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FINANCIAL INSTITUTION EXECUTION STATE OF CONNECTICUT EOL
PROCEEDINGS - JUDGMENT DEBTOR SUPERIOR COURT OAPEEABB®
WHO IS NOT A NATURAL PERSON, www,jud.ct.gov
APPLICATION AND EXECUTION (See page 2 for instructions to financial institution) EL
JD-CV-24N Rev. 10-09 C.G.S. 52-367 EXISS
- Att Instructions - Clerk
1. Type opin egth Jadament Croctor or Aorney 1, Check the file to ensure that the information provided on the application is correct.
. section; jinal and 2 copies. 2, Sign original execution.
3 Prasenta odin odat copies to "eieorout ana 2 cones. 3. Retum original and 1 copy to applicant, retain a copy for file.
‘Address of court [ix] susiciat District Geographical | Docket number
123 Hoyt Street, Stamford, CT 06905 [J Housing session [“] number FST-CV-14-6022323 S
Name and mailing address of Judgment Creditor or Attomey (To be completed by Judgment Creditor)
c q
James F. Simon, Esq.
196 North Street
Stamford, CT 06901
u
Nama(s) and address(es) of Judgment Creditor(s)
CITY OF STAMFORD
Fold}
888 Washington Blvd., Stamford, CT 06901
Name(s) and address(es) of Judgment Debtor(s)
BUD CONSTRUCTION INC.
clo Joseph Tomanto, 21 First Street, #3, Stamford, CT 06905
Application
Date of judgment . unt of judgment. (include, where applicable, | 2. Amount of costs 3. It of judgment, costs and fees:
10/16/2014 $54,630.94 prejudgment nferest end | $539.70 $55,170.64 (Add 1 and 2)
4, Total amount paid (if any) ©, Total amount unpaid (Subtract 4 trom 3) %. Application fee for financial Institution execution
| $0.00 $55,170.64 =» $100.00 (it not watved by the court}
7, Othier count ordered postjudgment cosis and fees 8. Total offems 6, 6 and 7 Check if applicable @ 16%
$0.00 $55 270.64 [in Post Judgment interest was ordered by the court
Sign Date signed ‘Telephone number
12/05/2014 (203) 359-8900
Financial Ingtitution Execution
To Any Proper Officer,
Whereas 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:
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 to you of any debt due said Judgment Debtor(s), which sum shall not exceed the total unpaid
judgment, costs and fees as stated above, plus post judgment interest as ordered by the court, if applicable, plus the application fee and
other court ordered postjudgment costs and fees, and your own fees. Said sum shall be received by you and applied on this execution.
After having made such demand you are directed to serve a true and attested copy hereof, with your doings thereon endorsed, with the
financial institution officer upon wham such demand was made. You shall not serve more than one financial institution execution per
judgment debtor at a time, including copies thereof. After service of an execution on one financial institution, you shall not serve the same
execution or a copy thereof upon another financial institution until receiving confirmation from the preceding financial institution that the
Judgment debtor had insufficient funds at the preceding financial institution avaliable for collection to satisfy the execution. If you do not
receive within twenty-five days of the service of the demand a response from the financial institution that was served indicating whether or
not the judgment debtor has funds at the financial institution available for collection, you may For Court Use Only
assume that sufficient funds are not available for collection and you may proceed to serve
another financial institution in accordance with section 52-367a of the General Statutes.
Con tor med Cg
Hereof fail not, and make due return of this writ with your doings thereon, 6. Gah /
+
according to law. ivan E TINY
epheri Cammy lol ead _
HAS FINANCIAL INSTITUTION EXECUTION PROCEEDINGS
WhoNote: The provisions of section 52-367a, 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 Not A Natural Person
. You must 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 Fee for Financial Institution Execution and
court ordered postjudgment costs or fees and the serving officer's fee.
2. Except as provided in #4 below, you must immediately pay to the serving officer the amount removed from the judgment debtor's
account. 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.
You must act on this execution according to section 42a-4-303 of the general statutes, before your midnight deadline.
. ff the deposit account is subject to a security interest of a secured party, other than you, pursuant to a control agreement between you
and such secured party under article 9 of title 42a, and if any funds removed from the judgment debtor's account pursuant to subsection
(c) of sectlon 52-367a of the general statutes you shall forthwith mail a copy of the execution when received from the serving officer,
postage prepaid, to the judgment debtor and to such other secured party at the last known address of such parties with respect to the
affected accounts on your records. You shall hold the amount removed from the judgment debtor's account for twenty days from the date
of the mailing to the judgment debtor and such other secured party, and during such period you shall not pay the serving officer. Such
other secured party shail give notice of its prior perfected security interest in such deposit account, by delivering to the clerk of the court
that issued the execution a written claim for determination of interests in property pursuant to section 52-365c and by delivering a copy of
such claim to the financial institution upon which such execution is served.
If a written claim for determination of interests In property is made pursuant to subsection (e) of section 52-367a of the general statutes,
you shall continue to hold the amount removed from the judgment debtor's account until a court order is received regarding disposition of
the funds. If no written claim for determination of interests in property is made you shall, upon demand, forthwith pay the serving officer
the amount removed from the judgment debtor's account, and the serving officer shall thereupon pay such sum, fess such serving
officer's fees, to the Judgment creditor, except to the extent otherwise ordered by a court.
ae
a
JD-CV-24N (back/page 2) Rev. 10-09 Page 2 of 2STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
EXEMPTION CLAIM FORM
FINANCIAL INSTITUTION EXECUTION
JD-CV-24A Rev. 4-43
C.G.S. 31-68()), 52-321, $2-350a, 52-352, 52-3614,
52-367b, 29 U.S.C. 206(a)(14)
SEE INSTRUCTIONS ON BACKIPAGE 2
Name and address of Judgment Debtor or Attorney
(To be completed by judgment creditor or attorney)
r 7
To:
James F. Simon, Esq.
196 North Street IAEV ENON
Stamford, CT 06901
L d
Section 1 — (To be completed by judgment creditor)
‘Judiclal Housing Geographical Name and address of Court (Number, Street, Town and Zip Code)
EX] istrict Oisession (1) Never Stamford Superior Court, 123 Hoyt Street, Stamford, CT 06905
‘Name of case jame of Judgment Debtor
Docket number
CITY OF STAMFORD vs Bud Construction,inc | Bud Construction, Inc. FST-CV-14-6022323 S
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 ba relumed Date of mailing to Judgment Dabtor
Last 4 Digits of the Account Number(s) “Amount removed pursuant to execution “Amount and type of readily identifiable exempl funds not removed
Additional sheet(s) altached 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. In compliance with this execution, the financial institution has removed the amount of money indicated
above from the account(s) enumerated 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 regulations of this state 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 law
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 financial Institution at the above address, This form must be received by the financial institution no later than
16 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above.
Upon receipt of this form the financial institution will forward 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 determine the issues ralsed by your claim.
SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
|, the judgment debtor named above, claim and certify under the penalty of false statement that the money In the above account
|s exempt by law from execution as follows: ("X" all that apply to the funds contained in this account)
( Social Security benefits (section 52-352(g))
gl Unemployment benefits (section 52-362b(g))
[] Worker's Compensation benefits (section 52-352b(g))
Veteran's benefits (section 52-352b(g))
[_] Public Assistance payments (sectlon 52-352b(d))
[_] Wages" (section 52-361a)
oO Wages earned by a public assistance recipient under an
incentive earnings or similar program (section 52-352(d))
QO Court-ordered child support payments (section 52-352b(h))
(21 Private pension, trust, retirement, or medical savings
account payments (sections 52-321a, 52-352b(m))
(J Health or disability insurance payments (section 52-352b(e))
[-] An amount in the bank not to exceed $1000 (section 52-352b(r))
fo Other claim of exempt funds (Explain basis for claim of exemption):
Amount claimed to be exempt
if less than the entire amount:
L) Alimony and support other than child support* (section §2-352b(n))
“See Note Regarding Exemption for Wages and Alimony on back/page 2.
‘Signed
pe Telephone number
‘Complete mailing address of Judgment Deblor
Subscribed and sworn Date
Y
to before me on:
‘Signed (Nolery Public, Commissioner of Superior Court)
Page 1 of 2Instructions
To Financial Institution
1. Complete section 2 of this form and send 2 copies
of this form and the financial institution execution
form to the judgment debtor and to any secured
party that is party to a control agreement between
the financial institution and such secured party
under article 9 of title 42a pursuant to section
52-367b of the General Statutes.
. If this claim of exemption is returned completed, fill
out section 4 of this form and mail, within two
business days, to the issuing clerk's office at the
N
To Clerk
1. Attach this form to each financial institution execution issued in a civil or
family matter against a judgment debtor that is a natural person.
2. Deliver the execution along with this form to the judgment creditor
requesting the execution.
3. If judgment debtor completes and returns this form claiming an
exemption, enter the appearance of the judgment debtor with address
set forth on page 1.
4. Set matter down for short calendar hearing.
5. Complete section 7 below.
6. Send fite-stamped copy of this form to judgment debtor and judgment
creditor.
address of court indicated on the front side. See
additional instructions on the financial institution
execution form.
7. After hearing, send copy of any order entered to the financial institution.
Note Regarding Exemption For Wages And Alimony
The amount of wages and alimony that may be subject to levy or other withholding for payment of a judgment is the lesser of (1) twenty-
five per cent of the individual's disposable eamings for that week, or (2) the amount by which the individual's disposable eamings 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. tit. 29, Section 206(a)(1), or (B), the state minimum hourly wage under subsection (j) of Section 31-58, in effect at the time the
eamings are payable,
Section 52-350a(4) of the Connecticut General Statutes defines "disposable eamings" as that part of the eamings of an individual
remaining after the deduction from those earings of amounts required to be withheld for payment of federal income and employment
faxes, 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
Telephone number
Name and title of proper officer ‘Date of service on financial institution
Section 6 — (To be completed by financial institution upon return of exemption claim form)
Date claim received Date mailed to court ‘Name of financial Institution Telephone number
Section 7 — Notice To Judgment Debtor And Judgment Creditor
The assets in dispute are being held for (1) forty-five days from the date the exemption clalm 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.
Date of hearing ime Of hearing
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 www,jud.ct.gov/ADA.
‘Signed (Assistant Clerk)
Tn
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/amily Support ‘Magistrate/Magistrate)
C1 Judge ( Fsm
Date signed
Page 2 of 2
L Magistrate
Signed (Judge/Family Support Magistrete/Magistrate/Assistant Clerk)
JD-CV-24A (page 2) Rev. 4-13
Preview
FINANCIAL INSTITUTION EXECUTION STATE OF CONNECTICUT EOL PROCEEDINGS - JUDGMENT DEBTOR SUPERIOR COURT OAPEEABB® WHO IS NOT A NATURAL PERSON, www,jud.ct.gov APPLICATION AND EXECUTION (See page 2 for instructions to financial institution) EL JD-CV-24N Rev. 10-09 C.G.S. 52-367 EXISS - Att Instructions - Clerk 1. Type opin egth Jadament Croctor or Aorney 1, Check the file to ensure that the information provided on the application is correct. . section; jinal and 2 copies. 2, Sign original execution. 3 Prasenta odin odat copies to "eieorout ana 2 cones. 3. Retum original and 1 copy to applicant, retain a copy for file. ‘Address of court [ix] susiciat District Geographical | Docket number 123 Hoyt Street, Stamford, CT 06905 [J Housing session [“] number FST-CV-14-6022323 S Name and mailing address of Judgment Creditor or Attomey (To be completed by Judgment Creditor) c q James F. Simon, Esq. 196 North Street Stamford, CT 06901 u Nama(s) and address(es) of Judgment Creditor(s) CITY OF STAMFORD Fold} 888 Washington Blvd., Stamford, CT 06901 Name(s) and address(es) of Judgment Debtor(s) BUD CONSTRUCTION INC. clo Joseph Tomanto, 21 First Street, #3, Stamford, CT 06905 Application Date of judgment . unt of judgment. (include, where applicable, | 2. Amount of costs 3. It of judgment, costs and fees: 10/16/2014 $54,630.94 prejudgment nferest end | $539.70 $55,170.64 (Add 1 and 2) 4, Total amount paid (if any) ©, Total amount unpaid (Subtract 4 trom 3) %. Application fee for financial Institution execution | $0.00 $55,170.64 =» $100.00 (it not watved by the court} 7, Othier count ordered postjudgment cosis and fees 8. Total offems 6, 6 and 7 Check if applicable @ 16% $0.00 $55 270.64 [in Post Judgment interest was ordered by the court Sign Date signed ‘Telephone number 12/05/2014 (203) 359-8900 Financial Ingtitution Execution To Any Proper Officer, Whereas 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: 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 to you of any debt due said Judgment Debtor(s), which sum shall not exceed the total unpaid judgment, costs and fees as stated above, plus post judgment interest as ordered by the court, if applicable, plus the application fee and other court ordered postjudgment costs and fees, and your own fees. Said sum shall be received by you and applied on this execution. After having made such demand you are directed to serve a true and attested copy hereof, with your doings thereon endorsed, with the financial institution officer upon wham such demand was made. You shall not serve more than one financial institution execution per judgment debtor at a time, including copies thereof. After service of an execution on one financial institution, you shall not serve the same execution or a copy thereof upon another financial institution until receiving confirmation from the preceding financial institution that the Judgment debtor had insufficient funds at the preceding financial institution avaliable for collection to satisfy the execution. If you do not receive within twenty-five days of the service of the demand a response from the financial institution that was served indicating whether or not the judgment debtor has funds at the financial institution available for collection, you may For Court Use Only assume that sufficient funds are not available for collection and you may proceed to serve another financial institution in accordance with section 52-367a of the General Statutes. Con tor med Cg Hereof fail not, and make due return of this writ with your doings thereon, 6. Gah / + according to law. ivan E TINY epheri Cammy lol ead _ HAS FINANCIAL INSTITUTION EXECUTION PROCEEDINGS WhoNote: The provisions of section 52-367a, 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 Not A Natural Person . You must 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 Fee for Financial Institution Execution and court ordered postjudgment costs or fees and the serving officer's fee. 2. Except as provided in #4 below, you must immediately pay to the serving officer the amount removed from the judgment debtor's account. 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. You must act on this execution according to section 42a-4-303 of the general statutes, before your midnight deadline. . ff the deposit account is subject to a security interest of a secured party, other than you, pursuant to a control agreement between you and such secured party under article 9 of title 42a, and if any funds removed from the judgment debtor's account pursuant to subsection (c) of sectlon 52-367a of the general statutes you shall forthwith mail a copy of the execution when received from the serving officer, postage prepaid, to the judgment debtor and to such other secured party at the last known address of such parties with respect to the affected accounts on your records. You shall hold the amount removed from the judgment debtor's account for twenty days from the date of the mailing to the judgment debtor and such other secured party, and during such period you shall not pay the serving officer. Such other secured party shail give notice of its prior perfected security interest in such deposit account, by delivering to the clerk of the court that issued the execution a written claim for determination of interests in property pursuant to section 52-365c and by delivering a copy of such claim to the financial institution upon which such execution is served. If a written claim for determination of interests In property is made pursuant to subsection (e) of section 52-367a of the general statutes, you shall continue to hold the amount removed from the judgment debtor's account until a court order is received regarding disposition of the funds. If no written claim for determination of interests in property is made you shall, upon demand, forthwith pay the serving officer the amount removed from the judgment debtor's account, and the serving officer shall thereupon pay such sum, fess such serving officer's fees, to the Judgment creditor, except to the extent otherwise ordered by a court. ae a JD-CV-24N (back/page 2) Rev. 10-09 Page 2 of 2STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov EXEMPTION CLAIM FORM FINANCIAL INSTITUTION EXECUTION JD-CV-24A Rev. 4-43 C.G.S. 31-68()), 52-321, $2-350a, 52-352, 52-3614, 52-367b, 29 U.S.C. 206(a)(14) SEE INSTRUCTIONS ON BACKIPAGE 2 Name and address of Judgment Debtor or Attorney (To be completed by judgment creditor or attorney) r 7 To: James F. Simon, Esq. 196 North Street IAEV ENON Stamford, CT 06901 L d Section 1 — (To be completed by judgment creditor) ‘Judiclal Housing Geographical Name and address of Court (Number, Street, Town and Zip Code) EX] istrict Oisession (1) Never Stamford Superior Court, 123 Hoyt Street, Stamford, CT 06905 ‘Name of case jame of Judgment Debtor Docket number CITY OF STAMFORD vs Bud Construction,inc | Bud Construction, Inc. FST-CV-14-6022323 S 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 ba relumed Date of mailing to Judgment Dabtor Last 4 Digits of the Account Number(s) “Amount removed pursuant to execution “Amount and type of readily identifiable exempl funds not removed Additional sheet(s) altached 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. In compliance with this execution, the financial institution has removed the amount of money indicated above from the account(s) enumerated 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 regulations of this state 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 law 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 financial Institution at the above address, This form must be received by the financial institution no later than 16 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above. Upon receipt of this form the financial institution will forward 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 determine the issues ralsed by your claim. SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW |, the judgment debtor named above, claim and certify under the penalty of false statement that the money In the above account |s exempt by law from execution as follows: ("X" all that apply to the funds contained in this account) ( Social Security benefits (section 52-352(g)) gl Unemployment benefits (section 52-362b(g)) [] Worker's Compensation benefits (section 52-352b(g)) Veteran's benefits (section 52-352b(g)) [_] Public Assistance payments (sectlon 52-352b(d)) [_] Wages" (section 52-361a) oO Wages earned by a public assistance recipient under an incentive earnings or similar program (section 52-352(d)) QO Court-ordered child support payments (section 52-352b(h)) (21 Private pension, trust, retirement, or medical savings account payments (sections 52-321a, 52-352b(m)) (J Health or disability insurance payments (section 52-352b(e)) [-] An amount in the bank not to exceed $1000 (section 52-352b(r)) fo Other claim of exempt funds (Explain basis for claim of exemption): Amount claimed to be exempt if less than the entire amount: L) Alimony and support other than child support* (section §2-352b(n)) “See Note Regarding Exemption for Wages and Alimony on back/page 2. ‘Signed pe Telephone number ‘Complete mailing address of Judgment Deblor Subscribed and sworn Date Y to before me on: ‘Signed (Nolery Public, Commissioner of Superior Court) Page 1 of 2Instructions To Financial Institution 1. Complete section 2 of this form and send 2 copies of this form and the financial institution execution form to the judgment debtor and to any secured party that is party to a control agreement between the financial institution and such secured party under article 9 of title 42a pursuant to section 52-367b of the General Statutes. . If this claim of exemption is returned completed, fill out section 4 of this form and mail, within two business days, to the issuing clerk's office at the N To Clerk 1. Attach this form to each financial institution execution issued in a civil or family matter against a judgment debtor that is a natural person. 2. Deliver the execution along with this form to the judgment creditor requesting the execution. 3. If judgment debtor completes and returns this form claiming an exemption, enter the appearance of the judgment debtor with address set forth on page 1. 4. Set matter down for short calendar hearing. 5. Complete section 7 below. 6. Send fite-stamped copy of this form to judgment debtor and judgment creditor. address of court indicated on the front side. See additional instructions on the financial institution execution form. 7. After hearing, send copy of any order entered to the financial institution. Note Regarding Exemption For Wages And Alimony The amount of wages and alimony that may be subject to levy or other withholding for payment of a judgment is the lesser of (1) twenty- five per cent of the individual's disposable eamings for that week, or (2) the amount by which the individual's disposable eamings 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. tit. 29, Section 206(a)(1), or (B), the state minimum hourly wage under subsection (j) of Section 31-58, in effect at the time the eamings are payable, Section 52-350a(4) of the Connecticut General Statutes defines "disposable eamings" as that part of the eamings of an individual remaining after the deduction from those earings of amounts required to be withheld for payment of federal income and employment faxes, 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 Telephone number Name and title of proper officer ‘Date of service on financial institution Section 6 — (To be completed by financial institution upon return of exemption claim form) Date claim received Date mailed to court ‘Name of financial Institution Telephone number Section 7 — Notice To Judgment Debtor And Judgment Creditor The assets in dispute are being held for (1) forty-five days from the date the exemption clalm 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. Date of hearing ime Of hearing 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 www,jud.ct.gov/ADA. ‘Signed (Assistant Clerk) Tn 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/amily Support ‘Magistrate/Magistrate) C1 Judge ( Fsm Date signed Page 2 of 2 L Magistrate Signed (Judge/Family Support Magistrete/Magistrate/Assistant Clerk) JD-CV-24A (page 2) Rev. 4-13