FINANGIAL INSTITUTION EXECUTION
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`WHO IS A NATURAL PERSON,
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`PROCEEDINGS - JUDGMENT DEBTOR
`APPLICATIONAND EXECUTION
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`C.G.S. §§ 52-355b, §2-367b
`P.A. 1467, 14-9
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`SUPERIOR COURT
`(Seepage 2 forinstructions to financialinstitution
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`STATE OF CONNECTICUT
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`www.jud. cl gov
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`and ADA Notice)
`instructions- Clerk
`Instructions - Judgment Creditor Or Attorney
`4. Checkthe file fo ensure that the information provided
`4. Type or print legibly.
`on the appiteation fs correct,
`2. Complete the application section; prepare original and 2 copies.
`2, Sign original execution,
`3. Complete section 7 of the Exempilon Claim Form, JD-CV-24a and alfach to this form,
`for file,
`3, Refum original to applicant, retaln a copy
`4, Presentoriginal and 1 copy
`fo clerk of court. Refain a copy.
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`‘Address of court Geographic|Docket number|} Judicial distriat
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`80 WashingtonStreet, Hartford, CT 06106
`Housing session
`number
`HFH-CV-16-5002962-S
`Name and mailing address of Judgment Creditor or Attorney (To be comploted by Judgment Credifor}
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`~
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`Margaret F. Rattigan
`Murphy, Laudatl, Kiel & Rattigan, LLC
`10 Talcott Notch Road, Suite 210
`Farmington, CT 06032
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`Name(s) and address(es) of Judgment Crealtor(s)
`Noemi DiCristofaro
`47 Robin Road, Farmington, CT 06032
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`tf|Name(s) and address(es) of Judgment Debtor(s)
`&|Kiril Nemirovsky
`y
`15 OaklawnDrive, Barkhamsted, CT 06063
`3, Amount of judgment, costs and fees (Add 7 and 2}
`2, Amount of costs
`Date of Judgment
`1. Amount ofjudgment
`(include, where applicable,
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`<|6-27-2016 projudgmentinterest and|$465.00$2,400.00 $2,565.00
`4, Total amount pald (if any)
`§.Total amount unpaid (Subtract 4 from 3)
`6. Application fee for financialinstitution execution (if not waived by fhe court)
`$1,365.00
`$1,200.00
`$105.00
`7. Application fees paid for prlor executions on this judgment
`8, Other court ordered postjudgment costs and fees
`$0.00
`$0.00
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`9.Total of Items 5,6, 7 and 8
`$1,305.00
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`Date sigg Bn
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`gC
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`Telephone number
`860-674-8296
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`Checkif-applicable
`postjudgmentInterest was ordered by the court
`Is this judgmentarising out of services rendered at a hospital?
`No
`L_] Yes
`[x] No
`If this is a judgmentarising out of services rendered at a hespital, has a stay of a financlal Institutlon execution been
`CO Yes
`entered pursuant to an installment payment order?
`if ajstay of 2 financial Institution execution has been entered, has the Judgment Debtor defaulted on an installment payment order?
`TANo
`yes (Spt):
`ne giuidg
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`Ws amey)
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`Financial Institutibn Exe¢ution
`To any properofficer,
`Whereas on said Date of Judgment 'itie above-namedJucgmant Creditor(s) recovered Judgment against the above-named Judgment Debtor(s) before the above-
`named court for the amount of Judgment, costs and fess 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 from your receipt of this execution, make demand upen the main office of any financial Institutlon having Its main office within your county, or if such
`main office is not within your county and such financialinstitution has ona 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 commissionerof banking, for
`payment to you pursuantto sectlon 52-367b{b) of the General Statutes of any nonexempt debt due said Judgment Debtor(s), which sum shall not exceed the total
`unpaid judgment, costs and fees as stated above, plus postjudgmentInierest as ardered by the court,if applicable, plus the application fee and other court ordered
`pastjudgment costs and feos and your own fee, After having made such demand you are directed to serve a true and altested copy ofthis execution, together with the
`attached affidavit and exemption claim form, with your doings endorsed thereon,with the financial institution officer upon whom such demand was mada, Said sum
`shall be recalvad 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
`financlalInstitution execution per judgment debtor at a time, Including copies thereof. After service of an execution on one
`For Court Use Only
`financialinstitution, you shall not serve the same execution or a copy thereof upon anotherfinancial institution until receiving
`confirmation from the preceding financialinstitution that the judgment debter had Insufficient funds at the preceding financia!
`institution avaltable far collection to satisfy the execution, provided any such additional service is made notlater than forty-five
`days from the receipt by you of such execution. After service of an execution, you shal! not serve the same execution or a
`copy thereof upon such financial Institutian if an elactronic direct deposit fram a readily idantifiable source describedin
`section 52 -376b (c} of the General Statutes was made to the judgment debtor's account within the look-back period
`described in section 52 -376b (c) of the General Statues {sixty days or, with regard to federal benafits, such greater period as
`required by federal law). If no such deposit was mace, you may subsequently serve the same execution or a copy thereof
`upon suchinstitution, provided the execution has not expired or otherwise become unenforceable.
`Hereoffail not, and make due return of this writ with your doings thereon, according to law.
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`Page 1 of 2
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`FINANCIALINSTITUTION EXECUTION PROCEEDINGS
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`NOTE:The provisions of section 52-367b, as amendedfrom time to time, take precedence overthese instructions.
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`1.
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`instructions To FinancialInstitution Upon Receipt Of A FinancialInstitution Execution
`When Judgment Debtor Is A Natural Person
`lf 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 underarticle 9 oftitle 42a of the General Statutes, postage pre-paid, at the last known addressof the judgment dedtor and
`of any such secured party with respect to the affected accounts on the records of yourinstitution 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 Fee for FinancialInstitution Execution and other court
`ordered postjudgment costs or fees and the servingofficer'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 notlimited 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
`undersection 52-352b of the Connecticut Genera! Statutes, or child support payments processed and received pursuantto 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 construedto limit yourright or obligation to remove such funds from the judgment debtor's accountif required by any
`other provision of law or by a court order. The judgment debtor shall have full and customary access to such fundsleft 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 shallalter 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 otherrights or obligations of the financial institution with regard to the funds in the
`judgment debtor's account.
`You must hold the amount removed from the judgment debtor's account pursuantto this execution forfifteen 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 suchfifteen day period you
`must not pay the officer serving this execution.
`_ Lf the judgment debtor retums 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 receipt 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 eaiiler. If no orderis 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 noticeis 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 orif 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 fall or refuse to do so, you shall be liable in an action therefor to the
`Judgment creditor(s) namein the execution for the amount of nonexempt monies which you fail or refuse to pay over, excluding funds of
`up to one thousand dollars which you in good faith ailowed 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
`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 52-3676 of the General
`Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid and you shall refund or waive
`any chargesof fees by you, including, but notlimited 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.
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`ADA NOTICE
`The Judislal Branch of the State of Connecticut complies with the Americans with
`Digabllities Act {ADA}, If you need a reasonable accommodation In accordance with the
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`ADA, contact a court clerk or an ADA contact person Ilsted at wwwjud.ctgowADA,
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`JD-CV-24 (backpage 2} Rev. 2-15
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`Page 2 of 2
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`FINANCIAL INSTITUTION EXECUTION
`EXEMPTION CLAIM FORM
`JD-CV-244 Rev, 1-17
`C.G.S. 31-58(), 52-3214, 62-3508, 52-362b, 62-3612,
`52-367b, 29 U.S.C. 206(a)(1)
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`SEE INSTRUCTIONS ON BACKIPAGE 2
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`STA hpenion COURT
`TE OF CONNECTICUT
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`www.fud.ch.gov
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`Name and address of Judgment Debtor or Attorney
`(To be completed by judgment creditor or attorney)
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`To.
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`J
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`Kirit Nemirovsky
`15 Oaklawn Drive
`Barkhamsted, CT 06032
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`7
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`For court use only
`MXMPEX
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`Section 1 — (To be completed byjudgmentcreditor)
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`eographica
`Name and address of Court (Number, Street, Town and Zip Cede)
`Judicial
`Housin:
`[7] district
`[x] Seesion
`Wea
`80 Washington Street, Hartford, CT 06106
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`Docket number
`Name of Judgment Debtor
`Name ef case
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`HFH-CV-16-5002962-8
`DiCristofaro v. Nemlrovsky
`Kiril Nemirovsky
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`Section 2 — (To be completed by financial institution - see instructions on back/page2)
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`Name and address of financlalinstitution to which exemption claim (f any) is to be retured
`Date of mailing to Judgment Debtor
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`‘Amount and type of readily Identifiable exempt funds not removed
`Amount removed pursuant to execution
` Last 4 Digits of the Account Number(s}
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` || Additional sheet(s) attached hereto and madeapart nereof (if necessary).
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`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
`flnancial institution named above. To comply with this execution, the financial institution has removed the amount of moneyindicated
`above from the account(s) listed above.
`THE MONEYIN YOUR ACCOUNT(S) MAY BE EXEMPT FROM EXECUTION - The money In your account(s} may be protected from
`execution by state statutes or by otherlaws or regulations 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 wishto claim that the money in your account(s) Is exempt by law
`from execution, you mustfill out and sign before a properofficial 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 financialinstitution no later than
`15 days from the DATE OF MAILING TO THE JUDGMENT DEBTOR indicated above.
`Upon receiptof this form the financial institution will sendit 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.
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`SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
`|, the judgment debtor named above, clalm and certify under the penalty of false statement that the moneyin the above account
`is exempt by law from execution as follows:
`("X”aif 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))
`[_] Health ordisability insurance payments (section 52-352b(e))
`[|] Veteran's benefits (section 52-352b(g))
`[_] An amountin the bank not to exceed $1000 (section 52-352b(r))
`[_] Public Assistance payments (section 52-352b(d})
`[| Otherclaim of exempt funds (Explain basis forclaim of exemption):
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`[| Wages earned by a public assistance recipient under an
`incentive earnings or similar program (section 52-352b(d))
`[| Court-ordered child support payments (section 52-352b(h))
`[_] Alimony and support other than child support* (section §2-352b(n))
`*See Note Regarding Exemption for Alimony and Support on baci/page 2.
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`Amount claimed to be exempt
`if less than the entire amount:
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`Signed
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`Complete mailing address of Judgment Debtor
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`Eesigned
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`Telephonsnumber
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`Signed (Notary Public, Commissioner of Superor Court)
`At (Town)
`Date
`Subscribed and sworn
`to before me on:
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`Page 1 of 2
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`a
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`Instructions
`To Financial Institution
`41, Complete section 2 of this form and (1) send 2 copies
`of this farm and the financial Institution execution form
`to the Judgment debtor and to any secured party thatIs
`party to a control agreement between the financial
`institution and such secured party underarticle 9 of
`tlle 42a pursuantto section 52-367b of the General
`Statutes and (2) mail notice to judgment debtor as
`required by 31CFR212.6 and 212.7.
`2. If this claim of exemption is returned compteted,fill out
`saction 6 of this form and mail, within two business
`days, to the Issuing clerk's office at the address of
`court indicated on the front side. See additional
`instructions on the financial institution execution form.
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`To Clerk
`1, Attach this form to eachfinancial institution execution issued in a civil or
`family matter against a judgment debtor that is a naturalperson.
`2. Deliver the execution along with this form to the judgmentcreditor
`requesting the execution.
`3, If judgment debtor completes and returns this form clairning an
`exemption, enter the appearanceof the judgmentdebtor with address
`set forth on page1.
`4, Set matter down for short calendar hearing.
`5, Complete section 7 below.
`6. Send file-stamped copy of this form to Judgment debtor and judgment
`creditor.
`7. After hearing, send copy of any order entered to the financial institution.
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`Note Regarding Exemption for Alimony and Support
`Allmony and Support, other than child support, are exemptonly to the following extent:
`The amountof alimony and support, other than child support, that may be subjectto levy or other withholding for paymentof ajudgmentis
`the lesser of (1) twenty-five percentof the individual's disposable earnings for that week, or (2) the amount by which the individual's
`disposable earnings for that week exceedforty times the higherof (A) the federal minimum hourly wage under Section G(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 earnings”as that part of the eamings ofan individual remaining
`after the deduction from those earnings of amounts required to be withheld for payment of federal income and employment faxes, normal
`retirement contributions, union dues andinitiation fees, grouplife insurance premiums, health insurance premiums and federaltax levies.
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`Section 5 — Proper Officer Must Complete This Section
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`Nameandtitleofproperofficer a|ofserviceonfinancialinstitution Telephonenumber
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`Section 6 — (To be completed by financial institution upon return of exemption claim form)
`Date claim received
`Date mailed to court
`Nameof financial Institution
`Telephone number
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`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 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 earlier.
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`Signed (Assistant Clerk)
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`Date of hearing
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`Time of hearing
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`| a.m.
`|_| p.m.
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`Courtroom
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`Date signed
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`Order
`The Court/Magistrate, having held a hearing to determine the issues raised by this claim, hereby ordersthat:
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`By the Court (Name of Judge/Family Support Magistrate/Magistrate)
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`Signed (Judge/Family Support Magistrate/Magistrate/Assistant Clerk)
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`[_] Judge
`Date signed
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`[_] Fsm
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`[_| Magistrate
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`ADA NOTICE
`The Judicial Branch of the State of Connecticut compties with the Americans with Disabilities Act (ADA). If you need a reasonable
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`accommodation in accordance with the ADA, contact a court clerk or an ADA contactpersonlisted at wwwjud.ct.gowADA.
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`JD-CV-24A (page 2) Rev. 1-17
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`Page 2 of 2
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