Form Sc-506 - Order For Financial Disclosure And Financial Disclosure Statement printable pdf download

STATE OF WISCONSIN, CIRCUIT COURT,

COUNTY

Order for Financial Disclosure

Creditor:

and

-vs-

Financial Disclosure Statement

Debtor:

Case No.

IT IS ORDERED THAT the judgment debtor within 15 days of entry of judgment either

• Pay the judgment in full, or

• Accurately complete the following Financial Disclosure Statement and mail or deliver it to the

judgment creditor or attorney at the following address:

Name:

Address:

• Imprisonment for up to 6 months.

Failure to comply with this order may

• Forfeitures of not more than $2000 per day.

be contempt of court and subject you

• Any other order necessary to ensure your compliance.

to the following penalties:

• Punitive (criminal) sanctions under Wis. Stats. Ch. 785.

BY THE COURT

Judgment Date

Circuit Court Judge/Circuit Court Commissioner

Date

Individuals should complete items 1 - 35 and 37. Corporations should complete items 25 - 33, 36 and 37.

FINANCIAL DISCLOSURE OF ASSETS

1. Your full name

2. Date of Birth

3. Social Security Number

4. Number of

Dependents

Phone No.

5. Your residence address (not P.O. box)

City

State

Zip Code

6. Spouse’s full name

7. Social Security Number

8. Do you have a marital property agreement?

Yes (Attach copy.)

Phone No.

9. Spouse’s residence address (if different)

City

State

Zip Code

10. Your employer’s name and address

11. Gross Wages

12. Paid

weekly

biweekly

monthly

13. Spouse’s employer’s name and address

14. Gross Wages

15. Paid

weekly

biweekly

monthly

You must complete this information (16 – 33 ) for both you and your spouse.

16. Other employers

17. Gross Wages

18. Paid

weekly

biweekly

monthly

19. Pension income (Give name and address of payor.)

20. Amount

21. Paid

weekly

biweekly

monthly

22. Social Security/Disability/SSI (Give name and address of payor.)

23. Amount

24. Paid

weekly

biweekly

monthly

25. Checking, savings, financial accounts (List name and address of institution, type of account and amount.)

26. Automobiles (Give year, make and market value.)

27. Stocks, bonds, life insurance, IRA’s and other financial investments (List name, number of shares and value.)

28. Other Income (Specify)

29. Real estate and other real property interests (List kind of property, location and market value.)

30. Does anyone owe you money?

31. Is anyone holding any assets or property for you?

32. Amount of cash on hand

Yes (Attach details.)

33. Other assets of value (Give details and values.)

Complete both pages and sign page 2.

SC-506, 10/05 Order for Financial Disclosure and Financial Disclosure Statement

Wis. Stats. §§799.26, 812.34 and 812.39

This form shall not be modified. It may be supplemented with additional material.

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Form Sc-506 - Order For Financial Disclosure And Financial Disclosure Statement

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