Maine Disclosure Hearing Income Exemption Statement
Maine Disclosure Hearing Income Exemption Statement
Before the hearing: Use this statement to organize income, expenses, and supporting records for the disclosure hearing identified in the court's notice. Maine Judicial Branch form SC-004 says the hearing addresses ability to pay and protected income or property. Attend the hearing and bring every document requested in your notice. Give the court and judgment creditor copies if you submit this statement.
Maine District Court
Court location: [TOWN] Docket number: [NUMBER]
| Party | Role |
|---|---|
| [JUDGMENT CREDITOR] | Judgment creditor |
| v. | |
| [JUDGMENT DEBTOR] | Judgment debtor |
Hearing date: [__/__/____]
Income and ability to pay
I, [JUDGMENT DEBTOR], submit the following facts for the disclosure hearing. I ask the Court to determine whether any installment payment should be ordered under 14 M.R.S. § 3126-A and to consider the statutory exemptions and my dependents' reasonable needs.
- Judgment and payments. The judgment was entered on [DATE] for $[AMOUNT]. Payments or credits already made total $[AMOUNT] on [DATES]. The creditor claims $[AMOUNT] remains. I ☐ agree ☐ dispute the balance because [FACTS AND RECORDS].
- Income. My gross weekly earnings are $[AMOUNT]. Legally required deductions total $[AMOUNT]. My weekly disposable earnings are $[AMOUNT]. Other weekly income is $[AMOUNT] from [SOURCE]. I attach pay statements, benefit notices, or other records for [DATES].
- Potentially exempt sources. I receive ☐ Social Security ☐ unemployment compensation ☐ local public assistance ☐ veterans' benefits ☐ disability, illness, or unemployment benefits ☐ support or maintenance reasonably needed for me or my dependents ☐ pension, retirement, or similar payments ☐ none of these. Amounts and supporting records: [DETAILS]. Section 3126-A(1) defines exempt income for this installment-payment analysis; other exemption sections may also apply to the particular source.
- Only exempt income, if applicable. ☐ All money or earnings I receive or expect to receive come only from sources exempt from attachment and execution. The sources and supporting records are [DETAILS]. I ask the Court to apply § 3126-A(2), which bars an installment order in that circumstance.
- Reasonable requirements. My necessary weekly expenses for me and my dependents total $[AMOUNT]. Schedule A lists the expenses and records. I also pay $[AMOUNT] per week under other judgment orders or wage assignments: [DETAILS]. I ask the Court to consider these matters under § 3126-A(4).
- Requested finding. If an installment order is considered, I ask the Court to apply § 3126-A(3)'s weekly limit, based on the least of the statutory measures, to the correct figures. My calculation and supporting records are [ATTACH OR DESCRIBE]. I request ☐ no installment order ☐ an installment amount of $[AMOUNT] per [PERIOD], because [FACTS].
I declare that the facts and figures in this statement and attached Schedule A are true to the best of my knowledge.
Signature: [SIGNATURE] Date: [__/__/____]
Printed name: [NAME]
Address and phone: [ADDRESS; PHONE]
Schedule A — weekly needs
| Expense for debtor or dependents | Weekly amount | Supporting record |
|---|---|---|
| Housing and utilities | $[AMOUNT] | [RECORD] |
| Food and household needs | $[AMOUNT] | [RECORD] |
| Transportation and work needs | $[AMOUNT] | [RECORD] |
| Medical and dependent care | $[AMOUNT] | [RECORD] |
| Other necessary expense: [DESCRIBE] | $[AMOUNT] | [RECORD] |
| Total | $[AMOUNT] |
Other records attached: [LIST]
Official sources
About this template
- Last updated
- October 27, 2026
- Citations checked
- October 27, 2026
- Jurisdiction
- Maine
- Category
- Litigation & Court Documents
Legal authority
- 14 M.R.S. § 3126-A(1)-(4) (exempt income and installment-payment findings)
These are the filings that drive a lawsuit through the system: complaints, answers, motions, briefs, discovery requests and responses, and post-judgment papers. Each has its own format requirements under federal and state procedural rules, and each has a deadline that cannot be missed without consequences. Clean, procedurally correct filings move a case forward; sloppy ones invite motions to strike, amended responses, and avoidable delays.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 27, 2026.
14 M.R.S. § 3126-A(2) (checked October 27, 2026): "The court may not order a judgment debtor to make installment payments if the judgment debtor is receiving or will receive money or earnings only from a source or sources exempt from attachment and execution"
14 M.R.S. § 3126-A(3) (checked October 27, 2026): "the maximum amount of earnings for any workweek that is subject to an installment order may not exceed the least of"
14 M.R.S. § 3126-A(4) (checked October 27, 2026): "In determining the amount of installment payments, the court may take into consideration: A. The reasonable requirements of the judgment debtor and the judgment debtor's dependents"
Maine Judicial Branch, Notice of Small Claims Disclosure Hearing (SC-004) (checked October 27, 2026): "This hearing is your opportunity to tell the court about your ability to pay the judgment and to determine if you have any protected property or income."
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