Chapter II


CLAIM FOR EXEMPTION

TO THE SHERIFF OF LAWRENCE COUNTY:
I, the above named defendant, claim exemption of personal earnings, including wages, from attachment for the following reasons (specify amount and basis of claim of exemption): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ I request a prompt court hearing to determine the exemption. Notice of the hearing should be given to me at:
____________________________________________________ ____________________________________________________ Address ____________________________________________________ Telephone Number
I verify that the statements made in this claim for exemption are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities.
_________________ (Date)	________________________________ (Defendant)

THIS CLAIM IS TO BE FILED WITH THE OFFICE OF THE SHERIFF OF LAWRENCE COUNTY:

Lawrence County Government Center 430 Court Street New Castle, PA 16101 (724) 656-2190