Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
_________________________
[DEFENDANT(S)]
Place of Birth: If No, Country of Citizenship: Drivers License: Work Number: Email Address: Position Title: per month per year
Spouse Information Last Name: Maiden Name: Date of Birth: U.S Citizen: SSN: Address: First: / Yes No / Middle: Other Names:
Phone Number: Cell Number: Employed? Y N Employment Name: Employment Address: Income: $ per week
Work Number: Email Address: Position Title: per month per year
Children/Dependents Full Name 1. 2. 3. 4. 5. 6. 7. Address (if different) Relationship $ $ $ $ $ $ $ Support Received Minor?
Type Property Property Property Property Savings Account Checking Account Stocks/Bonds Mutual Funds Insurance Insurance Retirement Plan Retirement Plan Inheritance Inheritance Vehicle Vehicle Vehicle Furniture Furniture Furniture Electronics Electronics Electronics Apparel Apparel Jewelry Jewelry Antiques Household Goods Livestock
Assets Description $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
Value
Monthly Expenses Mortgage Gas Electric Water/Sewer Telephone Cable/Internet Food Clothing Cleaning/Remodeling Car Payment Auto Insurance Gas Bus/Train/Cab Child Support Medical Insurance Tuition Credit Card Loans Other: Other: Is there money that you can borrow? Is there money that you are owed? Were you issued a refund on your tax return? Yes Yes Yes No No No If yes, how much? If yes, how much? If yes, how much? $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
Cost
I hereby declare the aforementioned information to be true, factual and correct according to my knowledge and belief. Printed Name Date Signature
Sworn and Subscribed to Before Me: Public Notary My Commission Expires the day of 20