Income And Asset Form | Pdf Fpdf Doc Docx | Illinois

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Income And Asset Form | Pdf Fpdf Doc Docx | Illinois

Income And Asset Form

This is a Illinois form that can be used for Civil within Local County, Madison.

Alternate TextLast updated: 6/18/2013

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CIRCUIT COURT THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS ________________________________, Judgment Creditor vs. ________________________________, Judgment Debtor INCOME AND ASSET FORM TO JUDGMENT DEBTOR: Please complete this form and bring it with you to the hearing referenced in the enclosed citation notice. You should also bring to the hearing any documents you have to support the information you provide in this form, such as pay stubs and account statements. The information you provide will help the court determine whether you have any property or income that can be used to satisfy the judgment entered against you in this matter. The information you provide must be accurate to the best of your knowledge. If you fail to appear at this hearing, you could be held in contempt of court and possibly arrested. In answer to the citation and supplemental proceedings served upon the judgment debtor, he or she answers as follows: Name: _____________________________________________________________________________________________ Home Phone Number: ________________________________________________________________________________ Home Address: ______________________________________________________________________________________ Date of Birth: _______________________________ Marital Status: ___________________________________________ I have ______________ dependents. JOB: Do you have a job: Yes No If yes, Company's name: _______________________________________________________________________ Company's address: ___________________________________________________________________________ I earn $ _____________________ per ____________________________ If self employed, list here your business name and address: ____________________________________________ Case # _______________ Income from self employment is $ _______________________________ per year. I have the following benefits with my employer. _____________________________________________________ I do not have a job, but I support myself through: Government Assistance $ ___________________________________ Unemployment $ _________________________________________ Social Security $ __________________________________________ SSI $ ___________________________________________________ Pension $ _______________________________________________ Other $ _________________________________________________ per month per month per month per month per month per month American LegalNet, Inc. www.FormsWorkFlow.com REAL ESTATE: Do you own any real estate: Yes No I own real estate at __________________________________________________________________ with names of other owners: __________________________________________________________ Additional real estate I own: __________________________________________________________ I have a beneficial interest in a land trust. The names and address of the trustee is: _______________ The beneficial interest is listed in my name and___________________________________________ There is a mortgage on my real estate. State the mortgage company's name and address for each parcel of real estate owned: ______________________________________________________ An assignment of beneficial interest in the land trust was signed to secure a loan from ____________ I have the following accounts: Checking Account at: ________________________________________________________________ Account balance: _________________________________________________________________ Savings Account at: _________________________________________________________________ Account balance: _________________________________________________________________ Money Market Account at: ____________________________________________________________ Account balance: _________________________________________________________________ Certificate of Deposit at:______________________________________________________________ Account balance: _________________________________________________________________ Safe Deposit Box at: _________________________________________________________________ Other accounts (please identify): _______________________________________________________ I own: A vehicle (state year, make, model & VIN):_____________________________________________________ Jewelry (please specify) ____________________________________________________________________ Other property described as: _________________________________________________________________ Stocks/Bonds: ____________________________________________________________________________ Personal computer: ________________________________________________________________________ DVD player: _____________________________________________________________________________ Television: _______________________________________________________________________________ Stove: __________________________________________________________________________________ Microwave: ______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Work tools: Business equipment: ______________________________________________________________________ Farm equipment: Other property (please specify): ______________________________________________________________ Dated this ________day of ___________________ , 20 Debtor's Signature Any action properly initiated under this Section may proceed notwithstanding an absent or incomplete Income and Asset Form, and a judgment debtor may be examined for the purpose of allowing the judgment creditor to discover income and assets belonging to the judgment debtor or in which the judgment debtor has an interest. 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