Claim for Exemption from Wage Attachment – Pennsylvania

This form, Claim for Exemption from Wage Attachment, is used by defendants to claim an exemption from wage attachment, asserting that their net monthly income is below the poverty guidelines set by the Federal Department of Health and Human Services or that the wage attachment would reduce their income below these guidelines.

This guide will help you correctly complete the Claim for Exemption from Wage Attachment form for the Court of Common Pleas of Lehigh County, Pennsylvania, Civil Division.

1. Court Information

• Court: Ensure you are filing in the Court of Common Pleas of Lehigh County, Civil Division.
• Case Details: Fill in the plaintiff’s name, defendant’s name (your name), and the file number at the top of the form.

2. Filing the Form

• Deadline: You must file this form within 30 days of receiving the Notice of Intent to Attach Wages.

3. Grounds for Exemption

• Option A: Check the box if your net monthly income is below the poverty guidelines as provided by the Federal Department of Health and Human Services.
• Option B: Check the box if the wage attachment would place your net income below the poverty guidelines.

4. Dependents

• Enter the number of dependents you financially support.

5. Net Monthly Income

• Calculation: Your net monthly income is your total monthly wages minus:
  • Any support payments made to the court
  • Federal, state, and local income taxes
  • I.C.A. payments and non-voluntary retirement payments
  • Union dues

• • Health insurance premiums

• Income Entry: Write your net monthly income in the designated space.

6. Certification

• Statement: Read the certification statement confirming that the information you provide is true and correct.
• Penalties: Understand that false statements are subject to penalties under 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

7. Signature and Date

• Sign and date the form at the bottom to certify the accuracy of your statements.

8. Submission

• Delivery: You can either deliver the form in person or mail it to the following address:
  • Lehigh County Clerk of Judicial Records – Civil Division 455 W Hamilton Street Allentown, PA 18101-1614
• Contact Information: If you have any questions, you can call (610) 782-3148.

Final Steps

• Double-check all entries for accuracy.
• Ensure you file the form within the 30-day deadline.

By following this guide, you will ensure that your Claim for Exemption from Wage Attachment form is completed correctly and submitted on time.