Cal. Fin. Code § 1411
(a) For the purposes of this section:
(c) Not later than the day following the exercise of any setoff with respect to a deposit account for any debt claimed to be owed to the bank by a customer, the bank shall deliver to each customer personally or send by first-class mail postage prepaid to the address of each customer as shown on the records of the bank a written notice in at least 10-point type containing the following:
(5) A response form in at least 10-point type containing substantially the following:
| “The debt described in the Notice of Setoff received from the bank is ____ is not ____ my debt or the debt of another person in whose name the account is maintained. “I claim that the debt: | ||
| has been paid. | ||
| is not now owing. | ||
| is not subject to setoff because the money in the account is: | ||
| Paid earnings (CCP 704.070) | ||
| Proceeds from execution sale of or insurance for loss of a motor vehicle (CCP 704.010) | ||
| Proceeds from execution sale of household furnishings or other personal effects (CCP 704.020) | ||
| Relocation benefits (CCP 704.180) | ||
| Life insurance proceeds (CCP 704.100) | ||
| Disability and health insurance benefits (CCP 704.130) | ||
| Workers’ compensation benefits (CCP 704.160) | ||
| Unemployment or strike benefits (CCP 704.120) | ||
| Retirement benefits including, but not limited to, social security benefits (CCP 704.080, 704.110, 704.115) | ||
| Public assistance benefits including welfare payments and supplemental security income (SSI) or charitable aid (CCP 704.170) | ||
| Proceeds from sale of or insurance for damage or destruction of a dwelling (CCP 704.720, CCP 704.960) | ||
| Proceeds from execution sale of or insurance for loss of tools of a trade (CCP 704.060) | ||
| Award of damages for personal injury (CCP 704.140) or wrongful death (CCP 704.150) | ||
| Financial aid paid by an institution of higher education to a student for expenses while attending school (CCP 704.190) | ||
“I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. |
| Date: | Signed: ” |
| (Customer) |