4-803

[1-065.1, 2-801, 3-801]

STATE OF NEW MEXICO
IN THE _________________ COURT

No. _________

_________________________ COUNTY

__________________________________, Plaintiff

against

__________________________________, Defendant

CLAIM OF EXEMPTIONS ON EXECUTION

A JUDGMENT HAS BEEN ENTERED AGAINST YOU. ALL OF THE PROPERTY YOU POSSESS MAY BE SEIZED AND SOLD TO PAY THIS JUDGMENT. YOU MUST COMPLETE AND RETURN THIS FORM WITHIN TEN (10) DAYS TO CLAIM ANY STATUTORY EXEMPTION FROM THIS SEIZURE AND SALE.

(check only applicable boxes)

Part I.    Homestead exemption
        (This part is for use only in the district court)

[ ]    Judgment debtor owns, leases or is purchasing a dwelling house which judgment debtor occupies and is entitled to hold exempt a homestead in the amount of thirty thousand dollars ($30,000) under Section 42-10-9 NMSA 1978.

Part II.    Exemption in lieu of homestead exemption
        (Parts II and III are for use in the district
        court, magistrate court and metropolitan court)

[ ]    Judgment debtor is a resident of this state who does not claim a homestead exemption, but claims an exemption of real or personal property in the amount of two thousand dollars ($2,000) under Section 42-10-10 NMSA 1978. The property claimed to be exempt is as follows:

         LIST PROPERTY             STATED VALUE

    _________________________________     $_______________

    _________________________________     $_______________
    (Attach additional page if necessary)


Part III.    Personal property exemptions

Unless the judgment debtor files a written waiver of exemption, the sheriff may not seize the judgment debtor's personal clothing, furniture or books.

In addition to the property claimed or listed as exempt above, the judgment debtor hereby claims the following exemptions:

(check only applicable boxes)

[ ]    personal property worth up to $500

         LIST ITEMS             STATED VALUE

    _________________________________     $_______________
    (Attach additional page if necessary)

[ ]    tools of the trade worth up to $1,500.
    Occupation of judgment debtor: _________________

         LIST ITEMS             STATED VALUE

    _________________________________     $_______________
    (Attach additional page if necessary)

[ ]    one motor vehicle worth up to $4,000 or that amount of equity in a more valuable vehicle

     MAKE, MODEL AND YEAR OF VEHICLE        FAIR MARKET VALUE

    _________________________________     $_________________

    Amount of any lien on vehicle: $___________.

[ ]    jewelry worth up to $2,500

         LIST JEWELRY ITEMS                 STATED VALUE
    _________________________________     $_______________
    (Attach additional page if necessary)

[ ]    medical-health equipment being used for the health of the claimant or a member of the household of the claimant and not in a profession; (Attach separate sheet setting forth items claimed and the name of the household member and the medical condition of the member.)

[ ]    pensions or retirement funds;

[ ]    not more than $5,000 in benefits from a benevolent association of which the judgment debtor is a member;

[ ]    building materials not financed by the judgment creditor in this action as provided by Section 48-2-15 NMSA 1978;

[ ]    a partner's interest in specific partnership property subject to the limitations of Section 54-1-25 NMSA 1978;

[ ]    worker's compensation benefits subject to the limitations of Section 52-1-52;

[ ]    occupational health benefits as provided by Section 52-3-37 NMSA 1978;

[ ]    unemployment compensation benefits subject to the limitations of Section 51-1-37 NMSA 1978 for necessities furnished while the debtor was unemployed and child support;

[ ]    public assistance and welfare benefits;

[ ]     cash surrender values and benefits of life insurance contracts;

[ ]    payment from life, accident and health insurance policies or annuity contracts;

[ ]    crime victims' reparation fund payments;

[ ]    fraternal benefit society benefits;

[ ]    the minimum amount of shares necessary for certain cooperative associations subject to the limitations provided by Section 53-4-28 NMSA 1978;

[ ]    the debtor's membership interest in the property of a club or association pursuant to Section 53-10-2 NMSA 1978;

[ ]    oil and gas equipment not financed by the judgment creditor to be used for purposes for which it was purchased as provided by Section 70-4-12 NMSA 1978;

[ ]    allowances to surviving spouse and children from estate of a deceased estate subject to the limitations of Sections 45-2-401 and 45-2-402 NMSA 1978;

     THIS LIST MAY NOT BE COMPLETE. YOU MAY CLAIM ANY OTHER EXEMPTION PERMITTED BY LAW BY COMPLETING THE FOLLOWING:


[ ]    other exemption (specify) __________________________
    ____________________________________________________.

I am aware of my exemption rights:

[ ]    I desire to claim my exemption rights

[ ]    I waive my right to claim my exemption rights to the following property

             LIST ITEMS                 STATED VALUE

    _________________________________     $_______________
    (Attach additional page if necessary)

    I understand that by waiving my statutory right to exempt property, this property may be seized and sold.

YOU MUST RETURN A COMPLETED AND SIGNED COPY OF THIS FORM TO THE CLERK OF THE COURT WHOSE ADDRESS IS SHOWN BELOW. YOU MUST ALSO SERVE A COPY ON THE JUDGMENT CREDITOR.

_________________, 19_____    ______________________________
                        Signature of judgment debtor

Return to clerk of the court

__________________________    _______________________________
Name of court                Printed name of judgment debtor

__________________________    _______________________________
Address                    Street address or P.O. box

__________________________    ________________________________
City, state & zip code        City, state & zip code

                        ________________________________
                        Telephone number

USE NOTE

        The judgment creditor may dispute any of the claimed exemptions. If the judgment creditor disputes claimed exemptions and files a request for hearing on the claimed exemptions, the clerk will schedule a hearing on the claimed exemptions.


[As amended, effective January 1, 1986; July 1, 1992; May 1, 1994; January 1, 1996.]