EFTA00316597.pdf

421- Exernpoon not:cc (p.11and 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; 9. Disability benefits; 2. Social security disability (SSD); 10. Income earned in the last 60 days (90% of 3. Supplemental security income (SSI): which is exempt); 4. Public assistance (welfare); 11. Workers' compensation benefits; 5. Income earned while receiving SSI or public 12. Child support; assistance; 13. Spousal support or maintenance (alimony); 6. Veterans benefits; 14. Railroad retirement; and/or 7. Unemployment insurance; 15. Black lung benefits. 8. Payments from pensions and retirement accounts; 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). 02009 BY Blumberg9(celsior. Inc pVOL ISMER. NYC 10013 triton:mem of judgments. I-09 www blurnbero corn SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK Index No.11/100107 JEFFREY E. EPSTEIN EXEMPTION PlaintiffisyPetitionerftyClaimant(s) CLAIM FORM Against ADAM BLY Defendant(sYRespondengs) Name and address of judgment creditor or attorney Name and address of financial institution To be completed by judgment creditor or attorney. To be completed by judgment creditor or attorney. AddressALAW OFFICE OF BARRY R. FERTEL Address B 270 NORTH AVENUE - SUITE 810 NEW ROCHELLE, NY 10801 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 ❑ Income earned in the last 60 days (90% of O Social security disability (SSD) which is exempt) O Supplemental security income (SSI) 0 Child support O Public assistance O Spousal support or maintenance (alimony) O Wages while receiving SSI or public assistance O Workers' compensation O Veterans benefits 0 Railroad retirement or black lung benefits O Unemployment insurance 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. Date: 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 the banking institution therein named, by delivering a true copy thereof to t. ❑ personally, whom deponent knew to be the of said institution: deponent knew the banking institution so served to be said banking institution. mien by mailing a copy of same, accompanied bye copy in a securely sealed postpaid wrapper properly addressed to By Mat z at WWW (a) by registered mail, return receipt requested. Deponent delivered said wrapper to the Registry Clerk at the WwW 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 O Black Hair O White Hair O14-20 Yrs. O Under 5' O Under 100 Lbs. ❑ Female O Black Skin ❑ Brown Hair O Balding O21-35 Yrs. ❑ 5'0'1-5'3" O 1C0-130 Lbs ❑ Yellow Skin ❑ Blonde Hair O Mustache O36-50 Yrs. ❑ 5'4"-5'8" O 131-160 Lbs. ❑ Brown Skin O Gray Hair O Beard O51-65 Yrs. O 5'9"-6'0" O 161-200 Lbs. O Red Skin O Red Hair 0 tilassec O Over 65 Yrs O Over 6' O Over NI) T in Other identifying features: Sworn to before me on Print name beneath signature. LICENSENO. SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK Index No.U. /100107 Restraining Nnfirr, lixemption 'mire anb lixentption Claim rfeforms JEFFREY E. EPSTEIN LAW OFFICES OF BARRY R. FERTEL Plaint:Ins) Attorneys)for Office and Post Office Address against 270 NORTH AVENUE - SUITE 810 ADAM BLY W REV-1MT T 11Y 10801 Defendant(s) EFTA00316599