Citation And Certification - Illinois Circuit Court Page 3
Download a blank fillable Citation And Certification - Illinois Circuit Court in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Citation And Certification - Illinois Circuit Court with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3CIRCUIT COURT OF ILLINOIS
Sixth Judicial Circuit
Champaign County
INCOME AND ASSET FORM
To Respondent: 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 infomation 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 Respondent, he or she answers as follows:
Name: _____________________________________________ Home Phone Number: ______________________
Home Address: _______________________________________________________________________________
Date of Birth: ______________________ Marital Status: ___________ I have _______ dependents.
Do you have a job? YES NO
Company’s name I work for: _____________________________________________________________________
Company’s address: ___________________________________________________________________________
JOB:
I earn $ _________ per ___________
If self employed, list here your business name and address: _________________________________________________________________
Income from self employment is $ ______________________________________________________________________________ per year
I have the following benifits with my employer: ____________________________________________________________________________
I do not have a job, but I support myself through:
Government Assistance $ _____________ per month
SSI $ ____________________________ per month
Unemployment $ ____________________ per month
Pension $ ________________________ per month
Social Security $_____________________ per month Other $ __________________________ per month
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 __________________________________;
Checking account balance $ ___________________________________
Savings account at ___________________________________;
Savings account balance $ ____________________________________
Money market or certificate of deposit at ___________________
Safe deposit box at __________________________________________
Other accounts (please identify): _______________________________________________________________________________________
I OWN:
A vehicle (state year, model, and VIN): __________________________________________________________________________________
Jewlery (please specify): _______________________________
Other property described as: ___________________________________
Stocks/Bonds: _______________________________________
Personal computer: __________________________________________
DVD player: _________________________________________
Television: _________________________________________________
Stove: ______________________________________________
Microwave: ________________________________________________
Work tools: __________________________________________
Business equipment: _________________________________________
Farm equipment: ___________________________________________________________________________________________________
Other property (please specify): ________________________________________________________________________________________
The undersigned certifies, under penalties provided by law pursuant to 735 ILCS 5/1/109, that the information contained herein is true and
correct.
___________________________
Signature: ___________________________________________________ Date:
page 3 of 3 - Citation and Certification
Clerk of the Sixth Judicial Circuit Court
101 E. Main Street
Urbana, Illinois 61801
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal