Preview
FINANCIAL INSTITUTION excourion STATE OF CONNECTICUT , a
PROCEEDINGS - JUDGMENT DEBTOR SUPERIOR COURT *APFEABA*
WHO IS A NATURAL PERSON, www,fud.ct.gov
spavize howe men ID EXECUTION (See page 2 for instructions to financial institution EAE
C.G.S, §§ 52-356b, 52-3675 and ADA Notice)
PATET 149 Instructions - Judgment Creditor Or Attorney Instructions - Clerk
1. Type or print igibly. 1. Check the file to ensure that the Information
2. Complete the application section; prepare original and 2 copies. (on the application is correct. 32247
3. Complete section 1 of the Exemption Claim Form, JO-CV-24a and attach fo this form. 2. Sign ergial executor
4. Present original and 1 copy to clerk of court. Retain a copy. to applicant, retain 2 copy for fite.
‘Address of court Judicial district Sie Docket number
123 HOYT ST STAMFORD CT 06905 /[] Housing session [] number 1450170638
Name and maliing address of Judgment Creditor or Atornay (To be completed by Judgment Gredilor]
rLaw Offices 4
Howard Lee Schiff ,P.C.
P.O.Box 280245
E Hartford, CT 06128 0245
aE POLIO RECOVERY ASSOCIATES, LLC
NORFOLK, VA
Fold]
S |“BARANTAP ” CHATURVEDI
| 415 FLAX HILL RD. APT 5 NORWALK, CT 06854
3 a Tr Tica Thea gen a anaes aT aR
Bl yoavia | "$1 s080-26 aon | FFs [SST age nee Caran
i, Tolar "88 Th anyy ST ai ra Suataet F gy
"7. Application tees pald for prior executions on this Judgment | 8. Other court ordered posljudgment costa and fees y Total of ems $, 6, 7 and 6
$205.00 | romng 00 $1,423.78
. ‘Chock If applicable
Ts this judgment arising out of services rendered at & hospital? Xs 1 Yes [[] postiudgment interest was ordered by the court
If this is a judgment arising out of services rendered at a hospital, has 6 stay of a financial institution execution been woe oO Yes
rer?
‘entered pursuant to an installment payment order?
Ife stay of a financial institution execution has been entered, has the Judgment Debtor defaulted on an installment pe ZERO >
= Aw
Date slaned [rn CBE > 528-9991
AUG 14 2018
To any proper officer,
Wheraas on said Date of Judgment the above-named Judgment Creditor(s) recovered judgment against the above-named Judgment Debtor(s) before the above-
named court for the amount of judgment, costs and fees stated above, as appears of record, whereof execution remains to be done.
‘These are, therefore, by authority of the state of Connecticut to command you:
‘Within seven days fram your receipt of this execution, make demand upon the main office of any financial Institution having its main office within your county, or if such
main office Is not within your county and such financial institution has one or more branch offices within your county, upon an employee of such a branch office, such
‘employee and such branch office having been designated by the financial institution in accordance with regulations adopted by the commissioner of banking, for
payment fo you pursuant to section 52-367b(b) of the General Statutes of any nonexempt debt due sald Judgment Debtor(s), which sum shall not exceed the total
Unpaid judgment, costs and fees as stated above, plus postjudgment interest as ordered by the court, if applicable, plus the application fee and other court ordered
postjudgment costs and fees and your own fee. After having made such demand you ara diracted to serve a true and attested copy of this execution, together with the
attached affidavit and exemption claim form, with your dolngs endorsed thereon, with the financial institution officer upon whom such demand was made. Said sum
shall be received by you and applied on this execution In accordance with the provisions of section 52-367b of the General Statutes. You shall not serve more than one
financial institution execution per Judgment debtor at a time, including coples thereof. After service of an execution on one For Court Use Only
financial institution, you shall not serve the same execution or a copy thereof upon another financial institution until recelving
confirmation from the preceding financial institution that the judgment debtor had Insufficient funds at the preceding financial
Institution available for collection to satisfy the execution, provided any such additional service Is made not later than forty-five|
days from the receipt by you of such execution. After service of an execution, you shall not serve the same execution or a
copy thereof upon such financial institution If an electronic direct deposit from a readily Identifiable source described in
‘section 52 -376b (c) of the General Statutes was made to the judgment debtor's account within the laok-back period
described In section 52 -376b (0) of the General Statues (sixty days or, with regard to federal benefits, such greeter period as
Tequired by federal law). if no such deposit was made, you may subsequently serve the same execution or a copy thereof
upon such Institution, provided the execution has nat expirad or otherwise become unenforceable.
Hereof fall not, and make due return of this writ with your doings thereon, according to law.
‘Signed (Aaslatant Clerk) ZK aa LOM lp acl yf
XB 8/08/18 Page 1 FINANCIAL INSTITUTION EXECUTION PROCEEDINGSNOTE: The provisions of section 52-367b, as amended from time to time, take precedence over these instructions.
Instructions To Financial Institution Upon Receipt Of A Financial Institution Execution ‘
When Judgment Debtor Is A Natural Person :
1. If any funds are removed from the judgment debtor's account pursuant to subsection (c) of section 52-367b of the General Statutes,
complete section Il of the accompanying Exemption Claim Form (JD-CV-24a) and (1) send, forthwith, 2 copies of both this form and the
Exemption Claim Form to the judgment debtor and to any secured party that is a party to a control agreement between you and such
secured party under article 9 of title 42a of the General Statutes, postage pre-paid, at the last known address of the judgment debtor and
of any such: secured party with respect to the affected accounts on the records of your institution and (2) mail notice to the judgment
debtor as required by 31CFR212.6 and 212.7.
Remove from the judgment debtor's account the amount of any debts due from you to the judgment debtor not exceeding the Total |
Amount Unpaid as appears on page 1 of this form plus interest and the Application Fée for Financial Institution Execution and other court {
ordered postjudgment costs or fees and the serving officer's fee, before your midnight deadline, as defined in section 42a-4-104 of the
General Statutes. If an electronic direct deposit is readily identifiable as exempt federal veterans’ benefits, Social Security benefits,
Including, but not limited to, retirement, survivors’ and disability benefits, supplemental security income benefits, exempt benefits paid by
the federal Railroad Retirement Board or the federal Office of Personnel Management, unemployment compensation benefits exempt
under section 52-352b of the Connecticut General Statutes, or child support payments processed and received pursuant to Title IV-D of
the Social Security Act were made to the judgment debtor's account during the look-back: period of either the sixty-day period preceding |
the date that the execution was served on you, or, with regard to federal benefits, such greater period as required by federal law then you
shall leave the lesser of the account balance or one thousand dollars in the judgment debtor's account, provided nothing in this
subsection shall be construed to limit your right or obligation to remove such funds from the judgment debtor's account if required by any
other provision of law or by a court order. The judgment debtor shall have full and customary access to such funds left in the judgment
debtor's account. You may notify the judgment creditor-that funds have been left in the judgment debtor's account pursuant to this
provision. Nothing herein shall alter the exempt status of funds which are exempt from execution under subsection (a) of section 52-367b |
of the General Statutes or under any other provision of state or federal law, or the right of a judgment debtor to claim such exemption.
Nothing herein shall be construed to affect any other rights or obligations of the financial institution with regard to the funds in the
judgment debtor's account.
N
3. You must hold the amount removed from the judgment debtor's account pursuant to this execution for fifteen days from the date you mail
the copies of this form and the Exemption Clalm Form to the judgment debtor and any secured party. During such fifteen day period you
must not pay the officer serving this execution.
. If the judgment debtor returns the Exemption Claim Form or other written notice that an exemption is being claimed, and if any secured
party delivers to you written notice of such secured party's claim of a prior perfected security interest in such deposit account, you must,
within two business days of réceipt of such notice, send a copy of such notice to the clerk of the court which issued the execution. You
must continue to hold the amount removed from the judgment debtor's account for forty-five days or until a court order is received
regarding disposition of the funds, whichever occurs earlier. If na order is received within forty-five days of the date you send a copy of
the Exemption Claim Form or notice of exemption or a secured party claim notice to the clerk of the court, you must return the funds to
the judgment debtor's account.
If you do not receive a claim of exemption or secured party claim notice within fifteen days of the mailing to the Judgment debtor and any
secured party of the execution and Exemption Claim Form you must, upon demand, forthwith pay the serving officer the amount
removed from the judgment debtor's account.
If no exemption claim or secured party claim notice is filed or if the court orders you to pay the serving officer an amount removed from
the judgment debtor's account not exceeding the amount due on the execution and you fail or refuse to do so, you shall be liable in an |
action therefor to the judgement creditor(s) named in the execution for the amount of nonexempt monies which you fail or refuse to pay
over. If no exemption claim is filed or if the court orders you to pay the serving officer an amount removed from the judgment debtor's
account not exceeding the amount due on the execution and you fail or refuse to do so, you shall be liable in an action therefor to the
judgment creditor(s) name in the execution for the amount of nonexempt monies which you fail or refuse to pay aver, excluding funds of
up to one thousand dollars which you in good faith allowed the judgment debtor to access pursuant to subsection (c) of section 52-367b
of the General Statutes. |
If you pay exempt monies from the account of the judgment debtor contrary to these instructions, or the provisions of section 52-367b of I
the General Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid. If you pay exempt
monies from the account of the judgment debtor contrary to these instructions, or the provisions of section 52-367b of the General
Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid and you shail refund or waive
any charges of fees by you, including, but not limited to, dishonored check fees, overdraft fees or minimum balance service charges and
legal process fees, which were assessed as a result of such payment of exempt monies.
»
a
S
n
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans with
Disabiliies Act (ADA). ff you need a reasonable accommodation in accordance with the
ADA, contact a court clerk or an ADA contact persan listed at www.Jud.ct.gov/ADA.
JO-CV-24 (back/page 2) Rev. 2-15 Page 2 of 2
eeEXEMPTION CLAIM FORM.
FINANCIAL INSTITUTION EXECUTION STATE Supzeion COURT
JD-CV-24A Rev. 1-17
C.G.S. 31-58()), 52-3214, 52-3508, 52-352b, 52-361, SEE INSTRUCTIONS ON BACKIPAGE 2 wwwjud.ct.gov
52-367b, 29 U.S.C. 206(a)(1)
Namé and address of Judgment Debtor or Attorney
(To be completed by judgment creditor or attomey)
To: © 7
PARANTAF CHATURVEDI - CN X32247
115 FLAX HILL RD APT 5
THIS COMMUN:
L NORWALE, CT 06854 FROM A DERT COLLECTOR
Section 1 — (To be completed by judgment creditor)
ats ‘Geographical ‘Name and address of Court (Number, Street, Town and Zip Cade)
al goura Area 123 HOYT ST STAMFORD CT 06905
istrict lumber,
lame of case Name of Judgment Det
tor Docket number
PORTFOLIO RECOVERY ASSOCIATEFARANTAP CHATURVEDE CV14501 7063S
vs PARANTAP CHATURVEDI
Section 2 — (To be completed by financial institution - see instructions on back/page 2)
Name and address of financial institution to which exemption claim (if any) Is to be retumed 7 Date of maliing to Judgment Debtor
Cast 4 Digits of the Account Number(s) “Amount removed pursuant to execution “Amount and type of readily Identifiable exempt funds not removed
L] Additional sheet(s) attached hereto and made a part hereof (if necessary).
Section 3 — Notice To Judgment Debtor
As a result of a judgment entered against you, the attached execution has been Issued against funds deposited by you in the
financial institution named above. To comply with thls execution, the financial Institution | has removed the amount of money indicated
above from the account(s) listed above.
THE MONEY IN YOUR ACCOUNT(S) MAY BE EXEMPT FROM EXECUTION - The money in your account(s) may be protected from
execution by state statutes or by other laws or regufations of Connecticut or of the United States. A checklist and a description of the most
common exemptions established by law are set forth below.
HOW TO CLAIM AN EXEMPTION ESTABLISHED BY LAW. If you wish to claim that the money in your account(s) is exempt by faw
from execution, you must fill out and sign before a proper official the Affidavit of Claim of Exemption below and mail or deliver this
exemption claim form to the flnanclal Institution at the above address. This form must be received by the financial institution no later than
15 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above.
Upon receipt of this form the financial institution will send it to the Superior Court and the court clerk will notify you and the judgment
creditor of the date on which a hearing will be held by the court to determirie the issues raised by your claim.
SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
I, the Judgment debtor named above, claim and certify under the penalty of false statement that the money In the above account
is exempt by law from execution as follows: ("X" ail that apply to the funds contained in this account)
Social Security benefits (section 52-352b(g)) Private pension, trust, retirement, or medical savings
Unemployment benefits (section 52-352b(g)) account payments (sections 52-3214, 52-352b(m))
Worker's Compensation benefits (section 52-352b(g)) (J Health or disability insurance payments (section 52-352b(e))
Veteran's benefits (section 52-352b(g)) An amount in the bank not to exceed $1000 (section 52-352b(r))
Oo Public Assistance payments (section 52-352b(d))
Other claim of exempt funds (Explain basis for claim of exemption):
[_] Wages earned by a public assistance recipient under an -
incentive eamings or similar program (section 52-352b(d))
(_] Court-ordered child support payments (section §2-352b(h)) Amount claimed to be exempt
[_] Alimony and support other than child support* (section 52-362b(n)) - _if less than the entire amount:
“See Note Regarding Exemption for Alimony and Support on back/page 2.
‘Signed Date signed | Tetaphone number
Complete maling address of Judgment Debtor
‘Subscribed and sworn _| Date AE (away ‘Signed (Notary Pubic, Commissioner of Superior Court)
to before me on :
Page 1 of 2Instructions
To Financial institution To Clerk
1. Complete section 2 of this form and (1) send 2 copies 1. Attach this form to each financial institution execution issued in a civil or
of this form and the financial institution execution form family matter against a judgment debtor that is a natural person.
to the judgment debtor and to any secured party that is _ 2. Deliver the execution along with this form to the judgment creditor
party to a control agreement between the financial requesting the execution.
institution and such secured party under article 9 of 3. Ifjudgment debtor completes and retums this form claiming an
title 42a pursuant to section 52-367b of the General exemption, enter the appearance of the judgment debtor with address
Statutes and (2) mail notice to judgment debtor as set forth on page 1.-
required by 31CFR212.6 and 212.7. 4, Set matter dawn for short calendar hearing.
2. If this claim of exemption is returned completed, fill out 5. Complete section 7 below.
section 6 of this form and mail, within two business 6. Send file-stamped copy of this form to judgment debtor and judgment
days, to the issuing clerk's office at the address of creditor.
court indicated on the front side. See additional 7. After hearing, send copy of any order entered to the financial institution,
instructions on the financial institution execution form.
Note Regarding Exemption for Alimony and Support
Alimony and Support, other than child support, are exempt only to the following extent:
The amount of alimony and support, other than child support, that may be subject to levy or other withholding for payment of a judgment is
the lesser of (1) twenty-five percent of the individual's disposable earnings for that week, or (2) the amount by which the individual's
disposable earings for that week exceed forty times the higher of (A) the federal minimum hourly wage under Section 6(a){1) of the Fair
Labor Standards Act of 1938, U.S.C. Title 29, Section 206(a)(1), or (B), the state minimum hourly wage under subsection (i} of Section
31-58, in effect at the time the earnings are payable.
Section 52-350a(4) of the Connecticut General Statutes defines "disposable earings" as that part of the earnings 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.
Section 5 — Proper.Officer Must Complete This Section
‘Name and title of proper officer Date of service on financial insiitulion ‘Telephone number
Section 6— (To be completed by financial institution upon return of exemption claim form)
Dale claim received Date mailed to court Name of financial institution Telephone number
The assets in dispute are being held for (1) forty-five days from the date the exemption claim form was received by the financial
Institution designated on the front of this form or (2) until disposition is ordered by the court at a hearing to be held at short
calendar on the date set forth below, whichever occurs earller.
p.
Signed (Assistant Clark} Dale signed
Order
* The Court/Magistrate, having held a hearing to determine the Issues raised by this claim, hereby orders that:
By the Court (Name of Judge/Family Support Magistrata/Magistrate)
Judge (1 Fsm (Magistrate
> “Signed (Judge/Family Support Magistrate/Magistrate/Assistant Clerk) ‘Date signed
ADA NOTICE
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 a court clerk or an ADA contact person listed at wwwjud.ct.gow/ADA.
JD-CV-24A (paga 2} Rev. 1-17 Page 2 of 2
Preview
FINANCIAL INSTITUTION excourion STATE OF CONNECTICUT , a PROCEEDINGS - JUDGMENT DEBTOR SUPERIOR COURT *APFEABA* WHO IS A NATURAL PERSON, www,fud.ct.gov spavize howe men ID EXECUTION (See page 2 for instructions to financial institution EAE C.G.S, §§ 52-356b, 52-3675 and ADA Notice) PATET 149 Instructions - Judgment Creditor Or Attorney Instructions - Clerk 1. Type or print igibly. 1. Check the file to ensure that the Information 2. Complete the application section; prepare original and 2 copies. (on the application is correct. 32247 3. Complete section 1 of the Exemption Claim Form, JO-CV-24a and attach fo this form. 2. Sign ergial executor 4. Present original and 1 copy to clerk of court. Retain a copy. to applicant, retain 2 copy for fite. ‘Address of court Judicial district Sie Docket number 123 HOYT ST STAMFORD CT 06905 /[] Housing session [] number 1450170638 Name and maliing address of Judgment Creditor or Atornay (To be completed by Judgment Gredilor] rLaw Offices 4 Howard Lee Schiff ,P.C. P.O.Box 280245 E Hartford, CT 06128 0245 aE POLIO RECOVERY ASSOCIATES, LLC NORFOLK, VA Fold] S |“BARANTAP ” CHATURVEDI | 415 FLAX HILL RD. APT 5 NORWALK, CT 06854 3 a Tr Tica Thea gen a anaes aT aR Bl yoavia | "$1 s080-26 aon | FFs [SST age nee Caran i, Tolar "88 Th anyy ST ai ra Suataet F gy "7. Application tees pald for prior executions on this Judgment | 8. Other court ordered posljudgment costa and fees y Total of ems $, 6, 7 and 6 $205.00 | romng 00 $1,423.78 . ‘Chock If applicable Ts this judgment arising out of services rendered at & hospital? Xs 1 Yes [[] postiudgment interest was ordered by the court If this is a judgment arising out of services rendered at a hospital, has 6 stay of a financial institution execution been woe oO Yes rer? ‘entered pursuant to an installment payment order? Ife stay of a financial institution execution has been entered, has the Judgment Debtor defaulted on an installment pe ZERO > = Aw Date slaned [rn CBE > 528-9991 AUG 14 2018 To any proper officer, Wheraas on said Date of Judgment the above-named Judgment Creditor(s) recovered judgment against the above-named Judgment Debtor(s) before the above- named court for the amount of judgment, costs and fees stated above, as appears of record, whereof execution remains to be done. ‘These are, therefore, by authority of the state of Connecticut to command you: ‘Within seven days fram your receipt of this execution, make demand upon the main office of any financial Institution having its main office within your county, or if such main office Is not within your county and such financial institution has one or more branch offices within your county, upon an employee of such a branch office, such ‘employee and such branch office having been designated by the financial institution in accordance with regulations adopted by the commissioner of banking, for payment fo you pursuant to section 52-367b(b) of the General Statutes of any nonexempt debt due sald Judgment Debtor(s), which sum shall not exceed the total Unpaid judgment, costs and fees as stated above, plus postjudgment interest as ordered by the court, if applicable, plus the application fee and other court ordered postjudgment costs and fees and your own fee. After having made such demand you ara diracted to serve a true and attested copy of this execution, together with the attached affidavit and exemption claim form, with your dolngs endorsed thereon, with the financial institution officer upon whom such demand was made. Said sum shall be received by you and applied on this execution In accordance with the provisions of section 52-367b of the General Statutes. You shall not serve more than one financial institution execution per Judgment debtor at a time, including coples thereof. After service of an execution on one For Court Use Only financial institution, you shall not serve the same execution or a copy thereof upon another financial institution until recelving confirmation from the preceding financial institution that the judgment debtor had Insufficient funds at the preceding financial Institution available for collection to satisfy the execution, provided any such additional service Is made not later than forty-five| days from the receipt by you of such execution. After service of an execution, you shall not serve the same execution or a copy thereof upon such financial institution If an electronic direct deposit from a readily Identifiable source described in ‘section 52 -376b (c) of the General Statutes was made to the judgment debtor's account within the laok-back period described In section 52 -376b (0) of the General Statues (sixty days or, with regard to federal benefits, such greeter period as Tequired by federal law). if no such deposit was made, you may subsequently serve the same execution or a copy thereof upon such Institution, provided the execution has nat expirad or otherwise become unenforceable. Hereof fall not, and make due return of this writ with your doings thereon, according to law. ‘Signed (Aaslatant Clerk) ZK aa LOM lp acl yf XB 8/08/18 Page 1 FINANCIAL INSTITUTION EXECUTION PROCEEDINGSNOTE: The provisions of section 52-367b, as amended from time to time, take precedence over these instructions. Instructions To Financial Institution Upon Receipt Of A Financial Institution Execution ‘ When Judgment Debtor Is A Natural Person : 1. If any funds are removed from the judgment debtor's account pursuant to subsection (c) of section 52-367b of the General Statutes, complete section Il of the accompanying Exemption Claim Form (JD-CV-24a) and (1) send, forthwith, 2 copies of both this form and the Exemption Claim Form to the judgment debtor and to any secured party that is a party to a control agreement between you and such secured party under article 9 of title 42a of the General Statutes, postage pre-paid, at the last known address of the judgment debtor and of any such: secured party with respect to the affected accounts on the records of your institution and (2) mail notice to the judgment debtor as required by 31CFR212.6 and 212.7. Remove from the judgment debtor's account the amount of any debts due from you to the judgment debtor not exceeding the Total | Amount Unpaid as appears on page 1 of this form plus interest and the Application Fée for Financial Institution Execution and other court { ordered postjudgment costs or fees and the serving officer's fee, before your midnight deadline, as defined in section 42a-4-104 of the General Statutes. If an electronic direct deposit is readily identifiable as exempt federal veterans’ benefits, Social Security benefits, Including, but not limited to, retirement, survivors’ and disability benefits, supplemental security income benefits, exempt benefits paid by the federal Railroad Retirement Board or the federal Office of Personnel Management, unemployment compensation benefits exempt under section 52-352b of the Connecticut General Statutes, or child support payments processed and received pursuant to Title IV-D of the Social Security Act were made to the judgment debtor's account during the look-back: period of either the sixty-day period preceding | the date that the execution was served on you, or, with regard to federal benefits, such greater period as required by federal law then you shall leave the lesser of the account balance or one thousand dollars in the judgment debtor's account, provided nothing in this subsection shall be construed to limit your right or obligation to remove such funds from the judgment debtor's account if required by any other provision of law or by a court order. The judgment debtor shall have full and customary access to such funds left in the judgment debtor's account. You may notify the judgment creditor-that funds have been left in the judgment debtor's account pursuant to this provision. Nothing herein shall alter the exempt status of funds which are exempt from execution under subsection (a) of section 52-367b | of the General Statutes or under any other provision of state or federal law, or the right of a judgment debtor to claim such exemption. Nothing herein shall be construed to affect any other rights or obligations of the financial institution with regard to the funds in the judgment debtor's account. N 3. You must hold the amount removed from the judgment debtor's account pursuant to this execution for fifteen days from the date you mail the copies of this form and the Exemption Clalm Form to the judgment debtor and any secured party. During such fifteen day period you must not pay the officer serving this execution. . If the judgment debtor returns the Exemption Claim Form or other written notice that an exemption is being claimed, and if any secured party delivers to you written notice of such secured party's claim of a prior perfected security interest in such deposit account, you must, within two business days of réceipt of such notice, send a copy of such notice to the clerk of the court which issued the execution. You must continue to hold the amount removed from the judgment debtor's account for forty-five days or until a court order is received regarding disposition of the funds, whichever occurs earlier. If na order is received within forty-five days of the date you send a copy of the Exemption Claim Form or notice of exemption or a secured party claim notice to the clerk of the court, you must return the funds to the judgment debtor's account. If you do not receive a claim of exemption or secured party claim notice within fifteen days of the mailing to the Judgment debtor and any secured party of the execution and Exemption Claim Form you must, upon demand, forthwith pay the serving officer the amount removed from the judgment debtor's account. If no exemption claim or secured party claim notice is filed or if the court orders you to pay the serving officer an amount removed from the judgment debtor's account not exceeding the amount due on the execution and you fail or refuse to do so, you shall be liable in an | action therefor to the judgement creditor(s) named in the execution for the amount of nonexempt monies which you fail or refuse to pay over. If no exemption claim is filed or if the court orders you to pay the serving officer an amount removed from the judgment debtor's account not exceeding the amount due on the execution and you fail or refuse to do so, you shall be liable in an action therefor to the judgment creditor(s) name in the execution for the amount of nonexempt monies which you fail or refuse to pay aver, excluding funds of up to one thousand dollars which you in good faith allowed the judgment debtor to access pursuant to subsection (c) of section 52-367b of the General Statutes. | If you pay exempt monies from the account of the judgment debtor contrary to these instructions, or the provisions of section 52-367b of I the General Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid. If you pay exempt monies from the account of the judgment debtor contrary to these instructions, or the provisions of section 52-367b of the General Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid and you shail refund or waive any charges of fees by you, including, but not limited to, dishonored check fees, overdraft fees or minimum balance service charges and legal process fees, which were assessed as a result of such payment of exempt monies. » a S n ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabiliies Act (ADA). ff you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact persan listed at www.Jud.ct.gov/ADA. JO-CV-24 (back/page 2) Rev. 2-15 Page 2 of 2 eeEXEMPTION CLAIM FORM. FINANCIAL INSTITUTION EXECUTION STATE Supzeion COURT JD-CV-24A Rev. 1-17 C.G.S. 31-58()), 52-3214, 52-3508, 52-352b, 52-361, SEE INSTRUCTIONS ON BACKIPAGE 2 wwwjud.ct.gov 52-367b, 29 U.S.C. 206(a)(1) Namé and address of Judgment Debtor or Attorney (To be completed by judgment creditor or attomey) To: © 7 PARANTAF CHATURVEDI - CN X32247 115 FLAX HILL RD APT 5 THIS COMMUN: L NORWALE, CT 06854 FROM A DERT COLLECTOR Section 1 — (To be completed by judgment creditor) ats ‘Geographical ‘Name and address of Court (Number, Street, Town and Zip Cade) al goura Area 123 HOYT ST STAMFORD CT 06905 istrict lumber, lame of case Name of Judgment Det tor Docket number PORTFOLIO RECOVERY ASSOCIATEFARANTAP CHATURVEDE CV14501 7063S vs PARANTAP CHATURVEDI Section 2 — (To be completed by financial institution - see instructions on back/page 2) Name and address of financial institution to which exemption claim (if any) Is to be retumed 7 Date of maliing to Judgment Debtor Cast 4 Digits of the Account Number(s) “Amount removed pursuant to execution “Amount and type of readily Identifiable exempt funds not removed L] Additional sheet(s) attached hereto and made a part hereof (if necessary). Section 3 — Notice To Judgment Debtor As a result of a judgment entered against you, the attached execution has been Issued against funds deposited by you in the financial institution named above. To comply with thls execution, the financial Institution | has removed the amount of money indicated above from the account(s) listed above. THE MONEY IN YOUR ACCOUNT(S) MAY BE EXEMPT FROM EXECUTION - The money in your account(s) may be protected from execution by state statutes or by other laws or regufations of Connecticut or of the United States. A checklist and a description of the most common exemptions established by law are set forth below. HOW TO CLAIM AN EXEMPTION ESTABLISHED BY LAW. If you wish to claim that the money in your account(s) is exempt by faw from execution, you must fill out and sign before a proper official the Affidavit of Claim of Exemption below and mail or deliver this exemption claim form to the flnanclal Institution at the above address. This form must be received by the financial institution no later than 15 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above. Upon receipt of this form the financial institution will send it to the Superior Court and the court clerk will notify you and the judgment creditor of the date on which a hearing will be held by the court to determirie the issues raised by your claim. SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW I, the Judgment debtor named above, claim and certify under the penalty of false statement that the money In the above account is exempt by law from execution as follows: ("X" ail that apply to the funds contained in this account) Social Security benefits (section 52-352b(g)) Private pension, trust, retirement, or medical savings Unemployment benefits (section 52-352b(g)) account payments (sections 52-3214, 52-352b(m)) Worker's Compensation benefits (section 52-352b(g)) (J Health or disability insurance payments (section 52-352b(e)) Veteran's benefits (section 52-352b(g)) An amount in the bank not to exceed $1000 (section 52-352b(r)) Oo Public Assistance payments (section 52-352b(d)) Other claim of exempt funds (Explain basis for claim of exemption): [_] Wages earned by a public assistance recipient under an - incentive eamings or similar program (section 52-352b(d)) (_] Court-ordered child support payments (section §2-352b(h)) Amount claimed to be exempt [_] Alimony and support other than child support* (section 52-362b(n)) - _if less than the entire amount: “See Note Regarding Exemption for Alimony and Support on back/page 2. ‘Signed Date signed | Tetaphone number Complete maling address of Judgment Debtor ‘Subscribed and sworn _| Date AE (away ‘Signed (Notary Pubic, Commissioner of Superior Court) to before me on : Page 1 of 2Instructions To Financial institution To Clerk 1. Complete section 2 of this form and (1) send 2 copies 1. Attach this form to each financial institution execution issued in a civil or of this form and the financial institution execution form family matter against a judgment debtor that is a natural person. to the judgment debtor and to any secured party that is _ 2. Deliver the execution along with this form to the judgment creditor party to a control agreement between the financial requesting the execution. institution and such secured party under article 9 of 3. Ifjudgment debtor completes and retums this form claiming an title 42a pursuant to section 52-367b of the General exemption, enter the appearance of the judgment debtor with address Statutes and (2) mail notice to judgment debtor as set forth on page 1.- required by 31CFR212.6 and 212.7. 4, Set matter dawn for short calendar hearing. 2. If this claim of exemption is returned completed, fill out 5. Complete section 7 below. section 6 of this form and mail, within two business 6. Send file-stamped copy of this form to judgment debtor and judgment days, to the issuing clerk's office at the address of creditor. court indicated on the front side. See additional 7. After hearing, send copy of any order entered to the financial institution, instructions on the financial institution execution form. Note Regarding Exemption for Alimony and Support Alimony and Support, other than child support, are exempt only to the following extent: The amount of alimony and support, other than child support, that may be subject to levy or other withholding for payment of a judgment is the lesser of (1) twenty-five percent of the individual's disposable earnings for that week, or (2) the amount by which the individual's disposable earings for that week exceed forty times the higher of (A) the federal minimum hourly wage under Section 6(a){1) of the Fair Labor Standards Act of 1938, U.S.C. Title 29, Section 206(a)(1), or (B), the state minimum hourly wage under subsection (i} of Section 31-58, in effect at the time the earnings are payable. Section 52-350a(4) of the Connecticut General Statutes defines "disposable earings" as that part of the earnings 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. Section 5 — Proper.Officer Must Complete This Section ‘Name and title of proper officer Date of service on financial insiitulion ‘Telephone number Section 6— (To be completed by financial institution upon return of exemption claim form) Dale claim received Date mailed to court Name of financial institution Telephone number The assets in dispute are being held for (1) forty-five days from the date the exemption claim form was received by the financial Institution designated on the front of this form or (2) until disposition is ordered by the court at a hearing to be held at short calendar on the date set forth below, whichever occurs earller. p. Signed (Assistant Clark} Dale signed Order * The Court/Magistrate, having held a hearing to determine the Issues raised by this claim, hereby orders that: By the Court (Name of Judge/Family Support Magistrata/Magistrate) Judge (1 Fsm (Magistrate > “Signed (Judge/Family Support Magistrate/Magistrate/Assistant Clerk) ‘Date signed ADA NOTICE 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 a court clerk or an ADA contact person listed at wwwjud.ct.gow/ADA. JD-CV-24A (paga 2} Rev. 1-17 Page 2 of 2