QUESTIONNAIRE FOR JUDGMENT DEBTOR EXAMINATION
1. Name of judgment debtor __________________________________________________
2. Address of judgment debtor _______________________________________________
3. What is your date of birth? ______________________________________________
4. Where were you born? _____________________________________________________
5. What is your Social Security number? _____________________________________
6. What is your Driver's license number? ____________________________________
7. What is your occupation? _________________________________________________
8. Are you employed by someone else? ___ If so, give name, address, and phone
number of your employer: _______________________________________________
________________________________________________________________________
9. Are you in business for yourself? ___ If so, give name, address, and phone
number of your business: _______________________________________________
________________________________________________________________________
10. Are you married? ___ If so, give your spouse's full name (including any
maiden name, if applicable): ___________________________________________
________________________________________________________________________
11. Do you have any children? ___ If so, give name, age and address of each:
________________________________________________________________________
________________________________________________________________________
12. Were you married before your current marriage? _____ If so, give the name
and address of each former spouse, the date of marriage, and the date of
divorce or death: ______________________________________________________
________________________________________________________________________
________________________________________________________________________
13. Do you live in a home? ___ If so, who owns it? ___________________________
14. Do you have any boarders or tenants? ___ If so, give name and address of
each and the amount of rent or other consideration paid each month:
________________________________________________________________________
15. Do you have any other sources of income? ___ If so, please describe them:
________________________________________________________________________
________________________________________________________________________
16. Are your or your spouse or any of your children employed or in business?
___ If so, give the name and address of the empoyment or for each and
the salary or income of each: __________________________________________
________________________________________________________________________
17. Do you or your spounse have a safe deposit box? ___ If so, give the name
and address of the bank or other institution where the safe deposit box
is located:_____________________________________________________________
________________________________________________________________________
18. Do you have the right to access any safe deposit box not listed above? ...
If so, state the name(s) of the owner(s) of the box and the name and
address fo the institution where the box is located: ___________________
________________________________________________________________________
19. How much cash do you have on your person at this time? $__________________
20. Do you or your spouse have any deposit, savings, checking, or other
accounts at any bank, credit union, savings institution, thrift and
loan, or other institution? ___ If so, state the name and address of the
institution(s) where the account(s) is/are held and the amount(s) of the
balance(s):_____________________________________________________________
________________________________________________________________________
________________________________________________________________________
21. Is there any deposit, savings, checking or other account that you have not
described that is subject to your control? ___ Describe: _______________
________________________________________________________________________
22. Do you have power of attorney or any other power to sign checks or other
instruments for the payment of money on any account? ___ Describe:
________________________________________________________________________
23. Do you or your spouse own a boat, automobile or other motor vehicle? ___
If so, for each give the manufacturer and model number, the year of the
vessel or vehicle, the balance due and owing thereon, and the name of
the legal owner: _______________________________________________________
________________________________________________________________________
24. Do you or your spouse have any interest in any real estate, land,
improvements, etc.? ___ Describe: ______________________________________
________________________________________________________________________
________________________________________________________________________
25. Do you or your spouse have any interest in any stocks, bonds or other
securities? ___ Describe: ______________________________________________
26. Do you or your spouse have any interest in any mortgages or trust deeds on
real property? ___ describe: ___________________________________________
________________________________________________________________________
27. Do you or your spouse have any interest in any security agreements or
liens on personal property? ___ Describe: ______________________________
________________________________________________________________________
28. Do you or your spouse have any interest in any promissory notes, drafts,
bills of exchange, commercial paper, or any other instruments? ___
Describe: ______________________________________________________________
29. Do you or your spouse have a judgment against anyone else? ___ Describe:
________________________________________________________________________
30. Do you or your spouse have any interest in any watch, diamond(s), other
jewelry or antiques? ___ Describe: _____________________________________
31. Do you or your spouse have any interest in any stamp or coin collection?
___ Describe: __________________________________________________________
32. Do you or your spouse have any interest in any patents, inventions,
trademarks, tradenames, or copyrights? ___ Describe: ___________________
________________________________________________________________________
33. Do you or your spouse have any interest in any joint ventures,
partnerships, or other business enterprises? ___ Describe: _____________
________________________________________________________________________
34. Do you or your spouse have any interest in any warehouse receipts, bills
of lading, or other documents of title? ___ Describe: __________________
________________________________________________________________________
35. Do you or your spouse have any interest in any musical instruments? ___
Describe: ______________________________________________________________
36. Have you or your spouse pawned any personal property? ___ If so, state the
name of the person or company with whom you pawned the property, the
address of such person or entity, and the amount necessary to to redeem
the personal property from that pawn: __________________________________
________________________________________________________________________
37. Do you or your spouse own any other property not listed above? ___________
If so, furnish complete details: _________________________________________
________________________________________________________________________
________________________________________________________________________
38. Are you or your spouse the beneficiary of any trust? ___ If so, furnish
complete details: ______________________________________________________
________________________________________________________________________
39. Have you or your spouse inherited any money or property? ___ If so,
furnish complete details: ______________________________________________
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