MN Stat § 571.912 (2021)
2021 Minnesota Statutes|Chapters 570 - 583 — Postjudgment Remedies; Alternative Dispute Resolution; Bonds|Chapter 571 — Garnishment|Section 571.912 — Form Of Notice, Instructions, And Exemption Notice.

571.912 FORM OF NOTICE, INSTRUCTIONS, AND EXEMPTION NOTICE. Subdivision 1. Form of notice. The notice, instructions, and exemption notice informing a debtor that a garnishment summons has been used to attach funds of the debtor to satisfy a claim must be a separate notice and must be substantially in the following form:     DISTRICT COURT   . JUDICIAL DISTRICT     IMPORTANT NOTICE   YOUR FUNDS HAVE BEEN GARNISHED  The Creditor has frozen money in your account at your financial institution.  Your account balance is $.......   The amount being held is $.......  The amount being held will be frozen for 14 days from the date of this notice.  Some of your money in your account may be protected (the legal word is exempt). You may be able to get it sooner than 14 days if you act quickly and follow the instructions on the next page.  The attached exemption form lists some different sources of money in your account that may be protected. If your money is from one or more of these sources, place a check on the line on the form next to the sources of your money. If it is from one of these sources, the Creditor cannot take it. BUT, you must follow the instructions and return the exemption form and copies of your bank statements from the last 60 days to have the bank unfreeze your money. If you do not follow the instructions or your Creditor gets an order from the court or writ of execution, your financial institution will give the money to your Creditor. If that happens and it is protected, you can still get it back from the Creditor later, but that is not as easy to do as filling in the form now. See next pages for instructions and the exemption form. Subd. 2. Form of instructions. The instructions required must be in a separate form and must be substantially in the following form:  INSTRUCTIONS  Note: The creditor is who you owe the money to. You are the debtor. 1. Fill out both of the attached exemption forms in this packet.  If you check one of the lines, you should also give proof that shows that some or all of the money in your account is from one or more of the protected sources. Creditors may ask for a hearing if they question your exemptions.   To avoid a hearing:   Case numbers should be added to the form.   Copies of documents should be sent with the form.   NOTICE: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS FOR THE PAST 60 DAYS BEFORE THE GARNISHMENT. Keep a copy of your bank statements in case there are questions about your claim. If you do not send to the creditor's attorney (or to the creditor, if no attorney) bank statements with your exemption claim, the financial institution may release your money to the creditor once the creditor gives the financial institution a court order directing it to turn over the funds.  2. Sign the exemption forms. Make one copy to keep for yourself. 3. Mail or deliver the other copies of the form by (insert date).  BOTH COPIES MUST BE MAILED OR DELIVERED THE SAME DAY.  One copy of the form and the copies of your bank statements go to:   DISTRICT COURT   . JUDICIAL DISTRICT     EXEMPTION FORM       HOW MUCH MONEY IS PROTECTED   I claim ALL of the money being frozen by the bank is protected.  I claim SOME of the money is protected. The amount I claim is protected is $.......   WHY THE MONEY IS PROTECTED    My money is protected because I get it from one or more of the following places: (Check all that apply)   Government benefits    Government benefits include, but are not limited to, the following:   MFIP - Minnesota family investment program,     MFIP Diversionary Work Program,     Work participation cash benefit,    GA - general assistance,   EA - emergency assistance,   MA - medical assistance,   EGA - emergency general assistance,   MSA - Minnesota supplemental aid,   MSA-EA - MSA emergency assistance,    Supplemental Nutrition Assistance Program (SNAP),     SSI - Supplemental Security Income,     MinnesotaCare,     Medicare Part B premium payments,     Medicare Part D extra help,     Energy or fuel assistance.     Case Number: .     County: .     Government benefits also include:    Social Security benefits    Unemployment benefits    Workers' compensation    Veterans benefits     If you receive any of these government benefits, include copies of any documents you have that show you receive Social Security, unemployment, workers' compensation, or veterans benefits.    Other assistance based on need    You may have assistance based on need from another source that is not on the list. If you do, check this box, and fill in the source of your money on the line below:  Source: .   Include copies of any documents you have that show the source of this money.        ALL or SOME of your earnings (wages) may also be protected.    All of your earnings (wages) are protected if:   You get government benefits (see list of government benefits)  You currently receive other assistance based on need  You have received government benefits in the last six months  You were in jail or prison in the last six months   If you check one of these lines, your wages are only protected for 60 days after they are deposited in your account so you MUST send the creditor a copy of BANK STATEMENTS that show what was in your account for the 60 days right before the bank froze your money.   Some of your earnings (wages) are protected.    If all of your earnings are not exempt, then some of your earnings are still protected for 20 days after they were deposited in your account. The amount protected is the larger amount of:   75 percent of your wages (after taxes are taken out); or   (insert the sum of the current federal minimum wage) multiplied by 40.    OTHER EXEMPT FUNDS    The money from the following are also completely protected after they are deposited in your account.   An accident, disability, or retirement pension or annuity    Payments to you from a life insurance policy    Earnings of your child who is under 18 years of age    Child support   Money paid to you from a claim for damage or destruction of property Property includes household goods, farm tools or machinery, tools for your job, business equipment, a mobile home, a car, a musical instrument, a pew or burial lot, clothes, furniture, or appliances.   Death benefits paid to you    I give permission to any agency that has given me cash benefits to give information about my benefits to the above-named creditor, or its attorney. The information will ONLY concern whether I get benefits or not, or whether I have gotten them in the past six months. If I was an inmate in the last six months, I give my permission to the correctional institution to tell the above-named creditor that I was an inmate there.  YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR THE PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.  I have mailed or delivered a copy of this form to:   DEBTOR   .   DEBTOR ADDRESS   .   DEBTOR TELEPHONE NUMBER   History:  1990 c 606 art 3 s 24; 1992 c 464 art 1 s 56; 1993 c 156 s 17; 1994 c 488 s 8; 1999 c 107 s 66; 1999 c 159 s 149; 2000 c 343 s 4; 2000 c 405 s 22; 2009 c 31 s 8; 2015 c 21 art 1 s 109; 1Sp2019 c 9 art 1 s 42