APPENDIX VI. NOTICE TO DEBTOR
(Rules 4:59-1(g) and 6:7 -1(b))
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION, SPECIAL CIVIL PART
COUNTY
Re: v. _____________________________________
Docket No. ________________________
To: , designated defendant:
Your asset, automobile (plate number ), or account no. in an amount
not to exceed $ at the ______________________________
has been levied upon at the instruction of to satisfy in
whole or in part the judgment against you in the above matter. Some property may be exempt
from execution by Federal and State law, including but not limited to clothing and a total of
$1,000.00 of cash and personal property, except for goods purchased as part of the transaction
which led to the judgment in this case. In addition, welfare benefits, social security benefits,
S.S.I. benefits, V.A. benefits, unemployment benefits, workers' compensation benefits and child
support you receive are exempt, even if the funds have been deposited in a bank account.
If the levy is against a bank account, the bank has already been notified to place a hold on
your account. However, the funds will not be taken from your account until the court so orders.
You may claim your exemption by notifying the clerk of the court and the person who ordered
this levy of your reasons why your property is exempt. This claim must be in writing and if it is
not mailed within 10 days of service of this notice, your property is subject to further
proceedings for execution. The address of the court is: _____________________________.
The address of the person who ordered this levy is:
.
CERTIFICATION OF SERVICE
I mailed a copy of this notice to the defendant(s), the clerk of the above named court, and the person
who requested the levy on , 20 , the same day this Levy was made. I
certify that the foregoing statements made by me are true. I am aware that if the foregoing statements
made by me are willfully false, I am subject to the punishment.
Date: , 20 _________________________________________
(Signature)
_________________________________________
(Court Officer)
Effective: 09/01/2006, CN: 10812-English
