S. § 31-68(|), 52-212, 52-350a, 2-352b, 52-3612, i | 52-361b, 29 U.S.C. 208(a)(1) www, jud.ct.gov Name and mailing address of judgment debtor (person who must pay money) or COON attorney of judgment debtor MXMPEX (To be completed by judgment creditor (person who money Is pald fo)) = Instructions To: . To proper officer: Complete Section I! below and . KARLA F SANTACRUZLARA make service on employer in accordance with the 7 CHESTNUT ST FL2 Instructions on form JD-CV-8. GREENWICH, CT 06830-5920 Toemployer: Complete Section Il! below and Immediately deliver to employee. L _ Section | - Judgment Creditor (person who money is paid to) must fill out this section and attach to one copy of the wage execution application (JD-CV-3). Geographical lame'and address.of court deal Housing pitt LJ Session Area Stamford Judicial District, 123 Hoyt St., Stamford CT 06905 Docket number Cavalry SPV 1, LLC v. KARLA F SANTACRUZLARA FST-CV1960412505 ‘Name of judgment deotar (person who must pay money) KARLA F SANTACRUZLARA Section Il_- Proper Officer must complete this section ‘Name of proper officer Date of service of wage execution on employer Employer must fill out this section and IMMEDIATELY send one copy of this form and the Wage Execution form (JD-CV-3) to the judgment debtor (General Statutes section 52-361a(d)). Section Ill - Section IV - Notice to judgment debtor (person who. must pay money) Because a Judgment entered against you, the attached execution has been Issued against wages earned by you from the employer named above. Beginning twenty (20) days from the Date of Service of Wage Execution on Employer Indicated above, the employer will remove from your weekly earnings an.amount of money which leaves you with (a) seventy-five percent (75%) of your disposable earnings OR (b) forty (40) times the higher of the minimum hourly wage set by federal law or state law; whichever Is the larger amount. On page 2 of this form are the sections of the Connecticut General Statutes. which your employer must follow to figure out (calculate) the weekly amount that may be taken out-of your wages to agree with the wage execution. If you think that-your employer has not calculated the weekly ‘amount correctly, you should tell your employer. Your earnings may be exempt from execution (do not have to be taken) — Any wages earned by a person who.gets public assistance.under an incentive earings or similar program are exempt from (may not be taken from you)’executlon. (Section 52-352b(d) of. the Connecticut General Statutes). How to.claim anexemption allowed by law — If you want'to claim that your-earnings are exempt by law from execution you must fill out and sign’the Claim of Exemption on page 2 of this form and return this exemption and modification clalm form to the ‘Superior Court at the above address. When the clerk of the Superior Court gets this form, the clerk will notify you and the judgment creditor of the date‘on which the court will have a hearing to figure out the Issues ralsed by your claim. If this form Is recelved by the court no later than twenty (20) days from the Date of Service of Wage Execution on Employer indicated above, the employer will not begin withholding (removing) your earnings from your ‘wages until after your claim is figured out by the court. A clalm may also be filed after the twenty (20) day period. No eamings claimed to be exempt may be withheld from any employee until the claim has been figured out. Modification of execution — If you have reasonable cause to believe that you have a‘tight to a modification (change) of the wage exeoution and you want to:ask for a modification (to have less money taken from your wages), you must fill out the Claim for Modification on page 2 of this form and return this exemption and modification claim form to the Superior Court at the address listed above. When the clerk of Superior Court gets this form the clerk will tell you and the judgment da creditor the date on which the court will have a hearing to figure out the Issues raised by your claim. If this form Is:received by the court no later than twenty (20).days from the Date of Service ‘of Wage Execution on Employer Indicated above, the employer will not begin withholding your earnings until after your clalm Is figured out by the court. A claim may also be filed after the twenty (20) day period. No earnings subject to a claim for modification may be withheld from any employee until the claim has been figured out. Setting aside judgment — If the judgment was made against you because you did not come to court, you may, within four (4) months of the date the court made its Judgment.and upon belief that you have reasonable cause, ask the court‘to set aside the judgment entered against you and the case will begin again. A fee will be charged to you for a motion to set aside Judgment. Page 1 of 2 Exemption and modification claim i=Resets!Section V - Claim of exemption established by law |, the Judgment Debtor (person who must pay money), claim and certify under the penalty of false statement that my earnings.are exempt from execution (do not have to be taken) because: [get public assistance and earn wages under an incentive earnings or similar program and my earnings are exempt from execution, or (1 Other statutory exemption (state exemption and statutory citation) “Signed (dudgment Debary ee Name and adgress of judgment debtor Telephone number Section VI - Claim for modification |, the Judgment Debtor (person who must pay money), ask-for a modification of the wage execution against me because: New amount requested Describe why you think you should get a modification (have less money taken fram your wages) / Per week Signed (Judgment Debtor) peer | ‘Name and-complete malling address of judgment debtor Telephone number Section Vii - Agreement to a modification The Judgment Creditor(s) (person who money is paid to) agrees to the modification of the Wage Execution claimed ae ee Section VIII - Notice of hearing on exemption / modification claim Date of hearing ‘Time of hearing ‘Courtroom: Mm By the Assistant Clerk Section IX - Order of court Itis ordered that: ‘Signed (Judge, Magistrate, Assistant Clerk} - ite signed . By order of the court General Statutes 4. The following is the part of section 52-361a(f) of the Connecticut General Statutes which says what part of your wages can be removed by the employer and given tothe judgment creditor. . "The maximum part of the aggregate weekly earnings of an Individual which may be subject under this section to levy or other withholding for payment of a judgment Is the lesser of (1) twenty-five (25) percent of his disposable earnings for that week, or (2) the amount by which his disposable earnings for that week exoped forty (40) times the higher of (A) the minitnum hourly wage prescribed by seotlon 6(a)(1) of the Fair Labor Standards Act of 1938, 29:U.S.C. Section 206(a)(4), or (B) the full minimum falr wage established by subsection (1) of section 31-68, in effect at the time the eamings are payable.” 2. The following is the part of section 52-350a(4) of the Connecticut General Statutes which defines disposable earnings and which defines ‘What parts.of your wages which can not be Included In’your total eamings when figuring out (calculating) the weekly amount which Is ‘subject to execution. “Disposable earnings’ means that part of the eamings of an Individual remaining after the deduction from those eamings of amounts required to be withheld for payment of federal Income and employment taxes, normal retirement contributions, union dues and initiation fees, group life:Insurance premiums, health insurance premiums and federal tax levies.” The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact the clerk at the court named.on page 1 or an ADA contact person listed at www.jud.ct.gov/ADA/. JD-GV-3a (back/page 2) Rev. 11-15 Page 2 of 2