Minnesota Statutes
Chapter 571 — Garnishment
Section 571.912 — Form Of Notice, Instructions, And Exemption Notice.

Subdivision 1. Form of notice. The notice, instructions, and exemption notice informing a debtor that a garnishment summons has been used to attach funds of the debtor to satisfy a claim must be a separate notice and must be substantially in the following form:
IMPORTANT NOTICE
YOUR FUNDS HAVE BEEN GARNISHED
The Creditor has frozen money in your account at your financial institution.
Your account balance is $.......
The amount being held is $.......
The amount being held will be frozen for 14 days from the date of this notice.
Some of your money in your account may be protected (the legal word is exempt). You may be able to get it sooner than 14 days if you act quickly and follow the instructions on the next page.
The attached exemption form lists some different sources of money in your account that may be protected. If your money is from one or more of these sources, place a check on the line on the form next to the sources of your money. If it is from one of these sources, the Creditor cannot take it.
BUT, you must follow the instructions and return the exemption form and copies of your bank statements from the last 60 days to have the bank unfreeze your money. If you do not follow the instructions or your Creditor gets an order from the court or writ of execution, your financial institution will give the money to your Creditor. If that happens and it is protected, you can still get it back from the Creditor later, but that is not as easy to do as filling in the form now.
See next pages for instructions and the exemption form.
Subd. 2. Form of instructions. The instructions required must be in a separate form and must be substantially in the following form:
INSTRUCTIONS
Note: The creditor is who you owe the money to. You are the debtor.
1. Fill out both of the attached exemption forms in this packet.
If you check one of the lines, you should also give proof that shows that some or all of the money in your account is from one or more of the protected sources. Creditors may ask for a hearing if they question your exemptions.
To avoid a hearing:
Case numbers should be added to the form.
Copies of documents should be sent with the form.
NOTICE: YOU MUST SEND TO THE CREDITOR'S ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) COPIES OF YOUR BANK STATEMENTS FOR THE PAST 60 DAYS BEFORE THE GARNISHMENT. Keep a copy of your bank statements in case there are questions about your claim. If you do not send to the creditor's attorney (or to the creditor, if no attorney) bank statements with your exemption claim, the financial institution may release your money to the creditor once the creditor gives the financial institution a court order directing it to turn over the funds.
2. Sign the exemption forms. Make one copy to keep for yourself.
3. Mail or deliver the other copies of the form by (insert date).
BOTH COPIES MUST BE MAILED OR DELIVERED THE SAME DAY.
One copy of the form and the copies of your bank statements go to:
EXEMPTION FORM
You may have assistance based on need from another source that is not on the list. If you do, check this box, and fill in the source of your money on the line below:
Source: .
Include copies of any documents you have that show the source of this money.
I give permission to any agency that has given me cash benefits to give information about my benefits to the above-named creditor, or its attorney. The information will ONLY concern whether I get benefits or not, or whether I have gotten them in the past six months.
If I was an inmate in the last six months, I give my permission to the correctional institution to tell the above-named creditor that I was an inmate there.
YOU MUST SIGN AND SEND THIS FORM BACK TO THE CREDITOR'S ATTORNEY (OR TO THE CREDITOR, IF NO ATTORNEY) AND THE BANK. REMEMBER TO INCLUDE A COPY OF YOUR BANK STATEMENTS FOR THE PAST 60 DAYS. FILL IN THE BLANKS BELOW AND GO BACK TO THE INSTRUCTIONS TO MAKE SURE YOU DO IT CORRECTLY.
I have mailed or delivered a copy of this form to:
1990 c 606 art 3 s 24; 1992 c 464 art 1 s 56; 1993 c 156 s 17; 1994 c 488 s 8; 1999 c 107 s 66; 1999 c 159 s 149; 2000 c 343 s 4; 2000 c 405 s 22; 2009 c 31 s 8; 2015 c 21 art 1 s 109; 1Sp2019 c 9 art 1 s 42