(a) The notice of attachment of wages required by Rule 3302(b) shall be sub- stantially in the following form: (CAPTION) NOTICE OF INTENT TO ATTACH WAGES, SALARY OR COMMISSIONS Date of service of this Notice: (Date to be inserted by the Sher- iff) A judgment has been entered against you in court for nonpayment of rent for, or damage to, residential property that you rented. The judgment creditor-landlord has begun proceedings to attach 10% of your net wages, salary or commissions for each pay period until the judgment is satisfied. The following exception will prevent your wages from being attached: Poverty Guidelines—Your wages may not be attached if your net income is below the poverty income guidelines as provided annually by the Federal Depart- ment of Health and Human Services or if the amount of the attachment would cause your net income to fall below the poverty income guidelines. A copy of the guidelines is attached to this notice. If this exemption is applicable to you, you must return the claim for exemption of wages which is attached to the prothonotary within 30 days of the date of ser- vice of this notice upon you. The date of service of this notice is set forth above. If you return the form claiming this exemption within 30 days, your wages will not be attached without subsequent court proceedings. There may be other legal grounds for opposing the wage attachment that you may be able to raise by filing a motion with the court. For example, your wages may not be attached if you are an abused person or victim as set forth in Section 8127(f) of the Judicial Code when the attachment is to satisfy a judgment for physical damages to the leased premises. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMA- TION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
(Name) (Address) (Telephone Number)
(b) The claim for exemption from wage attachment shall be substantially in the following form: (CAPTION) CLAIM FOR EXEMPTION FROM WAGE ATTACHMENT Notice This Claim for Exemption must be filed with the Prothonotary of the Court within 30 days of service upon you of the Notice of Intent to Attach Wages. To the Prothonotary: I, the above-named defendant, claim exemption of my wages, salary or com- missions from attachment on the following ground: My net monthly income is below the poverty income guidelines as pro- vided by the Federal Department of Health and Human Services. OR The amount of wages to be attached would place my net income below the poverty income guidelines as provided annually by the Federal Department of Health and Human Services. I have dependents. (Number) My net monthly income is $ . (Net monthly income is your total monthly wages less (1) any support payments made to the court, (2) federal, state and local income taxes, (3) F.I.C.A. payments and nonvoluntary retirement payments. (4) union dues and (5) health insurance premiums.) I certify that the statements made in this Claim for Exemption are true and cor- rect. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date: Defendant This claim shall be delivered or mailed to Office of the Prothonotary Court of Common Pleas Address Telephone Number
(c) The notice of claim of exemption required by Rule 3303(b) shall be sub- stantially in the following form: (CAPTION) NOTICE OF CLAIM OF EXEMPTION OF WAGES FROM ATTACHMENT To the above-named plaintiff: The defendant in the above-captioned matter has filed a claim for exemption from attachment of his or her wages, salary or commissions. A copy of the claim is attached. If you wish to challenge the claim for exemption, you should file with the court a motion setting forth facts which show that the defendant’s net income is not below the Federal Department of Health and Human Services poverty income guidelines or that the attachment will not cause the defendant’s net income to fall below those poverty income guidelines. Date: Prothonotary