Florida Garnishment Defense & Head of Family Intake

Caserta & Spiriti, PLLC

Florida Garnishment Defense Head of Family & Exemption Intake Questionnaire

Confidential

Completion or submission of this questionnaire does not create an attorney-client relationship. Representation begins only after Caserta & Spiriti, PLLC completes its conflict review and both the firm and client sign a written engagement agreement.

Please answer every applicable question and provide copies of all court papers, garnishment notices and supporting documents. Fields marked with * are required before saving the questionnaire.

Garnishment Matters May Be Time-Sensitive

Immediately provide the date you received the Writ of Garnishment, Notice to Defendant, Claim of Exemption form, employer notice, bank notice or any other court document.

Do not delay sending the documents while gathering the remaining financial records. Send the court papers first if necessary.

How to Submit This Questionnaire

Complete all applicable sections below.
Click Save Completed Form as PDF at the bottom of the page.
Choose Save as PDF in your browser’s print window.
Save the completed questionnaire to your computer or mobile device.
Click Email Questionnaire & Documents.
Attach the completed PDF and all court papers and supporting documents before sending.

Send all materials to info@csgfirm.com.

Do not email complete Social Security numbers, passwords, PIN numbers or complete account numbers. Redact all but the last four digits unless the firm specifically requests an unredacted copy through a secure method.

Client & Contact Information

Basic information for conflict review and communication

Full Legal Name *

Other Names, Former Names or Aliases

Email *

Telephone *

Current Residential Address *

County of Residence

How Long at This Address?

Preferred Contact Method

Are There Any Contact Restrictions or Safe Times to Contact You?

Court Case & Judgment Information

Information from the lawsuit, judgment and garnishment papers

Court Case Number

Court and County

Judgment Creditor / Plaintiff *

Creditor’s Attorney or Collection Firm

Garnishee

Approximate Judgment Balance

Date Judgment Was Entered, If Known

Original Creditor, If Different

Knowledge of the Original Lawsuit

Were you served with the original lawsuit?

Yes

Unsure

Did you know a judgment had been entered before the garnishment?

Yes

Briefly Describe What You Know About the Lawsuit and Judgment

Attach Immediately

Complaint, summons, final judgment, Writ of Garnishment, motion for writ, Notice to Defendant, Claim of Exemption form, garnishee answer, notices of hearing, employer notices, bank notices and all correspondence from the creditor or its attorney.

Urgent Dates & Current Garnishment Status

Dates used to evaluate immediate filing and hearing needs

Date Shown on Writ of Garnishment

Date You Received the Notice or Writ *

How Did You Receive It?

Any Hearing Date or Deadline Shown?

Current Status

Have wages already been withheld?

Yes

Has a bank account been frozen or restricted?

Yes

Have any funds already been sent to the creditor?

Yes

Unsure

Describe All Deductions, Frozen Funds and Dates

Type of Garnishment

Identify whether wages, bank funds or other property are involved

What Has Been Garnished or Threatened?

Approximate Amount Withheld or Frozen

Date of First Deduction or Freeze

Describe Any Other Property or Payment Involved

Marital Status & Household Information

Household structure and persons living with the client

Marital Status

Spouse or Partner Name

Total Number of People in Household

Other Adults Living in the Home

Children & Other Dependents

Persons for whom the client provides financial support

Name	Age	Relationship	Lives With You?	Approx. Support You Provide	Remove

If Any Child or Dependent Does Not Live With You Full-Time, Explain the Living Arrangement

Does Any Dependent Have a Disability, Medical Condition or Special Financial Need?

Identify Any Child Support, Alimony or Other Court-Ordered Support You Pay

Household Financial Support

Critical information regarding who actually pays household necessities

Expense	You Pay	Spouse / Other Pays	Monthly Amount	Paid From Which Account?
Rent / Mortgage
Electric / Water / Utilities
Groceries / Household Supplies
Childcare / School
Health Insurance / Medical
Transportation / Auto
Clothing / Personal Necessities
Other Necessary Expenses

Approximate Percentage of Total Household and Dependent Support You Provide

Approximate Total You Pay Each Month for Household and Dependents

Explain Why You Believe You Provide More Than One-Half of the Support for a Child or Other Dependent

Explain How Garnishment Would Affect Housing, Food, Utilities, Childcare, Medical Care or Other Necessities

Employment & Earnings

Client and spouse income information

Your Employer *

Employer Address

Employment Start Date

Gross Pay

Pay Frequency

Net / Take-Home Pay

Net Pay Frequency

Current Garnishment Deduction Per Paycheck

Spouse / Partner Employer

Spouse / Partner Gross and Net Income

Nature of Earnings

Whose income actually pays most household bills?

Mine

Spouse

Both

Written Garnishment Waiver

Information regarding any agreement allowing garnishment of earnings

Did you sign any separate document agreeing that your wages could be garnished?

Yes

Unsure

Describe Any Document You Recall Signing About Wage Garnishment

Attach the Original Contract and All Related Agreements

Include the credit agreement, loan agreement, application, amendments and any separate wage-garnishment waiver or acknowledgment.

Bank Accounts & Deposited Earnings

Tracing wages and identifying exempt or commingled funds

Bank or Financial Institution

Last Four Digits of Affected Account Only

Names on the Account

Amount Frozen

Are your wages directly deposited into this account?

Yes

Does the account contain money from sources other than your wages?

Yes

Identify All Other Sources of Deposits in the Account

Tax Filing & Dependent Claims

Tax information used only as supporting background

Most Recent Filing Status

Who Claims the Dependents?

Tax Year of Return Provided

Explain Any Difference Between the Tax Return and the Actual Household Support Arrangement

Prior Claims, Settlements & Bankruptcy

Other proceedings that may affect the defense strategy

Have you already filed a Claim of Exemption?

Yes

Unsure

Have you attended or been scheduled for a garnishment hearing?

Yes

Have you made a payment arrangement or settlement with this creditor?

Yes

Have you filed bankruptcy in the past eight years or consulted a bankruptcy attorney?

Yes

Provide Dates, Case Numbers and Details

Client Objectives & Additional Information

Desired result and facts the firm should know

What Assistance Are You Requesting?

Stop or Dissolve Wage Garnishment

Release Frozen Bank Funds

Prepare or File Claim of Exemption

Representation at Hearing

Negotiate Settlement or Payment Plan

Review Judgment or Service Issues

Anything Else the Firm Should Know?

Certification

Client confirmation of accuracy and submission instructions

I certify that the information provided in this questionnaire is true, accurate and complete to the best of my knowledge. I understand that the firm may rely on this information when evaluating potential exemptions, deadlines, defenses and representation.

Electronic Signature *

Date *

Important: This questionnaire is an intake and fact-gathering tool. It is not a court filing, does not automatically assert an exemption and does not stop a garnishment by itself.

Email Questionnaire & Documents

Florida Garnishment Defense Head of Family & Exemption Intake Questionnaire

Garnishment Matters May Be Time-Sensitive

How to Submit This Questionnaire

Client & Contact Information

Court Case & Judgment Information

Knowledge of the Original Lawsuit

Urgent Dates & Current Garnishment Status

Current Status

Type of Garnishment

Marital Status & Household Information

Children & Other Dependents

Household Financial Support

Employment & Earnings

Nature of Earnings

Written Garnishment Waiver

Bank Accounts & Deposited Earnings

Other Potential Exemptions

Tax Filing & Dependent Claims

Prior Claims, Settlements & Bankruptcy

Supporting Documents Checklist

Court & Garnishment Documents

Income & Household Support

Dependent Verification

Client Objectives & Additional Information

Certification