Kansas > Local District Court > 16th Judicial District > Small Claims
Judgment Debtors Statement Of Assets - Kansas
| Judgment Debtors Statement Of Assets Form. This is a Kansas form and can be used in Small Claims 16th Judicial District Local District Court . |
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DISTRICT COURT OF ______________COUNTY, KANSAS Small Claims Procedure ______________________________________________________________ Plaintiff-name and address vs. ______________________________________________________________ Defendant-name and address Case No. _________________ JUDGMENT DEBTORS STATEMENT OF ASSETS TO THE JUDGMENT CREDITOR: If the judgment debtor has not paid you or the Clerk of the Court the amount of the judgment with costs andinterest due within 15 days of the date that the judgment was entered, mail a copy of the judgment and this formto the judgment debtor by first class U.S. mail, postage prepaid. Also obtain a certificate of mailing from thepost office. TO THE JUDGMENT DEBTOR: A judgment has been entered against you and it may be enforced as provided by law at any time. In additionunless you pay the judgment, you must fill out this form and mail it or take it to the creditor within 30 days of thetime you received it. This communication is an attempt to collect a debt and any information obtained will beused for that purpose. EMPLOYMENT INFORMATION r Occupation ________________________________________ r Business or employer name and address ______________________________________________________r Pay schedule _____ daily; _____ weekly; _____every two weeks; _____ twice a month; _____monthly: _____ other (explain)_____________________________________________________________________r Gross pay each pay period $______________ r Take home pay each period $______________ CASH AND BANK ACCOUNT INFORMATION r Cash on hand $_____________ r Cash in banks, savings and loans, credit unions, and other financial institutions either in your own name or jointly (list): Name and address of financial institution: Account Number: Individual or Joint: Balance:_________________________________ ___________________ _________________ $____________<<<<<<<<<********>>>>>>>>>>>>> 2_________________________________ ___________________ _________________ $_____________________________________________ ___________________ _________________ $____________PROPERTY INFORMATION: r List of all automobiles, other vehicles, and boats owned jointly or in your name:Make and Year: Value: Legal Owner: Amount Owed:____________________ _______________ _______________________________ ____________________________________ _______________ _______________________________ ____________________________________ _______________ _______________________________ ________________r Real Estate in your name or jointly: Address of Real Estate Fair Market Value: Amount Owed:_______________________________________________ _____________________ ______________________________________________________________ _____________________ ______________________________________________________________ _____________________ ______________________________________________________________ _____________________ ______________________________________________________________ _____________________ _______________INSTRUCTIONS FOR CORPORATIONS OR PARTNERSHIPS Attach to this form a statement describing the nature, value, and exact location of all assets of the corporation ofthe partners, and a statement showing that the person signing this form is authorized to submit this form onbehalf of the corporation or partnership. I declare under penalty and perjury under the laws of the State of Kansas that the foregoing is true andcorrect. Date: _______________________________ ________________________________________ ________________________________________ Type or Print Name Signature of Judgment Debtor or Authorized Agent of Corporation or Partnership________________________________________ Type or Print Address
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