Motion To Claim Exempt Property Statutory Exemptions {CV-415}

File No.Judgment Abstract No.Date Judgment Filed Name Of Judgment Creditor (Plaintiff)MOTION TO CLAIMEXEMPT PROPERTY(STATUTORY EXEMPTIONS)(Use If Judgment Filed On Or After Jan. 1, 2006)G.S. 1C-1603(c)Name Of Judgment Debtor (Defendant) VERSUS In The General Court Of Justice District Superior Court Division STATE OF NORTH CAROLINA County(Over)NOTE TO JUDGMENT DEBTOR:I, the undersigned, move to set aside the property claimed below as exempt. þ 1. þ I am a citizen and resident of þ . þ 2. þ þ a. þ þ . þ þ b. þ I am not married. þ 3. þ My current address is þ . þ 4. þ The following persons are dependent on me for support:Street Address Of Residence þ 5. þ I wish to claim as exempt (keep from being taken) Name(s) Of Person(s) Dependent On MeAgeRelationship þ I am unmarried and 65 years of age or older and this property was previously owned by me as a tenant by entireties or as a joint tenant with rights of survivorship and the former co-owner of the property is deceased. Estimated Value Of Residence $ American LegalNet, Inc. www.FormsWorkFlow.com (Over)Amount Of Lien(s) And Name(s) And Address(es) Of Lienholder(s):Current Amount OwedValue Of Burial Plots Claimed$$$ þ 6. þ I wish to claim the following personal property, consisting of household furnishings, household goods, wearing apparel, appliances, books, animals, crops or musical instruments, as exempt from the claims of my creditors from me). These items of personal property are held primarily for my personal, family, or household use. þ I understand that I am entitled to personal property worth the sum of $5,000.00. I understand I am also entitled to an additional $1,000.00 for each person dependent upon me for support, but not to exceed $4,000.00 for dependents. I further understand that I am entitled to this amount after deducting from the value of the property the amount of any valid lien or security interest. Property purchased within ninety (90) days of this proceeding may not be exempt. Item Of PropertyFair MarketValue Amount Of Lien Or Security Interest Name(s) Of Lienholder(s) $$$$$$$$$$$ Year $ Item Of Personal Property ClaimedFair Market ValueAmount Of Lien(s)Name(s) Of Lienholder(s)Value Of Debtor222s (Defendant222s) Interest $$$$$$$$$$$$ þ 7. þ I wish to claim my interest in the following motor vehicle as exempt from the claims of my creditors. I understand that I am entitled to my interest in one motor vehicle worth the sum of $3,500.00 after deduction of any valid liens or security interests. I understand that a motor vehicle purchased within ninety (90) days of this proceeding may not be exempt. þ 8. þ þ I wish to claim the following property as exempt because I claimed residential real or personal property as exempt that is worth less than $35,000.00, or I made no claim for a residential exemption under section (5) above. I understand that I am entitled to an exemption of up to $5,000.00 on any property only if I made no claim under section (5) or a claim that was less than $35,000.00 under Section (5). I understand that I am entitled to claim any unused amount that I was permitted to take under section (5) up to a maximum of $5,000.00 in any property. I further understand that the amount of my claim under this section is after the deduction from the value of this property of the amount of any valid lien or security interests and that tangible personal property purchased within ninety (90) days of this proceeding may not be exempt. Value Of Debtor222s (Defendant222s) Interest American LegalNet, Inc. www.FormsWorkFlow.com File No.Judgment Abstract No. Date Judgment FiledName Of Judgment Creditor (Plaintiff)VERSUS(Over) Real Property Claimed þ (I understand that if I wish to claim more than one parcel, I must attach additional pages setting forth the following information for each parcel claimed as exempt.) Street Address$ þ 9. þ I wish to claim the following items of health care aid necessary for myself my dependents. PurposeItem þ 10. þ I wish to claim the following implements, professional books, or tools (not to exceed $2,000.00), of my trade or the trade of my dependent. I understand such property purchased within ninety (90) days of this proceeding may not be exempt. Policy NumberName Of Insurer þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 12. þ I wish to claim as exempt the following compensation that I received or to which I am entitled for the personal injury of myself or a person upon whom I was dependent for support, including compensation from a private disability policy or an annuity, or compensation that I received for the death of a person upon whom I was dependent for support. I understand that this compensation is not exempt from claims for funeral, legal, medical, dental, hospital or health care charges related to the accident or injury that resulted in the payment of the compensation to me. (Add additional sheets if more than one amount of compensation.) Estimated ValueWhat Business Or Trade Used InItem $$$ þ 13. þ I wish to claim my individual retirement accounts, including Roth accounts, and individual retirement annuities (IRAs) that are listed below.Account NumberAccount NumberAccount NumberAccount Number Amount Of Compensation $(Attach additional sheets for more lienholders.)$$ American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 16. þ I wish to claim as exempt any alimony, support, separate maintenance, or child support payments or funds that I have received or that I am entitled to receive. I understand that these payments are exempt only to the extent that they are reasonably necessary for my support or for the support of a person dependent on me for support. þ 17. þ The following is a complete listing of my property which I do NOT claim as exempt. þ 18. þ I certify that the above statements are true. Name Of Retirement PlanIdentifying NumberState/Governmental Unit Person Paying SupportAmount Of SupportLocation Of FundsType Of Support$$$ LocationEstimated ValueItem$$$ Date CERTIFICATE OF SERVICE þ 19. þ A copy of this Motion was served on the judgment creditor (plaintiff) by: delivering a copy to the judgment creditor (plaintiff) personally delivering a copy to , the judgment creditor222s attorney. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ judgment creditor (plaintiff) at the address shown on the notice of rights served on me. depositing a copy of this motion in a þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ address: þ . Date þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Code, not to exceed $25,000.00. I understand that the plan must be for my child and must actually be used for the child222s college expenses. I understand that I may not exempt any funds I placed in this account within the preceding 12 months, except to the þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ contributions. Account NumberValueCollege Saving Plan$$ American LegalNet, Inc. www.FormsWorkFlow.com