_____________ COUNTY, FLORIDA.

_______________________________,

Plaintiff,

vs. CASE NO._______________

______________________________,

Defendant.

_______________________________________/

EXEMPTION OF WAGES FROM GARNISHMENT

COMES NOW the undersigned, a head of household residing in the State of Florida, and hereby declares that he/she is the head of family and does provide more than one-half of the support for a child or other dependent; said declaration being pursuant to Section 222.11, Florida Statutes.

Dated this ________ day of ______________________, 200_.

___________________________________

Signature of Head of Household

SWORN TO AND SUBSCRIBED before me this ______ day of _______________, 200__.

____________________________________

DEPUTY CLERK/NOTARY PUBLIC