FINANCIAL INSTITUTION EXECUTION PROCEEDINGS
`JUDGMENT DEBTOR WHOIS A NATURAL PERSON,
`APPLICATIONAND EXECUTION
`C.G.S. §§ 52-358b, 52-367b
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`th
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`lication
`i
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`ine application is comec’
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`STATE OF CONNECTICUT
`SUPERIOR COURT
`www.jud.ct.gov
`(See page 2 for instructions to financial institution and ADA Notice)
`Instructions - Clerk
`Instructions - Judgment Creditor or Attorney
`4.
`Check
`the
`fi
`he
`ink
`ki
`1. Complete this form, an Exemption Claim form, anda FinancialInstitution Execution (form JD-CV-24A).
`- Check
`the file to ensure the information on
`iffiling electronically. combine into ane POF document. Iffiling on paper. prepare original, attach form
`2. Sign original execution.
`JD-CV-24A andfile the original with the clerk. Keep 1 copyfor your records.
`3. Uploadthe originalto the file.
`2. Applications must be accompanied by the statutory fee set in General Statutes § 52-367b.
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`Address of court Judicial District|Docket number
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`54 West Main Street, Meriden, CT 06451
`[_] Housing Session NNI-CV-23-6028845-S
`[Name and mailing address of Judgment Creditor or Attorney
`| (Number, sireet, town, state, zip code) (Tobe compléted.byJudgment Creditor) (Plaintiff
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`r
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`1
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`Margaret Fogerty Rattigan, MLK & R, LLC
`P.O. Box 93
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`Granby,CT06038
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`L
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`I
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`APFEABA
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`EXISSUE
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`Winn A
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`i
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`Name(s) and addressies) of Judgment Creditor(s) (Party to whom moneyis owed) (Number, Street, town, zip code)
`Anierican Builders and Contractors Supply Go., inc. trades asABC Supply Co., Inc.
`130 Frontage Road, West Haven, CT 06516
`Name(s) and address(es) of Judgment Debtor(s) (Party who owes money) (Number, street, town, zip code)
`Dehar Bajrami.
`305 Westledge Drive, Torrington, CT 06790
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`Date of judgment
`4, Amountof judgment
`(include. where applicable,| 2. Amount of costs and fees|3. Total amount of judgment, casts and fees {Add 1 and 2)
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`prejudgmentinterest and
`$ 648.87
`$ 29,457.96
`attommey's fees)
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`6/5/2023
`$ 28,809.09.
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`6. Application fee for financial instilution execution (if not waived by the card)
`4. Total amountpaid (If any}
`5.Total amount.unpaid (Subtract 4 from 3}
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`$ 105.00
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`8. Other court ordered postjudgmentcosts and fees
`7. Application fees paid for prior executions-onthis judgment
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`Application
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`;
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`G.Toial of lems 5,6, 7 and 8
` $ 29,562.96
`Is this judgmentarising out of services rendered at a hospital?.........
`[X} No [| Yes
`; “ fap,heen int
`ostjudgment
`interest was
`If yes above, has a stayof a financial. institution execution been
`ordered by the court
`entered pursuantto an installment payment Order? .....:sessessereeees
`LJ} No
`[] Yes
`if a stay of a financial institution execution has been entered, has the
`JudamentBebtordefaulted on an installmentay order? ........ [] No
`(] Yes (Specify):
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`- pepeawed) PATre/e®same
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`| i.
`ti
`i]
`860-674-8296
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`FinancialInstitution Execftid
`/
`To any proper officer,
`By authority of the State of Connecticut, and pursuant to General Statutes § 52-367b you are ordered as follows: Within 7 days, make demandfor
`paymentto you of any nonexempt debt owed by the JudgmentDebtor(s). Make this demand upon the main office of any financialinstitution having
`its main office within your county.If the main office is not within your county, but a branchoffice of the institution /s within your county, make-
`demand on an employee of such branchoffice as long the employee and the branchoffice have been designated by the financialinstitution in
`accordancewith regulations adopted by the commissioner of banking. Only upon demandofa financialinstitution which does not have any main
`office or branch office in this state, demand may be madebycertified mail, return receipt requested.
`After having made demand youare directed to serve a true andattested copyof this execution, together with the attached affidavit and Exemption
`Claim form, Financial Execution (form JD-CV-24A), with your doings endorsed thereon,upanthefinancialinstitution officer upon whom the demand
`was made. Receive the sum paid by thefinancialinstitution and apply it on this execution in accordancewiththe provisions of General Statutes §
`52-367b.
`.
`,
`Do not serve more than onefinancialinstitution execution per Judgment Debtorat a time, including copies.
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`For Court Use Only
`After service of an execution on one financialinstitution, do not serve the same execution or a copy on another
`financialinstitution until receiving confirmation from the precedingfinancial institution that the Judgment
`udicial District of New Haven at Meride
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`Debtorhad insufficient funds available for collection to satisfy the execution. However, any additional service
`SUPERIOR COURT
`of an execution must not be madelater than 45 days from yourinitial receipt of the execution.
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`FILED
`Also, after service of an execution, do not serve the same execution or a copy onthefinancial institulion if an
`electronic direct deposit fram a readily identifiable source described in General Statules § 52-376b (c) was
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`made to the Judgment Debtors accountwithin the look-back period described in General Statutes § 52-376b
`JUL 19 2023
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`(c) (2 months or, with regard to federal benefits, such greater period as required by federallaw). If no such
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`deposit was made, you may subsequently serve the same execution if the execution has not expired or
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`otherwise become unenforceable.
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`CHIEF CLERK'S OFFICE
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`Hereoffail not, and make duereturn of this writ with your doings thereon, according to law.
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`Date signed
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`7-19-2973
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`Reset Form:
`Page 1 of 2
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`NOTE:The provisions of General Statutes § 52-367b, as amended, take precedence overthese instructions.
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`Instructions to FinancialInstitution Upon Receipt of a Financial Institution Execution When Judgment
`Debtoris a Natural Person
`1. If any funds are removed from the Judgment Debtor's account pursuant to General Statutes §.52-367b(c), complete
`section |! 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 is a party to a control agreement between you.and the secured party under
`article 9 oftitle 42a of the General Statutes. Copies must be sent postage pre-paid, to the last known address in your
`recordsof the recipient; and (2) Issue notice to the account holder, or to a fiduciary who administers the account and
`receives communications on behalf of the account holder, in the time and mannerstated in Federal Regulations
`31 CFR 212.6 and 212.7.
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`2. 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 1 of this form, plus postjudgmentinterest, if ordered by the
`court, and 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 ofelectronic direct deposits that are readily identifiable as
`exemptfederal veterans’ benefits, Social Security benefits, including, butnotlimited 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 under General Statutes § 52-352b
`child support payments processed and received pursuantto Title IV-D of the Social Security Act, and (8) the amount of the
`electronic direct.deposits, not to exceed $1,000, that are readily identifiable 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-thefinancial
`institution, or, with regard to federal benefits, such greater time as required by federallaw. if no. such deposits have been
`made to the Judgment Debtor's account during the look-back period, orif 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 fundsare left in the account as exempt pursuant to General Statutes §
`52-352b(18), the provisions of that section shall not be the basis for a claim of exemption pursuantto this section in
`responseto alévy of execution, However,nothing in this paragraph 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 accessto any fundsleft in the account. You may notify the Judgment
`Creditor that funds have beenleft in the Judgment Debtor's account pursuantto this provision. Also, nothingin this
`paragraph shall alter the exempt status of funds which are exemptfrom 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,
`nothingin this paragraph shall be construed toaffect any other rights or obligations ofthe financial institution with regard to
`the funds in the Judgment Debtor's account.
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`3. Hold the amount removed from the Judgment Debtor's account pursuant to this execution for 15 days from the date you
`mail the copies ofthis form and the Exemption Claim Form, FinancialInstitution Execution form to the Judgment Debtor
`and any secured party. During the 15 day period you must not paythe officer serving this execution.
`4. !f the Judgment Debtor returns the Exemption Claim Form, Financial Institution Execution form or other written notice that
`an exemption is being claimedorif any secured party delivers to you written notice of their claim of a prior perfected
`security interest in the account, you must, within 2 business days of receipt of such notice, send a copy of such notice to
`the clerk of the court that issued the execution. Continue to hold the amount removed from the Judgment Debtor's account
`for 45 days or until you receive a court order regarding disposition of the funds, whichever occursfirst. If no orderis
`received within 45 days of the date you send a copy of the Exemption Claim Form, Financial Institution Execution form or
`notice of exemption or a secured party claim notice to the clerk of the court, return the funds to the Judgment Debtor's
`account.
`5. If you do not receive 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. Ino Exemption Claim Form, Financial Institution Execution form or secured party claim noticeis filed orif the court orders
`youto pay the servingofficer an amount removed from the Judgment Debtor's account not exceeding the amount due on
`the execution and youfail or refuse to da so, you shall beliable in an action to the Judgement Creditor(s) named in the
`execution for the amount of nonexempt monies whichyoufail or refuse to pay, excluding funds of up to $1,000 which you
`in good faith allowed the Judgment Debtor to access pursuant to General Statutes § 52-367b(c).
`7. If you pay exempt monies from the accountof the Judgment Debtorcontrary to these instructions, or the provisions of
`General Statutes § 52-367b, you shall be liable in an action to the Judgment Debtor for any exempt monies paid and you
`shall refund or waive any chargesof fees by you, including, but natlimited 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.
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`| For information on ADA accommodations,
`| contact a court clerk or go to: www.jud.ct.gov/ADA.
`Page 2 of 2
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`JD-CV-24 Rev. 11-21
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`EXEMPTION CLAIM FORM
`FINANCIALINSTITUTION EXECUTION
`JD-CV-24A Rev, 10-21
`C.G.S. §§ 31-58(i), 52-321a, 52-350a, 52-352b, 52-361a,
`52-367b: 29 U.S.C. 206(a){1)
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`SEE INSTRUCTIONS ON BACKIPAGE 2
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`STATE OF CONNECTICUT
`SUPERIOR COURT (?—%
`‘.
`.
`www.jud.ct.gov
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`or
`To:
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`Name and address of Judgment Debtor or Attorney
`(To be completed byjudgmentcreditor or attorney)
`Dehar Bajrami
`a0vestedge Dr
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`L
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`J
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`COURT USE ONLY
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`MXMPEX
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`oo
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`Section 1 - (To be completed by judgmentcreditor)
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`Name and address of Court (Number, Street, Town and Zip Code)
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` Judicial Housing
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`[x] District
`Session
`54 West Main Street, Meriden, CT 06451
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`Nameof case
`Docket number
`Name of Judgment Debtor
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`NNI-CV-23-6028845-S
`Dehar Bajrami
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`American Builders and Contractors Supply
`Co., Inc. v. Bajrami’s Construction, LLC Et Al.
`Section 2 - (To be completed by financial institution - see instructions on back/page 2)
`Name and addressof financial institution to which exemptionclaim (if any) is ta be returned
`| 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 of exemptfunds not removed
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`|_| Additional sheet(s) attached hereto and made a part hereof (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
`financial institution named above. To comply with this execution, the financial institution has removed the amount of moneyindicated
`abovefrom the account(s)listed above.
`THE MONEYIN YOUR ACCOUNT(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.
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`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 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 send il to the Superior Court and the court clerkwill 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 yourclaim.
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`SECTION 4 - AFFIDAVIT OF CLAIM OF EXEMPTION ESTABLISHED BY LAW
`1, the judgment debtor named above, claim and certify under the penalty of false statement that the money in the above accountis
`exempt by law from execution as follows:
`(select ail that apply to the funds containedin this account)
`[| Social Security benefits (section 52-352b(7))
`[-] Private pension,trust, retirement, or medical savings account
`C4 Unemployment benefits (section 52-352b(7))
`payments (sections 52-321a, 52-352b(13))
`[_] Workers Compensation benefits (section 52-352b(7))
`[_] Health or disability insurance payments (section 52-352b(5))
`(_] Veteran's benefits (section 52-352b(7))
`[_] Other claim of exempt funds (Explain basis for claim of exemption):
`C] Public Assistance payments (section 52-352b(4))
`C4 Wagesearned by a public assistance recipient under an
`incentive earnings or similar program (section 52-352b(4))
`C] Court-ordered child support payments (section 52-352b(8))
`C] Alimony and support other than child support* (section 52-352b(14))
`*See Note Regarding Exemption for Alimony and Support on hack/page2.
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`Amount claimed to be exempt
`if less than the entire amount:
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`oo_ | a
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`Complete mailing address of Judgment Debtor
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`|
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`ee—
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` Subscribed and sworn
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`to before me on:
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`Page 1 of 2
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`At
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`(Town)
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`| Signed (Notary Public, Commissioner ofSuperior Court)
`ee
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`PFRESEYEORM2
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`

`instructions
`
`To Financial Institution
`1. Complete section 2 of this form and (1) send 2 copies
`of this form and the financial institution execution form
`to the judgment debtor and to any secured party thatis
`party to a control agreement betweeri the financial
`institution and such securedparty underarticle 9 of
`title 42a pursuant to General Statutes § 52-367b and
`(2) mail notice to judgment debtor asrequired 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
`:
`'
`ne
`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
`4. Attach this form to eachfinancial institution execution issued in a civil or
`family matter against a judgment debtor thatis a natural person.
`2. Deliver the execution along with this formto the judgment creditor
`requesting the execution.
`3. If judgment debtor completes and returns this form claiming an exemption,
`enter the appearanceof the judgment debtor with address set forth on
`page 1.
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`4. Set matter down for hearing.
`5. Complete Section 7 below.
`4d
`Tt
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`;
`:
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`file-
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`6 Sentie stamped copyof this form to judgment debtor and: judgment
`7. After hearing, send copy of any order entered to the financial institution.
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`Note Regarding Exemption for Alimony and Support
`Alimony and Support, other than child support, are exempt only to the following extent:
`The amount of alimony and suppor, other than child support, that may be subjectto levy or other withholding for paymentof a judgmentis
`the lesserof (1) twenty-five percentof the individual's disposable earnings for that week, or (2) the amount by which the individual's.
`disposable earningsfor that week exceedforty times the higherof (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 (8), the state minimum hourly wage under subsection(i) of Section
`31-58, in effect at the time the earnings are payable.
`General Statutes §52-350a(4) defines “disposable earnings" as that part of the earnings ofan individual remaining after the. deduction from
`those eamings ofamounts required:to be withheld for paymentof federal income and employmenttaxes, normalretirement 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
`Name andUtle of proper officer
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`Section 6 - (To be completed byfinancial institution upon return of exemption claim form)
`Date claim raceived
`Date mailed ‘to court
`Nameoffinancialinstitution
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`Dateofservice on financialinstitution
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`Telephone number
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`2
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`Telephone number
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`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 bythe financial instituti6n designated on the front of this form or (2) until disposition is
`ordered by the court at a hearing to be held at on the date set forth below, whichever occursearlier.
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`f
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`Date of hearing
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`Time ofhearing
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`|_| a.m.
`[_| p.m.
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`Courtroom
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`Signed (Assistant Clerk)
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`Date signed
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`Order
`The Court/Magistrate, having held a hearing to determinethe issues raised bythis claim, hereby ordersthat:
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`By Ihe Court (Name of Judge/Family Support Magistrate/‘Magistrate)
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`{_] Judge
`Date signed
`Signed (Judge/Family Support Magistrate/Magistrate/Assistant Clerk)
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`[| Fsm
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`[_] Magistrate
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`|
`— ADA NOTICE
`{
`| The Judicial Branchof the State of Connecticut complies with the Americans with Disabitities Act (ADA). If you need a reasonable
`
`accommodation in accordance with the ADA,contact a court clerk or an ADA contactpersonlisted at www.jud.ct.gov/ADA.
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`Page 2 of 2
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`aResetForm
`JO-CV-24A (page 2) Rev. 10-21
`.uPrint.Form.:
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