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To Clerk: Do not use this form for AS 09.38.020 property. IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ___________________ ) ) ) ) ) ) ) ) ) ) )

Plaintiff(s), vs.

CASE NO. CLAIM OF EXEMPTIONS

Defendant(s). 1.

I do not wish to claim exemptions in the property described below. (You must fill out item 2 below.) I do wish to claim exemptions in the property described below. (You must fill out items 2 and 3 below.)

2.

The following is a complete description of the property and how much it is worth. Description Value

3.

I believe this property is exempt for the following reasons:

Date

Signature of Debtor Debtor's Name (please print) Mailing Address City State Daytime Phone ZIP

I certify that on , a copy of this claim and form CIV-516 were sent to: Debtor Creditor/Atty: Court Bookkeeper Clerk: CIV-515 (3/00)(st.5) CLAIM OF EXEMPTIONS AS 09.38.035-.080