On January 30, 2024 a
COMPLAINT
was filed
involving a dispute between
Commissioner Of Revenue Services,
and
Sharona Nichols,
for M90 - Misc - All other
in the District Court of Hartford County.
Preview
01/80/2024 11:55AK FAX 2035797290+ - @ooos/0011
State Connecticut
te Fe
Letter ID: Lo06084176
Exemption and Modification Claim Form
Employer Wage Execution In Accordance with Tax Warrant
Rocket JANE
"HARTFORD
NID
feceigt Abr
08
tai
Section { (Compteted by Commissloner of Revenue Services)
‘Address of Court
| BUSO $19, tebod es
RD J WD.
9585 Washington Steet, Hanford CT 06106 MANU Aas is alo traneis Thus company”
Name rot debtor wearral
SHARONA NICHOLS 76133, 2108/2023
Section Il (Completed by employer upon receipt
of exemption claim form)
Complete Seclion 1! and send ona capy of this form and tha tax watrant to the debtor in accordance with Conn. Gan, Stat. §52-381a(d). —
tees oT employer
fone ane : seaarginuns fer varie,
“Date
of maling Tolsramaunt at wage execution ‘Amount
to be taken out trom weakly eammngs
Sactlon Ill - Noticeto Debtor .
‘The attached tax warrant
has been isaued ea our by you you fom te empiayer named ous, twenty (20) days from the Date of
{gsuance of Warrant indicated above,the weakly asmings an amcunt of money leaves you with (a) seventy-five
gercrt 70%) a your sonata emia or tary (4 mea in Higher of sinivem eur woos taw or state law, whichaveris
statutes your amy yy With the warrant
must vt caste
= sled alow uncer Gonaka| Statutes, if you Hunk Urat your employer
Your Earnings
ely cnt al ty betaen oa
bap: ated the weokly amount
ay bo protected fram exacaion
Syryou shou ta
fol your employer.
adana ofthe State of
jecticut OF oF the.United States. A chuckiist and a description of the exemy ions establshed by law ara sted
Howta an Exemption Allowed by Law - IF you believe that your: ja re fromexacution,-You Tat ffout nd algn Section
WV~ Claim: id by Law, below aiid rial! or deliver thls Fair to the’ Supaitér Court at the
addracs
boring
aed shove,
of court i
wl ld bythe court “Ths court clerk will notify you, your employer, and the ‘Gol loaner of Revenca arviogs: oF th dats on which a
co io determine tne as cleo by your oll Hf ths fori recived by thie cour later tian fwer from the
‘earnings tnt after your ctaim is ravigwe the cour.A
‘Warrent indicated above, the empl
claim may also be Sted afer the twenty 20) day perod.
ee
iinod tone
bi exempt may bo whe fram he claim hea been
How to Claim & Modification of Execution -' if | hava esgonable cause to bellave that you have a right a soaton"— {ange
Chale
fin wage
Ca soa caren culver this Exempbon And the Suparior Court: addressaes
‘and you wantto request a modification {to have lgas monoy {akon from your wages Loumust fl out Se
above‘The court cla will
your employer, ani dine Camrolasionar of Revenue Senoas ofthe deta on which a heeting il bs held ty ans eoxrt ne corey ts tonto
raleod ty
‘by Your claim, ifthis fam ts racalvad ‘by the court no later than twenty (20) days from the Date
of fesuance: Warrant indicated above, |
‘omployerwill not begin wtthholding
your earniny a unt afterYour cain ano out, Acn may ae
fo be exempt may i il
File
period. No earings claimed em ary ome tb co een
~
1. The following Is the partof nn. Gen, Stat. §52.361a hich identifies what par wages be removed by
the employer and aNen t the judgment creditor.
"The maximum
part of tha. -eamings of an individual which may be subject under this for
payment
nfo gan fs: toca ot sent ve‘times(25 theparca
higher af (A) the minimum.
forthe wool ia
‘saction 6fa)(1) of fhe Fatr
Lal -Stansarde ff Yous 20.6 Seclon SOR), (6) me tu minimum folr woe established by’ @ oF saction 31-58, in
TRS icaig Re ent or nn. Gen. Stat. §52-350a(4) which defines disposable eat ings and, in doing 30,
‘explaing what parts of your wages which cannot be Included in your total eamings wher figuring out {calcutating) the
weekly amount which is subjectfo execution.
Seppe eta neon oo tc a cena te aig ofemeur rautadtc
be witnold For payment off ba employment taxes,6 normal retrement contributions, union dues end iniietion
fees, group life
‘insurance premiums, health:
450 Columbus
Bivd., Suita.4 File Your Taxes: Etectronlcally Hartford CT 08103-1837
‘Airave Acdns gue! Cpportanly
Op Employer 7
01/30/2024 11:55AN FAX 2035797290+ 0010/0011
A
Letter ID: Looos084176 bLEg8
. Rav. 11/23
Section WV - Claim of Established by Law (Campiated by debtor upon recelpt of Exemption|and Modification China.
{, the debtor
named above, Cleland cary under tho panaly of flae statement that my eemings ara prompt fram execution (donot
have fo be taken) because:
or g6t public assistance and eam wages under en incentive. camings or énllar program and my eamings ara exempt from
execution;
OR -
o Other statutory exemption (List each exemption below, the amaunt of the exemption, and the statutory authority for the
exemption. Attach additional pagesas needed.)
—SeRrTToTy AR [ATO CTSTRTST GS ERE DRSHed CTO EwamapHOTS ENGNG Gy La
se a4
Signed Address of debtor
Sactlon V - Claimed for Modification by debi apon recalpt
recat of Exemption and Modification Form)
see ask
Seay wee ‘execution
Say oe
AY
you shoul loss money i ‘your wages
EN SuWvlexh
‘al if) AN eee e ~~ Bai © RA I
‘Address
of debtor
(ps
L BRO Vonbed
(CT OLY
Section VI-he Gist Ct promi ves
Complete Section V and sand a file-stamped copy
1... The. debtor atthe address.o
debtor,
f ren lnsShcten MoV.
‘The employer indicated fon Ik
3 ‘The Department of Revenue Servicas, Offica of Couinsal, jathria 06103; and
4. ‘The Office of the Atformay General, Attention: ance, Department 4, 65 Elm Steet, Hartord C/c0108
Date ofheanng Time oF heanng Courtroom number
Order of the Court
Judge Date
480 Columbus Blvd., Suite. 1 File Your Taxeu Eluctronically ‘Hartford, CT 06103-1837
Affirmative Action / Equal Opportunity Employor 8
Document Filed Date
January 30, 2024
Case Filing Date
January 30, 2024
Category
M90 - Misc - All other
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01/80/2024 11:55AK FAX 2035797290+ - @ooos/0011 State Connecticut te Fe Letter ID: Lo06084176 Exemption and Modification Claim Form Employer Wage Execution In Accordance with Tax Warrant Rocket JANE "HARTFORD NID feceigt Abr 08 tai Section { (Compteted by Commissloner of Revenue Services) ‘Address of Court | BUSO $19, tebod es RD J WD. 9585 Washington Steet, Hanford CT 06106 MANU Aas is alo traneis Thus company” Name rot debtor wearral SHARONA NICHOLS 76133, 2108/2023 Section Il (Completed by employer upon receipt of exemption claim form) Complete Seclion 1! and send ona capy of this form and tha tax watrant to the debtor in accordance with Conn. Gan, Stat. §52-381a(d). — tees oT employer fone ane : seaarginuns fer varie, “Date of maling Tolsramaunt at wage execution ‘Amount to be taken out trom weakly eammngs Sactlon Ill - Noticeto Debtor . ‘The attached tax warrant has been isaued ea our by you you fom te empiayer named ous, twenty (20) days from the Date of {gsuance of Warrant indicated above,the weakly asmings an amcunt of money leaves you with (a) seventy-five gercrt 70%) a your sonata emia or tary (4 mea in Higher of sinivem eur woos taw or state law, whichaveris statutes your amy yy With the warrant must vt caste = sled alow uncer Gonaka| Statutes, if you Hunk Urat your employer Your Earnings ely cnt al ty betaen oa bap: ated the weokly amount ay bo protected fram exacaion Syryou shou ta fol your employer. adana ofthe State of jecticut OF oF the.United States. A chuckiist and a description of the exemy ions establshed by law ara sted Howta an Exemption Allowed by Law - IF you believe that your: ja re fromexacution,-You Tat ffout nd algn Section WV~ Claim: id by Law, below aiid rial! or deliver thls Fair to the’ Supaitér Court at the addracs boring aed shove, of court i wl ld bythe court “Ths court clerk will notify you, your employer, and the ‘Gol loaner of Revenca arviogs: oF th dats on which a co io determine tne as cleo by your oll Hf ths fori recived by thie cour later tian fwer from the ‘earnings tnt after your ctaim is ravigwe the cour.A ‘Warrent indicated above, the empl claim may also be Sted afer the twenty 20) day perod. ee iinod tone bi exempt may bo whe fram he claim hea been How to Claim & Modification of Execution -' if | hava esgonable cause to bellave that you have a right a soaton"— {ange Chale fin wage Ca soa caren culver this Exempbon And the Suparior Court: addressaes ‘and you wantto request a modification {to have lgas monoy {akon from your wages Loumust fl out Se above‘The court cla will your employer, ani dine Camrolasionar of Revenue Senoas ofthe deta on which a heeting il bs held ty ans eoxrt ne corey ts tonto raleod ty ‘by Your claim, ifthis fam ts racalvad ‘by the court no later than twenty (20) days from the Date of fesuance: Warrant indicated above, | ‘omployerwill not begin wtthholding your earniny a unt afterYour cain ano out, Acn may ae fo be exempt may i il File period. No earings claimed em ary ome tb co een ~ 1. The following Is the partof nn. Gen, Stat. §52.361a hich identifies what par wages be removed by the employer and aNen t the judgment creditor. "The maximum part of tha. -eamings of an individual which may be subject under this for payment nfo gan fs: toca ot sent ve‘times(25 theparca higher af (A) the minimum. forthe wool ia ‘saction 6fa)(1) of fhe Fatr Lal -Stansarde ff Yous 20.6 Seclon SOR), (6) me tu minimum folr woe established by’ @ oF saction 31-58, in TRS icaig Re ent or nn. Gen. Stat. §52-350a(4) which defines disposable eat ings and, in doing 30, ‘explaing what parts of your wages which cannot be Included in your total eamings wher figuring out {calcutating) the weekly amount which is subjectfo execution. Seppe eta neon oo tc a cena te aig ofemeur rautadtc be witnold For payment off ba employment taxes,6 normal retrement contributions, union dues end iniietion fees, group life ‘insurance premiums, health: 450 Columbus Bivd., Suita.4 File Your Taxes: Etectronlcally Hartford CT 08103-1837 ‘Airave Acdns gue! Cpportanly Op Employer 7 01/30/2024 11:55AN FAX 2035797290+ 0010/0011 A Letter ID: Looos084176 bLEg8 . Rav. 11/23 Section WV - Claim of Established by Law (Campiated by debtor upon recelpt of Exemption|and Modification China. {, the debtor named above, Cleland cary under tho panaly of flae statement that my eemings ara prompt fram execution (donot have fo be taken) because: or g6t public assistance and eam wages under en incentive. camings or énllar program and my eamings ara exempt from execution; OR - o Other statutory exemption (List each exemption below, the amaunt of the exemption, and the statutory authority for the exemption. Attach additional pagesas needed.) —SeRrTToTy AR [ATO CTSTRTST GS ERE DRSHed CTO EwamapHOTS ENGNG Gy La se a4 Signed Address of debtor Sactlon V - Claimed for Modification by debi apon recalpt recat of Exemption and Modification Form) see ask Seay wee ‘execution Say oe AY you shoul loss money i ‘your wages EN SuWvlexh ‘al if) AN eee e ~~ Bai © RA I ‘Address of debtor (ps L BRO Vonbed (CT OLY Section VI-he Gist Ct promi ves Complete Section V and sand a file-stamped copy 1... The. debtor atthe address.o debtor, f ren lnsShcten MoV. ‘The employer indicated fon Ik 3 ‘The Department of Revenue Servicas, Offica of Couinsal, jathria 06103; and 4. ‘The Office of the Atformay General, Attention: ance, Department 4, 65 Elm Steet, Hartord C/c0108 Date ofheanng Time oF heanng Courtroom number Order of the Court Judge Date 480 Columbus Blvd., Suite. 1 File Your Taxeu Eluctronically ‘Hartford, CT 06103-1837 Affirmative Action / Equal Opportunity Employor 8