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AFFIDAVIT OF CURRENT FAMILY STATUS I SSN Being first duly sworn upon oath depose and state 1. The Defense Finance and Accounting Service Cleveland Center has notified me of service of a garnishment that affects my pay. Section 1673. As routine uses of this information the Defense Finance and Accounting Service may provide the affidavit to State courts and appropriate State agencies in support of your claims for exemption based on family status. Such affidavit will be provided to Plaintiff or Plaintiff s counsel pursuant to applicable State law and to the Department of Justice in the event of civil litigation. Disclosure is voluntary however failure to complete the affidavit may result in a loss of exemption based on family status pursuant to 15 U.S.C. 2. I desire to claim an exemption based upon my current family status pursuant to 15 U*S*C. Section 1673 b 2 A and in support of this claim I state that a I am currently providing over half of my spouse s support other than the person with respect to whose support the present documentation was issued. My present spouse s name is Such marriage has not been dissolved or annulled* AND/OR child or children with respect to whose support the present documentation was issued. The names and dates of birth of my children are NAME DATE OF BIRTH IN TESTIMONY THEREOF I have hereunto set my hand this day of 20. Signature Subscribed and sworn to before me Notary Public for the County of State of or an Officer authorized to administer oaths pursuant to the Uniform Code of Military Justice this day of 20. Privacy Act Statement The information sought in the preceding affidavit is authorized by 42 U*S*C. section 659 et. Seq. or 42 U*S*C. section 665 and 15 U*S*C. section 1673 b 2. The information will be used to determine the applicability of exemptions pursuant to 15 U*S*C. 2. I desire to claim an exemption based upon my current family status pursuant to 15 U*S*C. Section 1673 b 2 A and in support of this claim I state that a I am currently providing over half of my spouse s support other than the person with respect to whose support the present documentation was issued. My present spouse s name is Such marriage has not been dissolved or annulled* AND/OR child or children with respect to whose support the present documentation was issued. My present spouse s name is Such marriage has not been dissolved or annulled* AND/OR child or children with respect to whose support the present documentation was issued. The names and dates of birth of my children are NAME DATE OF BIRTH IN TESTIMONY THEREOF I have hereunto set my hand this day of 20. The names and dates of birth of my children are NAME DATE OF BIRTH IN TESTIMONY THEREOF I have hereunto set my hand this day of 20. Signature Subscribed and sworn to before me Notary Public for the County of State of or an Officer authorized to administer oaths pursuant to the Uniform Code of Military Justice this day of 20. Signature Subscribed and sworn to before me Notary Public for the County of State of or an Officer authorized to administer oaths pursuant to the Uniform Code of Military Justice this day of 20. Privacy Act Statement The information sought in the preceding affidavit is authorized by 42 U*S*C. section 659 et..

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