Answer To Citation To Discover Assets Proceeding Form - Lake County, Illinois
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2IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
)
)
)
Plaintiff,
)
vs.
)
Case. No.
)
)
)
Defendant.
)
ANSWER TO CITATION TO DISCOVER ASSETS PROCEEDING
In answer to the Citation and supplemental proceedings served upon _________________________________________
he/she answers under oath as follows:
Name: _____________________________________________________
Home Address: ____________________________________________________________________________________
Home Phone: _______________________________________________ DL#: _________________________________
Date of Birth: _________________ I am
Single
Married
Divorced
Widowed
I have _________ dependents. List names and ages. ______________________________________________________
_________________________________________________________________________________________________
Employed?:
Yes
No
I do not have a job, but I support myself through:
If yes, are you self-employed?
Yes
No
Public Aid $ ______________________ per month
Company Name and Address:
Unemployment $ __________________ per month
_____________________________________________
Social Security $ __________________ per month
_____________________________________________
SSI $ ___________________________ per month
_____________________________________________
Pension $ _______________________ per month
Work Phone:___________________________________
Other $ _________________________ per month
Job Title: ______________________________________
(list source) ___________________________________
I earn $ _____________ per
____________________
_____________________________________________
I have no money in bank accounts, savings & loans, credit unions, money market or mutual funds
I have the following accounts:
Checking Account at _____________________________________________ with a balance of $ ________________
Savings Account at ______________________________________________ with a balance of $ ________________
Money Market at ________________________________________________ with a balance of $ ________________
Certificate of Deposit at ___________________________________________ with a balance of $ ________________
Safe Deposit Box at _____________________________________________ containing _______________________
I do not own any real estate.
I own property at ________________________________________________ with ____________________________
I have a beneficial interest in a land trust. The name and address of the trustee are:
_________________________________________________________________________________________________
The beneficial interest is listed in my name and ________________________________________________________
There is a mortgage on my property. The mortgage company’s name and address are:
_________________________________________________________________________________________________
Page 1 of 2
171-351 (Rev. 08/12)
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