FINANCIAL INSTITUTION EXECUTION
`PROCEEDINGS - JUDGMENT DEBTOR
`WHO IS A NATURAL PERSON,
`TeneEXECUTION
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`’ STATE OF CONNECTICUT
`SUPERIOR GOURT
`www,jud.ci.gov
`(Seepage 2forInstructionsto financtalinstitution
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`il ALTA cM
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`“APFEABA*
`VNi
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`Margaret F. Rattigan
`Murphy, Laudatl, Klel & Rattigan, LLC
`10 Talcott Notch Road, Suite 210°
`Farmington, CT 06032
`L.
`Name(s) and address(es) of Judgment Creditor(s)
`Noemi DiCristofaro
`:
`17 Robin Road, Farmington, CT 06032
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`and ADA Notices)
`C.G.S. §§ 62-356b, 62-367b
`:
`A.
`14-7,
`14-
`Instructions- Clark
`instructions - Judgment Creditor Or Aftorney
`PA 14-7, 140
`4. Check the file to ensure that the Information provided
`4. Type orprintlegibly.
`on the application ts correct,
`.
`2. Complete the application section; prepare original and 2 coples.
`2, Sign original execution,
`3. Complete section 1 of tha Exemption Claim Form, JD-CV-24a and attach to this form.
`3, Retum original to applicant, retain a copy
`for file,
`4, Presentoriginal and 1 copy
`fo clerk ofcourt. Retain a copy.
`Geographic
`Docket number
`Address of court
`EE Judiclal district
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`80 WashingtonStreet, Hartford, CT 06106 area,_| HFH-CV-16-5002962-SHousing session
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`Name and mailing address of Judgment Croditor or Attomey (To be completed by Judgment Creditor)
`—
`7
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`aenpcHeentHnetPeesed
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`tf|Name(s) and address(es) of Judgment Debtor(s)
`&|Kiril Nemirovsky
`15 OaklawnDrive, Barkhamsted, CT 06063
`3. Amount ofjudgment, costs and fees (Add 7 and 2)
`2, Amount ofcosts
`2 Date ofJudgment
`1. AmountofJudgment
`(include, where applicable,
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`
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`<|6-27-2016 praludgmentinterest and|$465.00$2,400.00 $2,565.00
`4, Total amount pald (ifany)
`§.Total amount unpatd (Subiract 4 from 3)
`6. Application fee forfinancial Institution executlon (if not walved by tha coun)
`$1,365.00
`$1,200.00
`$105.00
`9.Total of Items 5, 6, 7 and 8
`7, Application fees paid for prior executions on this Judgment
`8, Other court ordered postiudgment costs and fees
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`$0.00 .|$4,305.00* $0.00 , ot : -
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`Check if-applicable
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`is this kidgment arising out of services rendered at a hospital?|[x] No [] Yes [3<] postjudgmentInterest was ordered by the court
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`if this ts aJudgment arising out of services renderedat a hospital, has a stay of a financial Institution execution been
`[x] No
`Ol Yes
`entered pursuant to an installment payment order?
`>
`ifalstayofa financial Institution execution has been entered, has the Judgment Debtor defaulted on an Installment payment order?
`[Ne
`Yes (Srp):
`Sig Pe Aiudep antChe
`Afon
`Date sigg 3
`Telephone number
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`WMA TO4°¢ I ie 860-674-8296
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`FinancialInstitufibn Exe¢uijon
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`To any properofficef,
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`Whereason said Date of Judgment ite above-named: JucgmentCreditor(s) recavered judgment against the above-named Judgment Debtor(s) before the above-
`named court for the amountofjudgment, costs and fees stated above, as appears of record, whersof execution remains to be done.
`Theseare, therefore, by authority of the state of Connecticut to command you:
`Within seven days from your recelptof this execution, make demand uponthe matn office of any financialInstitution having lts main office within your county, or if such
`main office Is net within your county and such financialinstitution has ons or more branch offices within your county, upon an employee of such a branch office, such
`employee and such branchoffice having been designated by the financialinstitution in accordance with regulations adopted by the commissionerof banking,for
`paymentto you pursuantto section 52-367b(b)of the General Statutes of any nonexempt debt due said Judgment Debtor(s), which sum shail not exceed the total
`unpald judgment, costs and fees as stated above, plus postjudgmentInterest as ordered by the court, if applicable, plus the appllcation fee and other court ordered
`postJudgmentcosts and fees and your own fee, After having made such demand youara directed to serve a true andattested copyofthis execution, together with the
`attachedaffidavit and exemption clalm form, with your doings endorsed thereon,with the financial institution officer upon whom such demand wes made. Sald sum
`shall be received by you and appiled on this execution in accordance with the provisions of section 52-367b ofthe General Statutes. You shall not serve more than one
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`financlal Institution execution perjudgment debtorat a time,Including coples thereof. After service of an execulion on one
`For Court Use Only
`financial institution, you shall not serve the same execution or a copy thereof upon anotherfinancial institution until receiving
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`confirmation from the preceding financialinstitution that the judgment debtor had Insufficient funds at the precading financla!
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`institution avallable for collection to satisfy the execution, provided any such additional service is madenotlater thanforty-five
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`days from the receipt by you of such execution. After service of an execution, you shall not serve the same execution or a
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`copy thereof upon such financialInstitution if an electronic direct deposit from a readily identifiable source described in
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`section 52 -376b(0) of the General Statutes was made to the judgment debtor's accountwithin the look-back period
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`described In section 52 -376b {c) of the General Statues (sixty days or, with regard to federal benefits, such greater period as
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`required by federallaw). If no such deposit was made, you may subsequently serve the same execution or a copy thereof
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`upon suchInstitution, provided the execution has not expired or otherwise become unenforceable.
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`Hereoffail not, and make due return of this writ with your doings thereon, according to law.
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`Signed (Assistant Clerk)
`Date signed
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`2
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`Page 1 of 2
`FINANCIAL INSTITUTION EXECUTION PROCEEDINGS
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`1.
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`NOTE: The provisions of section 52-367b, as amended from timeto time, fake precedence over these instructions.
`instructions To FinancialInstitution Upon Receipt Of A FinancialInstitution Execution
`When Judgment DebtorIs A Natural Person
`\f any funds are removed from: the judgment debtor's account pursuant to subsection (c) of section 52-367b of the General Statutes,
`complete section Ii 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 parly underarticle 9 oftitle 42a of the GeneralStatutes, postage pre-paid, at the last known address of the judgment debtor and
`of any such secured party with respect to the affected accounts on the records of yourinstitution and (2) mail notice to the judgment
`debtor as required by 31CFR212.6 and 212.7,
`‘
`, Removefrom 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 ofthis form plus interest and the Application Fee for FinanclalInstitution Execution and other court
`ordered postjudgmentcosts or fees and the serving officer's fee, before your midnight deadline, as defined in section 42a-4-104 of the
`General Statutes.
`If an electronic direct deposit is readily identifiable as exempt federal veterans' benefits, Social Security benefits,
`including, but not limited to, retirement, survivors’ and disability benefits, supplemental security incomebenefits, exempt benefits paid by
`the federal Railroad Retirement Board or the federal Office of Personnel Management, unemployment compensation benefits exempt
`under section 52-352b of the Connecticut General Statutes, or child support payments processed and raceived 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 requiréd 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 te this
`provision. Nothing herein shall alter the exempt status of funds which are exempt from execution under subsection (a) of sectlon 52-367b
`of the General Statutes or under any other provision of state or federallaw, or the right of a judgment debtorto claim such exemption.
`Nothing herein shail 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 hold the amount removed from the judgment debtor's account pursuant.to this execution for fifteen days from the date you mail
`the copies of this form and the Exemption Clalm Form to the judgment debtor and any secured party. During such fifteen day period you
`must not pay the officer serving this execution.
`if the judgment debtor retums the Exemption Claim Form orother written notice that an exemption is being claimed, and if any secured
`party delivers to you written notice of such secured party'sclaim 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 fo 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 eariler. If no order is received within forty-five days of the date you send a copy of
`the Exemption Claim Form ornotice of exemption or a secured party claim notice to the clerk of the court, you mustreturn the funds to
`the judgmentdebtor'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.
`. lf 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 or {f 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 youfail or refuse to do so, you shall be liable in an action therefor to the
`Judgment creditor(s) namein the execution for the amountof nonexempt monies which you fail or refuse to pay over, excluding funds of
`up to one thousand dollars which you in good faith allowed the judgment debtor to access pursuant to subsection (c) of section 52-367b
`ofthe GeneralStatutes.
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`If you pay exempt monies from the accountof the judgment debtor contrary to these instructions, or the provisions of section 52-367b of
`the GeneralStatutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so pald. If you pay exempt
`monies from the account of the judgment debtorcontrary to these instructions, or the provisions of section 52-367b of the General
`Statutes, you shall be liable in an action therefor to the judgment debtor for any exempt monies so paid and you shall refund or waive
`any charges-of 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 paymentof exempt monies.
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`ADA NOTICE
`The Judiclal Branch of the State of Connecticut complies with the Americans with
`Disabilities Act (ADA), If you need a reasonable accommodation In accordance with the
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`ADA,contact a court clerk or an ADA contactpersonIlsted at www.jud.cf.goWwADA.
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`JD-GV-24 (back/page 2) Rev. 2-15
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`Page 2 of 2
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`EXEMPTION CLAIM FORM
`FINANCIAL INSTITUTION EXECUTION
`C.G.S, 31-68(), 52-924a, 62-350a, §2-352b,62-361a,
`62-367b, 29 U.S.C, 206(a)(1)
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`SEE INSTRUCTIONS ON BACK/PAGE 2
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`STATE OF CONNECTICUT
`SUPERIOR COURT
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`www.jud,cl.gov
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`Name and address of Judgment Debtor orAttorney
`(To be completed byjudgment crealtor or attorney)
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`To:
`
`J
`Kirit Nemirovsky
`15 Oaklawn Drive
`Barkhamsted, CT 06032
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`7
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`For court use only
`MXNPEX
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`Section 1 — (To be completed byjudgment creditor)
`eographica
`Name and address of Court (Number, Sireef, Town and Zip Code)
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`Judicial
`Housing
`Area
`;
`:
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`[J district
`[X} session
`{|
`Number
`80 Washington Street, Hartford, CT 06106
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`Name of Judgment Debtor
`Docket number
`Name of casa
`Kiril Nemirovsky
`HFH-CV-16-5002962-S
`DiCristofaro v. Nemlrovsky
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`Section 2 — (To be completed by financial institution - see Instructions on back/page 2)
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`Name and address of financial institution fo which exemption claim (iany) is to be retumed
`Date of mailing to Judgment Debtor
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`Last 4 Digits of the Account Number(s)
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`Amount removed pursuant to execution
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`Amount and type ofreadily Identifiable exemptfunds not removed
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`|| Additional sheet(s) attached hereto and made a part hereof (if necessary).
`Section 3 — Notice To Judgment Debtor
`As a result of a Judgment entered against you, the attached execution has been issued against funds deposited by you In the
`financial Institution named above. To comply with this execution, the financial institution has removed the amount of money indicated
`abovefrom the account(s) listed above.
`i,
`THE MONEY IN YOUR ACGOUNT(S) MAY BE EXEMPT FROM EXECUTION- The moneyin your account(s) may be protected from =
`execution by state statutes or by other laws 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.!f you wishto claim that the moneyin your account(s) is exempt by law
`from execution, you must fill out and sign before a properofficial the Affidavit of Claim of Exemption below and mail or deliverthis
`exemption claim form to the financialinstitution at the above address, This form must be received by the financialinstitution no later than
`45 days from the DATE OF MAILING TO THE JUDGMENT DEBTORindicated above.
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`Upon recelptof this form the financial institution will send it'to the Superior Court and the court clerk will notify you and the judgment
`creditor of the date on which a hearing will be held by the court to determine the issues raised by your claim.
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`SECTION 4 — AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
`1,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”aff that apply fo the funds containedIn thts account)
`[_] Private pension,trust, retirement, or medical savings
`[_] Social Security benefits (section 62-352b(g))
`account payments (sections 52-321a, 62-352b(m))
`[_] Unemploymentbenefits (section 52-352b(g))
`[_] Health or disability insurance payments (section 52-352b(e))
`[_] Worker's Compensation benefits (section 52-352b(g))
`[_] An amountin the bank notto exceed $1000(section 52-352b(1))
`[] Veteran's benefits (section 52-352b(g))
`[_] Otherclaim of exempt funds (Explain basis forclatm of exemption):
`[_] Public Assistance payments (section 52-352b(d))
`nr
`[| Wages earned bya public assistance recipient under an
`incentive earnings or similar program (section 52-352b(d))
`C1] Court-ordered child support payments (section 52-352b(h))
`[_] Alimony and support other than child-support* (section 62-352b{n))
`*See Note Regarding Exemption for Alimony and Support on back/page2.
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`Amountclaimed to be exempt
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`if less than the entire amount: aleeanettenenpeeanlhe neeeenreeeeeeeoasineneseeeeetseenedenee=eee
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`Signed
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`Complete mailing address of Judgment Debtor
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`Subscribed and swom
`to before me on:
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`Date
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`ersigned :
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`Telephonenumber
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`At (Town)
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`Signed (NotaryPublic, Commissionerof Superior Court)
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`Page 7 of 2
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`Instructions
`To Financial Institution
`4, Complete section 2 of this form and (1) send 2 copies
`of this form andthe financialInstitution execution form
`to the judgmentdebtor and to any secured partythatIs
`party fo a control agreement betweenthefinanclal
`Institution and such secured parly underarticle 9 of
`tItie 42a pursuant to section 52-367hof the General
`Statutes and (2) mail notice to Judgmentdebtor as
`required by 31CFR212.6 and 212.7.
`2. If this claim of exemption Is returned completed,fill out
`section 6 of this form and mail, within two business
`days,to the Issuing clerk's offica at the address of
`court indicated onthe front side, See additional
`instructions on the financial institution execution form.
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`To Clerk
`1, Attach this form to eachfinancialinstitution execution Issuedin a civil or
`family matter against a judgment debtorthatis a natural person.
`2. Deliver the execution along with this form to the judgmentcreditor
`requesting the execution.
`3, Ifjudgment debtor completes and returnsthis form claiming an
`exemption, enter the appearance of the judgmentdebtor with address
`setforth on page 1.
`4. Set matter down for short calendar hearing.
`5, Complete section 7 below.
`6. Send fila-stamped copy ofthis form to judgment debtor and judgment
`creditor,
`|
`7. After hearing, send copy of any orderenteredto the financialinstitution.
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`Note Regarding Exemption for Alimony and Support
`Allmony and Support, other than child support, are exempt only to the following extent:
`The amountof alimony and support, other than child support, that may be subjectto levy or other withholding for paymentofajudgmentis
`the Jesserof (1) twenty-five percentofthe individual's disposable eamings for that week, or (2) the amount by which the individuat's
`disposable earnings for that week exceedforty times the higher of (A) the federal minimum hourly wage under Section 6(a)(1) ofthe 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 effactat the time the earings are payable.
`°
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`Section 52-350a(4) of the Connecticut General Statutes defines “disposable earings"as that part of the earings ofan individual remaining
`after the deduction from those earnings of amounts required to be withheld for paymentof federal income and employmenttaxes, normal
`retirement contributions, union dues andinitiation fees, grouplife insurance premiums, health insurance premiumsand federaltax levies.
`Section 5 — Proper Officer Must Complete This Section
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`Telephonenumber
`. |ofserviceonfinancialInstitution
`Nameandfitleofproperofficer
`en :
`Section 6 — (To be completed byfinancial institution upon return of exemption claim form)
`Date claim received
`Date mailed to court
`Nameof financta! Institution
`Telephone number
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`mere
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`Section 7 — Notice To Judgment Debtor And Judgment Creditor
`The assets In dispute are being hetd for (1) forty-five days from the date the exemption claim form was recelved hy the financial ;
`institution designated on the front of this form or (2) until disposition Is ordered bythe court at a hearing to be held at short
`calendaron the date set forth below, whichever occurs earlier,
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`Courtroom
`| am.
`Time of hearing
`hearing
`Date of
`||p.m.
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`Signed (AssistantClerk)
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`| Datesigned
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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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`i
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`By the Court (Name ofJudga/Family Support Magistrete/Magistrate)
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`Signed (Judge/Family Support Magistrate/Magistrate/Assistant Clark)
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`[_] Judge
`Date signe
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`[| Fsm
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`_] Magistrate
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`ADA NOTICE
`The Judicial Branch of the State of Connecticut complies with the Americans with Disabllitles Act (ADA).If you need a reasonable
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`accommodation in accordance with the ADA, contact a court clerk or an ADA contact personlisted at www.jud.cl.gov/ADA.
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`JD-CV-24A (page 2) Rev. 1-17
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`Page 2 of 2:
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