Case File
efta-efta00316597DOJ Data Set 9Other421- Exernpoon not:cc (p.11 and claim form (p.2), CPUt5222-8(b).
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DOJ Data Set 9
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efta-efta00316597
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3
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421- Exernpoon not:cc (p.11 and claim form (p.2), CPUt5222-8(b).
02009 wr B9111901917021901, Inc., PURSER. NYC 10013
color( oneni of odscoentr. I-09
www.blunberg.can
EXEMPTION NOTICE
as required by New York Law
Your bank account is restrained or "frozen."
The attached Restraining Notice or Notice of Levy by Execution has been issued against your bank
account. You are receiving this notice because a creditor has obtained a money judgment against you,
and one or more of your bank accounts has been restrained to pay the judgment. A money judgment is a
court's decision that you owe money to a creditor. You should be aware that FUTURE DEPOSITS into
your account(s) might also be restrained if you do not respond to this notice.
You may be able to "vacate" (remove) the judgment. If the judgment is vacated, your bank account
will be released. Consult an attorney (including free legal services) or visit the Court Clerk for more
information about how to do this.
Under state and federal law, certain types of funds cannot be taken from your bank account to pay a
judgment. Such money is said to be "exempt:'
Does your bank account contain any of the following types of funds?
1. Social security;
2. Social security disability (SSD);
3. Supplemental security income (SSI):
4. Public assistance (welfare);
5. Income earned while receiving SSI or public
assistance;
6. Veterans benefits;
7. Unemployment insurance;
8. Payments from pensions and retirement accounts;
9. Disability benefits;
10. Income earned in the last 60 days (90% of
which is exempt);
11. Workers' compensation benefits;
12. Child support;
13. Spousal support or maintenance (alimony);
14. Railroad retirement; and/or
15. Black lung benefits.
If YES, you can claim that your money is exempt and cannot be taken. To make the claim, you must
(a) complete the EXEMPTION CLAIM FORM attached;
(b) deliver or mail the form to the bank with the restrained or "frozen" account; and
(c) deliver or mail the form to the creditor or its attorney at the address listed on the form.
You must send the forms within 20 DAYS of the postmarked date on the envelope holding this notice.
You may be able to get your account released faster if you send to the creditor or its attorney written
proof that your money is exempt. Proof can include an award letter from the government, an annual
statement from your pension, pay stubs, copies of checks, bank records showing the last two months of
account activity, or other papers showing that the money in your bank account is exempt. If you send the
creditor's attorney proof that the money in your account is exempt, the attorney must release that money
within seven days. You do not need an attorney to make an exemption claim using the form"
EFTA00316597
° 421- P 2 Exempoon claim form. CPLR 5222-.O).
triton:mem of judgments. I-09
02009 BY Blumberg9(celsior. Inc pVOL ISMER. NYC 10013
www blurnbero corn
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
JEFFREY
ADAM BLY
E. EPSTEIN
Against
PlaintiffisyPetitionerftyClaimant(s)
Defendant(sYRespondengs)
Name and address of judgment creditor or attorney
To be completed by judgment creditor or attorney.
AddressALAW OFFICE OF BARRY R. FERTEL
270 NORTH AVENUE - SUITE 810
NEW ROCHELLE, NY 10801
Index No.11/100107
EXEMPTION
CLAIM FORM
Name and address of financial institution
To be completed by judgment creditor or attorney.
Address B
Directions: To claim that some or all of the funds in your account are exempt, complete both copies
of this form, and make one copy for yourself. Mail or deliver one form to Address A and one form to
Address B within twenty days of the date on the envelope holding this notice.
**If you have any documents, such as an award letter, an annual statement from your pension, paystubs,
copies of checks or bank records showing the last two months of account activity, include copies of
the documents with this form. Your account may be released more quickly.
I state that my account contains the following type(s) of funds (check all that apply):
O Social security
O Social security disability (SSD)
O Supplemental security income (SSI)
O Public assistance
O Wages while receiving SSI or public assistance
O Veterans benefits
O Unemployment insurance
K Income earned in the last 60 days (90% of
which is exempt)
0 Child support
O Spousal support or maintenance (alimony)
O Workers' compensation
0 Railroad retirement or black lung benefits
0 Other (describe exemption):
0 Payments from pensions and retirement accounts
I request that any correspondence to me regarding my claim be sent to the following address:
Fill in your complete address.
I certify under penalty of perjury that the statement above is true to the best of my knowledge and belief.
Signature of Judgment Debtor
EFTA00316598
STATE OF NEW YORK, COUNTY OF
SS:
being duly sworn, says: that the deponent is not a party
herein, is over 18 years of age and resides at
That on
at No.
deponent served the within restraining notice, exemption notice and two exemption claim forms on
wmamm
t. K
mien
By
Mat
z
WWW
WwW
the banking institution therein named, by delivering a true copy thereof to
personally, whom deponent knew to be the
of said institution: deponent knew the banking institution so served to be said banking institution.
by mailing a copy of same, accompanied bye copy in a securely sealed postpaid wrapper properly addressed to
at
(a) by registered mail, return receipt requested. Deponent delivered said wrapper to the Registry Clerk at the
post office and paid the requisite fee. Return Receipt No.
is attached hereto.
(b) by certified mail, return receipt requested. Deponent deposited said wrapper with the requisite postage
and return receipt card affixed, in—a post office—official depository under the care and custody of the United
States Postal Service within the State of New York. Return Receipt No.
is attached hereto.
Deponent describes the individual served as follows:
O Male
O White Skin
K Female O Black Skin
K Yellow Skin
K Brown Skin
O Red Skin
Other identifying features:
Sworn to before me on
O Black Hair
O White Hair O14-20 Yrs.
K Brown Hair
K Blonde Hair
O Gray Hair
O Red Hair
O Balding
O Mustache
O Beard
0 tilassec
O21-35 Yrs.
O36-50 Yrs.
O51-65 Yrs.
O Over 65 Yrs
Print name beneath signature.
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
O Under 5' O Under 100 Lbs.
K 5'0'1-5'3" O 1C0-130 Lbs
K 5'4"-5'8" O 131-160 Lbs.
O 5'9"-6'0" O 161-200 Lbs.
O Over 6'
O Over NI) T in
LICENSE NO.
Index No.U. /100107
Restraining Nnfirr, lixemption 'mire anb lixentption Claim rfeforms
JEFFREY E. EPSTEIN
against
ADAM BLY
Plaint: Ins)
Defendant(s)
LAW OFFICES OF
BARRY R. FERTEL
Attorneys) for
Office and Post Office Address
270 NORTH AVENUE - SUITE 810
W REV-1MT T
11Y 10801
EFTA00316599
Technical Artifacts (2)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Phone
17021901SWIFT/BIC
DEPOSITSRelated Documents (6)
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