PS–13

8/08

Request to Stop Garnishment
of Bank Account

Case Number: 

In the (circle one): District / Circuit Court of (county): _______________________________________ County, Alabama

Plaintiff’s first and last name
(The person who started this case)

Your first and last name
(You are the Defendant)

v.

q I am the Defendant in this case.
w I declare that the following information is true:
• 
I am an adult and of sound mind.
•  My name is on this bank account

(account number):                                                                                                     

(name of bank):                                                                                                                   
•  My contact information is (street address):                                                                                                                       
(city, state, zip):                                                                                                                      

(phone #):                                                                                                                               

e I ask the Court to stop the garnishment of money from this account, and to order a refund of any money that

has already been garnished, because (check all that apply):

a. 
b. 
c.

All funds in this account are from Social Security benefits or SSI.
All funds in this account are from Veterans Administration benefits.
All funds in this account are from (specify):                                                                    ,which is protected
from garnishment. (Most child support, welfare, TANF, unemployment compensation, workman’s
compensation, and some retirement or disability benefits are protected from garnishment.)
All funds in this account belong to someone else (explain below):
(Other person’s name):                                                                                                                                                 
(Other person’s relationship to you):                                                                                                                           
(Reasons your name is on the account):                                                                                                                    
                                                                                                                                                                                          
r I swear that all of the information I provided above is complete and accurate. I understand that if I lie on

d.

this form, I can be fined and sent to jail.

Sign below in front of a notary:

                                                                                                                                                            Date:                                                                                  

Notary fills out below—
Sworn to and subscribed before me, the undersigned authority,

By (Print name of notary):                                                                                                     

On this date:                                                                                                                              

    /     /

                                                                                                                                                  
   Notary signs here
Date notary’s commission expires

Certificate of Service — (Server fills out below.)

I certify that a true copy of this Request was mailed first
class, postage prepaid to the Plaintiff or his/her lawyer
on (date):                                                       , at this address  state

street address

(Notary’s seal here)

city

zip

Sign here after mailing or delivering:

                                                                  

Date:                                              

Rev. 10/08

 2008 Alabama State Bar