Answer To Citation To Discover Assets Proceeding {171-351}

IN 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 If yes, are you self-employed? Yes No Company Name and Address: _____________________________________________ _____________________________________________ _____________________________________________ Work Phone:___________________________________ Job Title: ______________________________________ I earn $ _____________ per ____________________ I do not have a job, but I support myself through: Public Aid $ ______________________ per month Unemployment $ __________________ per month Social Security $ __________________ per month SSI $ ___________________________ per month Pension $ _______________________ per month Other $ _________________________ per month (list source) ___________________________________ _____________________________________________ 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) American LegalNet, Inc. www.FormsWorkFlow.com  An assignment of beneficial interest in the land trust was signed to secure a loan from: _________________________________________________________________________________________________ I own: ___ car(s): (make and model) _____________________________ VIN: ____________________________ Lien holder: ___________________________________________________________________ (make and model) _____________________________ VIN: ____________________________ Lien holder: ___________________________________________________________________ (make and model) _____________________________ VIN: ____________________________ Lien holder: ___________________________________________________________________ Jewelry: (description) _____________________________________________________________________________ _________________________________________________________________________________________________ Stocks/Bonds (name/institution and value) _____________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Income Tax Returns presented for tax years: _____________________________________________________________ Any asset/property not noted above valued over $500.00: ___________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Money people owe debtor: From Whom:_________________________________________ Amount:$ _____________________________________ From Whom:_________________________________________ Amount:$ _____________________________________ From Whom:_________________________________________ Amount:$ _____________________________________ From Whom:_________________________________________ Amount:$ _____________________________________ Debtor's Signature(s) _________________________________ _____________________________________________ _________________________________ _____________________________________________ Print Name Print Name Dated: ________________________ 20 ____ Page 2 of 2 171-351 (Rev. 08/12) American LegalNet, Inc. www.FormsWorkFlow.com