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aR
FINANCIAL INSTITUTION EXECUTION PROCEEDINGS STATE OF CONNECTICUT
JUDGMENT DEBTOR WHO JS A’NATURAL PERSON, SUPERIOR COURT
APPLICATION AND EXECUTION wanw.jud.ct.gov
JO-CV-24 Rev. 11-21
C.G'S. §§ 52-3660, 52-967b. (See page 2 for instrdctions to financial institution and ADA Notice}
Instructions ~Judgment Creditor or Attorney instructions - Clerk
4: te this form, an Exemplion Claini form, and a'Fiancial tnstitution Execution (férm JD-CV-24a), 1. Check the fileto ensure the information on the application is comect.
IF filing electronically, combine into one PDF document. filvig' on paper, prepare original, attach’form 2. Sign original execution.
JO-CV-24A and. fe the orginal with the clerk. Keep 1 copy for your records.
2. Applications must be-accompanied by the.statuiory fee set.in General Statetes § 52-367b. 3. Upioad the otiginal to the fle.
‘Address of court [x] Judiciat District Docket number
50 FIELD ST TORRINGTON CT 06790 (C] Housing Session LLI~CV14~-6011160-S
‘Name.and mailing address of Judgment Creditor or Atomey
(Number, street, (own, state, 2ip code) (To.be completed by Judgmerit Creditoi} (Plaintity
COURT USE ONLY
Law ices APFEABA EXISSUE.
Howard Lee Schiff,P.c
P.O.Box 280245
E Hartford, CT 06108
CROCE | TCA
L
Name Pas PRR Eee” 1 whem money 1s owed) (Number, skeet, lovin, zip coda)
350 CAMINO DE LA REINA, SUITE 100 SAN DIEGO, CA 92108
& Name(s) and address(es) of Judgment Deblor(s) (Party wiio owes money) (Number, street, lown, zip code
NDER ST
14 DRAPEAU RD ‘NEW MILFORD, CT 06776
Date ofjudament 7 . Amountor judgment jinclude, where applicable, | 2 Amount of eosts and fees. 3, Total amountof judgment. costs and fees (Add 7 and 2)
1/28/15 $19:,483.7 Qpreiidament‘attomey’s
ininterest and $433.8 $19,917.54
“4. Total amount paid (iFany) Total amount unpaid ‘tae From 3) ‘6. Application fee for financial institution execution (if of waivedby the court)
$.00 $19,917.54 $105.00
7. Application fees paid for prior executions on this judgment & Olher court ordered postudgment costs and fees ‘S.fotal of tems & 6, 7-and 6
$415.00 $0.00 $20,437.54)
‘Select if applicable:
is this judgment-arising out of services rendered at'a hospital?. [x]No (0 Yes
yas above, has a stay of 2 financial institution execution. beens _ Ne Yes a Postjudgment interest was
ordered by the cou
entered pursuant to an inst iment payrnent order?
Ifa stay of a:financial i tion execution hi 1aS been 1 9, has the
Judgment Debtor deta fea anginstatiment rapa pay! order?.. . . [IN BB Yes (Speci: Non coMPLIANCE
Date signed THR EUT'S 28-9991.
Serre PY‘Spf
7. eeraid
we >
A. Feinberg
Fei DEC
0 5 onge
Financial Institution E: ion
To’any proper officer,
By authority of the State of Connecticut, and pursuant to General Statiites § 52-367b you are ordered as follows: Within 7 days, make demand for
payment to you of any nonexémpt debt owed by the Judgment Debtor(s). Make this demand upon the miain office’ of any financial institution having
‘its main office within your county, If the main office is not within your county, but a branch office of the institution is within your county, make
demiand onan employee of such branch officé as long the employee and the branch office have been designated by the financial institution in
accordance with regulations adopted by the Cominissioner of banking. Only upon demand of a financial institution which does-not have any main
office or branch office in this state, demand may be made by certified mail, return receipt requested.
After having made demandyou are directed to serve-a true and attested copy of this.execution,.together with the attached affidavit and Exemption
‘Claim: form, Financial Execution (form JD-CV-24A), with your doings endorsed thereon, upon the financiat institution-officer upon whom the demand
was made. Receive the sum paid by the financial institution and apply it on this execution in accordance with the provisions.of General Statutes §
62-3671
Bo not serve more than one financial institution execution per Judgment Debtor at a time, including copies. For Court Use Only
After service ofan execution:on one financial institution, do not serve the same-execution ‘or-a copy on another
financial institution until receiving confirmation from the precedingfinancial institution that the Judgment
‘Debtor had insufficient funds available for collection to’ satisfy the execution. However, any additional service
‘of an execution mivst not be made later than 45 days from your initial receipt of the execution.
Also, after'service'of.an-execution, do not'serve the same executiori or a copy cn the financial institution if an
electronic direct deposit from a readily identifiable source described in General Statutes § 52-376b (c) was
made to the Judgment Debtor's account within the look-back periad described in General Statutes'§ 52-376b
{c) (2 months or, with regard to federal benefits, such greater period as required by federal law). If'no such
deposit was made, you may subsequently serve the same execution if the execution has novexpired or
Wee become unenforceable:
HefSo} fail not,.and make-due réturn of this writ with your doings thereon, according to law.
TA fant Clerk) aid Signed
Irfan
lal?
Page 1 of 2
NS
NOTE: The provisions of General Statutes § 52-367b, as amended, take precedence over thése instructions,
Instructions to Finaticial institution Upon Receipt of a Financial Institution Execution When Judgment
Debtor is a Natural Person
4. If any funds are removed fram the Judgment Debtor's account pursuant to General Statutes § 52-367b(c), complete
section 1] of the attached Exemption Claim Form, Financial Institution Execution (form JD-CV-24A) and take the following
actions: (1) Send 2 copies of both this form and the: Exemption Claim Form, Financial Institution Execution form to the
Judgment Debtor and any secured party that isa party to a control agreement between you and:the secured party under
article.9 of title 42a of the General Statutes. Copies.must be-sent postage pre-paid, to the.last known-address in your
records of the recipient; and (2) Issue riotice to thie account holder, or to a fiduciary who administers the account and
receives communications on behaif of the account holder, in:the time and.manner stated in Federal Regulations
31 CFR 212,6.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:included in box:9 of the application on page 4 of this form, plus postjudgment interest, if ordered by the
court, ahd the serving officer's fee. You must take. this action before your midnight deadline, as defined in General Statutes
§ 42a-4-104,
Leave in the Judgment Debtor’s account (A) the full amount of-electronicdirect deposits that are readily identifiable:as
exempt federal veterans’ benefits, Social Security benefits, including, but not limited to, cetifement, survivors’ and disability
bénefits, 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 General Statutes § 52-352b
child support payments processed-and received pursuant to Title. IV-D. of the Social Seciirity. Act, and (B) the amount of the
éléétronic direct deposits, not to-exceed $1,000, that are réadily identifiablé'as Wages. provided such deposits were made to
the account during the look-back period of two months preceding the date that the execution was served on the financial
institution,-or, with regard to federal benefits, such greater time as required by federal law. If no such deposits’have beén
triade to the Judgment Debtor's account during the Idok-back period, or if such readily identifiable funds are less than
$1,000, leave-in the account‘as exempt pursuant to General Statutes § 52-352b(18), the lesser of the account balance.or
$1,000 in'the aggregate. To:the extent that such funds are left in the account as exempt pursuant to General Statutes §
§2-352b(18), the provisions of that section. stall not be the basis for a claim of exemption’ pursuant to this section in
response to a levy of execution. However, nothing in this paragraph 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 any funds left in the-account. You may notify the Judgment
Creditor that funds have been left in the Judgment Debtor's account pursuant to this provision. Also, nothing in this
paragraph shall alter the.exémpt-status of funds which are exempt from execution under General Statutes § 52-367b(a)- or
under any other’provision of state or federal law,.or the right of a Judgment Debtor to claim such exemption. Further,
nothing in this paragraph shall be construed to affect any other rights or obligations of the financial institution with regard to
the funds in the Judgment Debter's account.
Hold the amount,removed from.the Judgment Debtor's account pursuant to this executidn’for 15 days from the: date you
mail the-copies of this form and the Exemption Claim Form, Financial Institution Execution‘form to the Judgment Debtor
and any secured.party. During the 15 day period you must not pay-the officer serving this exectition.
If the Judgment Debtor returns the Exemption Claim Form, Financial Institution Execution form of other written notice that
an exemption is being claimed or if any secured party delivers to you written noti ‘their claim/of a prior perfected
security interest in the account, you must, within 2 business days of receipt of suc! tice, send.a copy of such notice:to
the clerk of the court that issued the execution: Continue ‘to hold-the amount temoved from the Judgment Debtor's account
for. 45 days r inti] you receive:a. court order regarding disposition of thie funds, whichever occurs first. If no order is
received within 45 days-of the date you send a copy of the Exemption Claim Form, Financial Institution Execution form or.
notice of ‘exemption ora secured party claim notice'to the clerk of the court, return the funds to the Judgment Debtor's
account.
5. If you do not.teceive the Exemption Claim Form, Financial institution Execution form or secured party claim notice within 15
days of ‘mailing the required documents to-the Judgment Debtor and any secured party, you must, upon demand, pay the
serving officer the amount removed from the Judgment Debtor's. account.
6. If no Exemption Claim Foim, Finaricial Institution Execution form or secured:party claim notice is filed or if the court orders:
you to pay the-Serving officer'an amount retnoved from the’ Judgment Debtor's account notexceeding the amount due on
the-execution-and you fail or refuse.to do.so, you'shall be liable in-an action to the Judgement Creditor(s) named in the
execution forthe amount of nonexempt:monies which you fail or refuse'‘to pay, excluding funds of up-to $1,000 which:you
in good faith’ allowed the Judgment Debtor to access pursuantto General Statutes § 52-367b(c).
If you pay exempt monies from the’ account of the: Judgment Debtor contrary:to these instructions, or the provisions of
General Statutes §52-367b, you shall.be liable in an actionto the Judgment Debtor forany exempt monies. paid and you
shall refund or:waive any charges of fees by you, including, but not limited to, dishonored check fees, overdraft or minimum
balance-service charges.and legal process fees, which were assessed as’a result of such payment of exempt monies.
For information on ADA accommodations,
contact a court clerk or go to: www.jud.ct.gov/ADA.
JOOV-24 Rew 11-21 Page 2 0f2
SS .-
EXEMPTION CLAIM FORM STATE OF CONNECTICUT
FINANCIAL INSTITUTION EXECUTION
JOCV-248 Rev, 16:21 SUPERIOR COURT
C.G.S.§§ 31-58(i), 52-321a, $2°35da, §2:962p, 52-3614, SEE INSTRUCTIONS: ON BACKIPAGE 2 wnvinjadict. gov Ne, ee
52:367b; 29 U.S.C, 206(a)(1)
Name and address-¢f Judgment Debtor of Attorney
{To be'complated by judgment creditor
or attomey) COURT USE ONLY
[ BHUPINDER SINGH 4 MXMPEX
To: CN X54790
14 DRAPEAU RD
THIS COMMUNICAT: roll NE il
EW MILFORD, CT 06776 FROM A DEBT COLLECTOR
L
Section 1 - (To.be completed by judgnient creditor)
Judicial Name and address of Coun’ (Number. Street, Town and Zip Code)
Housing
EX] district O 50 FIELD ST
Session TORRINGTON CT 06790
Name of case ‘Narne of Judgment Debtor Doeket number
MIDLAND FUNDING, LLC BHUPINDER SINGH LLI-CV14-6011160-s
vs BHUPINDER SINGH
Section 2 - (To:be completed by-financial institution - see instructions on back/page 2)
Name and address of financial institution fo which exemption claim (ifany)is to be retuned Date of mailing to Judgment Debtor
Casta Digits of the Account Number(s) “Amount femaved pursuant 16 execution ‘Amount
and type of exempt funds not removed
[[] Additional sheetis) attached hereto and made a part hereat (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 inthe
financial institution nanied above. To comply with this 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 youraccount(s) may be protected from
execution by state statutes or by other iaws or regulations.of Connecticut or of the United States. A checklistand a description of the most
common éxémptions established by law are set forth below.
HOW TO CLAIM AN EXEMPTION ESTABLISHED BY LAW. If you wish to claim that the money removed from your account(s) pursuant
to this‘execution 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.15 days from the DATE OF MAILING TO. THE JUDGMENT DEBTOR indicated above.
Upan receipt of this.form the financi stitution 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 determine the issues raised by your claim.
SECTION 4 - AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
1, the judgment debtor named above, claim and certify under the penalty of faise:statement that the money in the above account is
exemipt by'law from execution as follows: (select.ail that apply to the funds contained in this account)
(0 Social Security benefits (section §2-362b(7)) 7] Péivate pension, trust, retirement, or medical savings account
(J Unemployment benefits (section 52-352b(7)) payments (sections 52-3214, 52-352b(13))
( Worker's Gompensation benefits (section 52-352(7)) (J) Heath or disability insurance payments (section 52-3526(5))
[5] Veteran's benefits (section 52-3520(7)) (F) Other ctainy of exempt funds (Explain basis for claim of exemption):
[5] Public Assistance payments (section 52-352b(4))
[_] Wages earned by a public assistance recipient under an
incentive eatnings or similar program (section 52-352b(4))
[J] Court-ordered child support payments (section 52-352b(8)) Amount claimed tobe exempt
{_} Alimony and support other-than child support* (section 52-352b(14)) if less than the entire amount:
“See Nolte, Regarding Exemption for Alimony and Support on back/page2.
Signed Date signed ‘Telephone number
‘Compieie mating address cf Judgmem Debio
Subséribed and'sworn Date ‘At (Tawny ‘Signed (Notary Publi, Commissioner of Superior Cou)
to:before me on
Page t of 2
=
Instructions
To Financial Institution To Clerk
4 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 jadgment:debtor that is a natural person.
to the judgment debtor and to‘any secured party thatis 2. Deliver'the execution aldng with this form to the judgment creditor
party to.a control agreement between the financial fequesting the-execution
institution and-such secured party under article 9:of 3. if judgment debtor completes and returns this.form claiming an-exemption,
title 42a pursuant to General Statutes §.52-367b and €nter the’appearance of the judgment-debtor-with address 'set forth on
(2) fail notice to judgment debtar as required by page 1.
31CFR212.6 and 212.7.
Set matter down for hearing
2.(If this claim of exemption is returned. completed, fill out Complete Section 7 below.
‘Séction 6 of this form and mail, within two business Send file-stamped:copy.of this. form to judgment debtor and judgment
‘days, to the issuing clerk's office atthe address.of creditor.
court indicated on the front side. See additional
7. After héaritig. 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 aniount 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, of (2) the amount by which the individual's.
‘disposable earnings for that week-exceed forty:times the higher of (A) the federal: minimun 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. minimuri:shourly wage under subsection (i) of Section
31-58, in effect-at the tinie-the earnings are payable.
General Statutes § 52-350a(4) defines “disposable earnings” as thal part of the earnings of an individual remaining after the deduction from
those. eamings of amounts réquired to be withfield for payment of federal income-and employment taxes, normal retirement contributions,
union dues and initiation fees, group fife insurance premiums, health insurance premiums and federal tax levies.
Section 5 - Proper Officer Must Complete this Section
Name and ttle of proper officer Date of serviceon financial institution, ‘Telephone number
Section 6 - (To.be completed by financial institution upon return of exemption claim form)
Date claim received Dale mailed to cout Name of financial institution Telephone number
Section 7 - Notice to Judgment Debtor and Judgment Creditor
The money removed from your-account(s) pursuantto this execution is 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 ata hearing to.be‘held at on the date set forth below, whichever occurs earlier.
Date of hearing Time of hearing [yam Teurtroom,
Clem.
‘Signed {Assistant Clerk) Bate signed
Order
The CourtMagistrate, having held a hearing to'determine the issues raised by this claim, hereby orders that:
By the Court (Name of Judge/Femily Suppor Mapistate/Magisirate)
(7) Judge 1] Fsm (T] Magistrate
Signed (udgemPamily Support Magistrate/Magistrate/Assistant Clerk) Date signed
ADA NOTICE
with Disabilities Act (ADA). If you need a reasonable’
The Judicial Branch of the State of Connecticut complies with the. Americans:
accommodation in accordarice with the ADA, contact’a court-clerk or an ADA;contact person listed at www. jud.cf.gawADA,
JO-CV-24A (page 2) Rev. 10:21 Page 2 of 2
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aR FINANCIAL INSTITUTION EXECUTION PROCEEDINGS STATE OF CONNECTICUT JUDGMENT DEBTOR WHO JS A’NATURAL PERSON, SUPERIOR COURT APPLICATION AND EXECUTION wanw.jud.ct.gov JO-CV-24 Rev. 11-21 C.G'S. §§ 52-3660, 52-967b. (See page 2 for instrdctions to financial institution and ADA Notice} Instructions ~Judgment Creditor or Attorney instructions - Clerk 4: te this form, an Exemplion Claini form, and a'Fiancial tnstitution Execution (férm JD-CV-24a), 1. Check the fileto ensure the information on the application is comect. IF filing electronically, combine into one PDF document. filvig' on paper, prepare original, attach’form 2. Sign original execution. JO-CV-24A and. fe the orginal with the clerk. Keep 1 copy for your records. 2. Applications must be-accompanied by the.statuiory fee set.in General Statetes § 52-367b. 3. Upioad the otiginal to the fle. ‘Address of court [x] Judiciat District Docket number 50 FIELD ST TORRINGTON CT 06790 (C] Housing Session LLI~CV14~-6011160-S ‘Name.and mailing address of Judgment Creditor or Atomey (Number, street, (own, state, 2ip code) (To.be completed by Judgmerit Creditoi} (Plaintity COURT USE ONLY Law ices APFEABA EXISSUE. Howard Lee Schiff,P.c P.O.Box 280245 E Hartford, CT 06108 CROCE | TCA L Name Pas PRR Eee” 1 whem money 1s owed) (Number, skeet, lovin, zip coda) 350 CAMINO DE LA REINA, SUITE 100 SAN DIEGO, CA 92108 & Name(s) and address(es) of Judgment Deblor(s) (Party wiio owes money) (Number, street, lown, zip code NDER ST 14 DRAPEAU RD ‘NEW MILFORD, CT 06776 Date ofjudament 7 . Amountor judgment jinclude, where applicable, | 2 Amount of eosts and fees. 3, Total amountof judgment. costs and fees (Add 7 and 2) 1/28/15 $19:,483.7 Qpreiidament‘attomey’s ininterest and $433.8 $19,917.54 “4. Total amount paid (iFany) Total amount unpaid ‘tae From 3) ‘6. Application fee for financial institution execution (if of waivedby the court) $.00 $19,917.54 $105.00 7. Application fees paid for prior executions on this judgment & Olher court ordered postudgment costs and fees ‘S.fotal of tems & 6, 7-and 6 $415.00 $0.00 $20,437.54) ‘Select if applicable: is this judgment-arising out of services rendered at'a hospital?. [x]No (0 Yes yas above, has a stay of 2 financial institution execution. beens _ Ne Yes a Postjudgment interest was ordered by the cou entered pursuant to an inst iment payrnent order? Ifa stay of a:financial i tion execution hi 1aS been 1 9, has the Judgment Debtor deta fea anginstatiment rapa pay! order?.. . . [IN BB Yes (Speci: Non coMPLIANCE Date signed THR EUT'S 28-9991. Serre PY‘Spf 7. eeraid we > A. Feinberg Fei DEC 0 5 onge Financial Institution E: ion To’any proper officer, By authority of the State of Connecticut, and pursuant to General Statiites § 52-367b you are ordered as follows: Within 7 days, make demand for payment to you of any nonexémpt debt owed by the Judgment Debtor(s). Make this demand upon the miain office’ of any financial institution having ‘its main office within your county, If the main office is not within your county, but a branch office of the institution is within your county, make demiand onan employee of such branch officé as long the employee and the branch office have been designated by the financial institution in accordance with regulations adopted by the Cominissioner of banking. Only upon demand of a financial institution which does-not have any main office or branch office in this state, demand may be made by certified mail, return receipt requested. After having made demandyou are directed to serve-a true and attested copy of this.execution,.together with the attached affidavit and Exemption ‘Claim: form, Financial Execution (form JD-CV-24A), with your doings endorsed thereon, upon the financiat institution-officer upon whom the demand was made. Receive the sum paid by the financial institution and apply it on this execution in accordance with the provisions.of General Statutes § 62-3671 Bo not serve more than one financial institution execution per Judgment Debtor at a time, including copies. For Court Use Only After service ofan execution:on one financial institution, do not serve the same-execution ‘or-a copy on another financial institution until receiving confirmation from the precedingfinancial institution that the Judgment ‘Debtor had insufficient funds available for collection to’ satisfy the execution. However, any additional service ‘of an execution mivst not be made later than 45 days from your initial receipt of the execution. Also, after'service'of.an-execution, do not'serve the same executiori or a copy cn the financial institution if an electronic direct deposit from a readily identifiable source described in General Statutes § 52-376b (c) was made to the Judgment Debtor's account within the look-back periad described in General Statutes'§ 52-376b {c) (2 months or, with regard to federal benefits, such greater period as required by federal law). If'no such deposit was made, you may subsequently serve the same execution if the execution has novexpired or Wee become unenforceable: HefSo} fail not,.and make-due réturn of this writ with your doings thereon, according to law. TA fant Clerk) aid Signed Irfan lal? Page 1 of 2 NS NOTE: The provisions of General Statutes § 52-367b, as amended, take precedence over thése instructions, Instructions to Finaticial institution Upon Receipt of a Financial Institution Execution When Judgment Debtor is a Natural Person 4. If any funds are removed fram the Judgment Debtor's account pursuant to General Statutes § 52-367b(c), complete section 1] of the attached Exemption Claim Form, Financial Institution Execution (form JD-CV-24A) and take the following actions: (1) Send 2 copies of both this form and the: Exemption Claim Form, Financial Institution Execution form to the Judgment Debtor and any secured party that isa party to a control agreement between you and:the secured party under article.9 of title 42a of the General Statutes. Copies.must be-sent postage pre-paid, to the.last known-address in your records of the recipient; and (2) Issue riotice to thie account holder, or to a fiduciary who administers the account and receives communications on behaif of the account holder, in:the time and.manner stated in Federal Regulations 31 CFR 212,6.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:included in box:9 of the application on page 4 of this form, plus postjudgment interest, if ordered by the court, ahd the serving officer's fee. You must take. this action before your midnight deadline, as defined in General Statutes § 42a-4-104, Leave in the Judgment Debtor’s account (A) the full amount of-electronicdirect deposits that are readily identifiable:as exempt federal veterans’ benefits, Social Security benefits, including, but not limited to, cetifement, survivors’ and disability bénefits, 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 General Statutes § 52-352b child support payments processed-and received pursuant to Title. IV-D. of the Social Seciirity. Act, and (B) the amount of the éléétronic direct deposits, not to-exceed $1,000, that are réadily identifiablé'as Wages. provided such deposits were made to the account during the look-back period of two months preceding the date that the execution was served on the financial institution,-or, with regard to federal benefits, such greater time as required by federal law. If no such deposits’have beén triade to the Judgment Debtor's account during the Idok-back period, or if such readily identifiable funds are less than $1,000, leave-in the account‘as exempt pursuant to General Statutes § 52-352b(18), the lesser of the account balance.or $1,000 in'the aggregate. To:the extent that such funds are left in the account as exempt pursuant to General Statutes § §2-352b(18), the provisions of that section. stall not be the basis for a claim of exemption’ pursuant to this section in response to a levy of execution. However, nothing in this paragraph 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 any funds left in the-account. You may notify the Judgment Creditor that funds have been left in the Judgment Debtor's account pursuant to this provision. Also, nothing in this paragraph shall alter the.exémpt-status of funds which are exempt from execution under General Statutes § 52-367b(a)- or under any other’provision of state or federal law,.or the right of a Judgment Debtor to claim such exemption. Further, nothing in this paragraph shall be construed to affect any other rights or obligations of the financial institution with regard to the funds in the Judgment Debter's account. Hold the amount,removed from.the Judgment Debtor's account pursuant to this executidn’for 15 days from the: date you mail the-copies of this form and the Exemption Claim Form, Financial Institution Execution‘form to the Judgment Debtor and any secured.party. During the 15 day period you must not pay-the officer serving this exectition. If the Judgment Debtor returns the Exemption Claim Form, Financial Institution Execution form of other written notice that an exemption is being claimed or if any secured party delivers to you written noti ‘their claim/of a prior perfected security interest in the account, you must, within 2 business days of receipt of suc! tice, send.a copy of such notice:to the clerk of the court that issued the execution: Continue ‘to hold-the amount temoved from the Judgment Debtor's account for. 45 days r inti] you receive:a. court order regarding disposition of thie funds, whichever occurs first. If no order is received within 45 days-of the date you send a copy of the Exemption Claim Form, Financial Institution Execution form or. notice of ‘exemption ora secured party claim notice'to the clerk of the court, return the funds to the Judgment Debtor's account. 5. If you do not.teceive the Exemption Claim Form, Financial institution Execution form or secured party claim notice within 15 days of ‘mailing the required documents to-the Judgment Debtor and any secured party, you must, upon demand, pay the serving officer the amount removed from the Judgment Debtor's. account. 6. If no Exemption Claim Foim, Finaricial Institution Execution form or secured:party claim notice is filed or if the court orders: you to pay the-Serving officer'an amount retnoved from the’ Judgment Debtor's account notexceeding the amount due on the-execution-and you fail or refuse.to do.so, you'shall be liable in-an action to the Judgement Creditor(s) named in the execution forthe amount of nonexempt:monies which you fail or refuse'‘to pay, excluding funds of up-to $1,000 which:you in good faith’ allowed the Judgment Debtor to access pursuantto General Statutes § 52-367b(c). If you pay exempt monies from the’ account of the: Judgment Debtor contrary:to these instructions, or the provisions of General Statutes §52-367b, you shall.be liable in an actionto the Judgment Debtor forany exempt monies. paid and you shall refund or:waive any charges of fees by you, including, but not limited to, dishonored check fees, overdraft or minimum balance-service charges.and legal process fees, which were assessed as’a result of such payment of exempt monies. For information on ADA accommodations, contact a court clerk or go to: www.jud.ct.gov/ADA. JOOV-24 Rew 11-21 Page 2 0f2 SS .- EXEMPTION CLAIM FORM STATE OF CONNECTICUT FINANCIAL INSTITUTION EXECUTION JOCV-248 Rev, 16:21 SUPERIOR COURT C.G.S.§§ 31-58(i), 52-321a, $2°35da, §2:962p, 52-3614, SEE INSTRUCTIONS: ON BACKIPAGE 2 wnvinjadict. gov Ne, ee 52:367b; 29 U.S.C, 206(a)(1) Name and address-¢f Judgment Debtor of Attorney {To be'complated by judgment creditor or attomey) COURT USE ONLY [ BHUPINDER SINGH 4 MXMPEX To: CN X54790 14 DRAPEAU RD THIS COMMUNICAT: roll NE il EW MILFORD, CT 06776 FROM A DEBT COLLECTOR L Section 1 - (To.be completed by judgnient creditor) Judicial Name and address of Coun’ (Number. Street, Town and Zip Code) Housing EX] district O 50 FIELD ST Session TORRINGTON CT 06790 Name of case ‘Narne of Judgment Debtor Doeket number MIDLAND FUNDING, LLC BHUPINDER SINGH LLI-CV14-6011160-s vs BHUPINDER SINGH Section 2 - (To:be completed by-financial institution - see instructions on back/page 2) Name and address of financial institution fo which exemption claim (ifany)is to be retuned Date of mailing to Judgment Debtor Casta Digits of the Account Number(s) “Amount femaved pursuant 16 execution ‘Amount and type of exempt funds not removed [[] Additional sheetis) attached hereto and made a part hereat (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 inthe financial institution nanied above. To comply with this 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 youraccount(s) may be protected from execution by state statutes or by other iaws or regulations.of Connecticut or of the United States. A checklistand a description of the most common éxémptions established by law are set forth below. HOW TO CLAIM AN EXEMPTION ESTABLISHED BY LAW. If you wish to claim that the money removed from your account(s) pursuant to this‘execution 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.15 days from the DATE OF MAILING TO. THE JUDGMENT DEBTOR indicated above. Upan receipt of this.form the financi stitution 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 determine the issues raised by your claim. SECTION 4 - AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW 1, the judgment debtor named above, claim and certify under the penalty of faise:statement that the money in the above account is exemipt by'law from execution as follows: (select.ail that apply to the funds contained in this account) (0 Social Security benefits (section §2-362b(7)) 7] Péivate pension, trust, retirement, or medical savings account (J Unemployment benefits (section 52-352b(7)) payments (sections 52-3214, 52-352b(13)) ( Worker's Gompensation benefits (section 52-352(7)) (J) Heath or disability insurance payments (section 52-3526(5)) [5] Veteran's benefits (section 52-3520(7)) (F) Other ctainy of exempt funds (Explain basis for claim of exemption): [5] Public Assistance payments (section 52-352b(4)) [_] Wages earned by a public assistance recipient under an incentive eatnings or similar program (section 52-352b(4)) [J] Court-ordered child support payments (section 52-352b(8)) Amount claimed tobe exempt {_} Alimony and support other-than child support* (section 52-352b(14)) if less than the entire amount: “See Nolte, Regarding Exemption for Alimony and Support on back/page2. Signed Date signed ‘Telephone number ‘Compieie mating address cf Judgmem Debio Subséribed and'sworn Date ‘At (Tawny ‘Signed (Notary Publi, Commissioner of Superior Cou) to:before me on Page t of 2 = Instructions To Financial Institution To Clerk 4 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 jadgment:debtor that is a natural person. to the judgment debtor and to‘any secured party thatis 2. Deliver'the execution aldng with this form to the judgment creditor party to.a control agreement between the financial fequesting the-execution institution and-such secured party under article 9:of 3. if judgment debtor completes and returns this.form claiming an-exemption, title 42a pursuant to General Statutes §.52-367b and €nter the’appearance of the judgment-debtor-with address 'set forth on (2) fail notice to judgment debtar as required by page 1. 31CFR212.6 and 212.7. Set matter down for hearing 2.(If this claim of exemption is returned. completed, fill out Complete Section 7 below. ‘Séction 6 of this form and mail, within two business Send file-stamped:copy.of this. form to judgment debtor and judgment ‘days, to the issuing clerk's office atthe address.of creditor. court indicated on the front side. See additional 7. After héaritig. 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 aniount 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, of (2) the amount by which the individual's. ‘disposable earnings for that week-exceed forty:times the higher of (A) the federal: minimun 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. minimuri:shourly wage under subsection (i) of Section 31-58, in effect-at the tinie-the earnings are payable. General Statutes § 52-350a(4) defines “disposable earnings” as thal part of the earnings of an individual remaining after the deduction from those. eamings of amounts réquired to be withfield for payment of federal income-and employment taxes, normal retirement contributions, union dues and initiation fees, group fife insurance premiums, health insurance premiums and federal tax levies. Section 5 - Proper Officer Must Complete this Section Name and ttle of proper officer Date of serviceon financial institution, ‘Telephone number Section 6 - (To.be completed by financial institution upon return of exemption claim form) Date claim received Dale mailed to cout Name of financial institution Telephone number Section 7 - Notice to Judgment Debtor and Judgment Creditor The money removed from your-account(s) pursuantto this execution is 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 ata hearing to.be‘held at on the date set forth below, whichever occurs earlier. Date of hearing Time of hearing [yam Teurtroom, Clem. ‘Signed {Assistant Clerk) Bate signed Order The CourtMagistrate, having held a hearing to'determine the issues raised by this claim, hereby orders that: By the Court (Name of Judge/Femily Suppor Mapistate/Magisirate) (7) Judge 1] Fsm (T] Magistrate Signed (udgemPamily Support Magistrate/Magistrate/Assistant Clerk) Date signed ADA NOTICE with Disabilities Act (ADA). If you need a reasonable’ The Judicial Branch of the State of Connecticut complies with the. Americans: accommodation in accordarice with the ADA, contact’a court-clerk or an ADA;contact person listed at www. jud.cf.gawADA, JO-CV-24A (page 2) Rev. 10:21 Page 2 of 2