APPENDIX XI-L.
INFORMATION SUBPOENA AND WRITTEN QUESTIONS
IMPORTANT NOTICE--PLEASE READ CAREFULLY
FAILURE TO COMPLY WITH THIS INFORMATION SUBPOENA MAY
RESULT IN YOUR ARREST AND INCARCERATION
NAME: SUPERIOR COURT OF NEW JERSEY
ADDRESS: LAW DIVISION: SPECIAL CIVIL PART
_______________ COUNTY
TELEPHONE NO.: DOCKET NO.
Attorneys for:
Plaintiff CIVIL ACTION
INFORMATION SUBPOENA
-vs-
Defendant
THE STATE OF NEW JERSEY, to: ______________________________________________
Judgment has been entered against you in the Superior Court of New Jersey, Law Division, Special
Civil Part, _______ County, on _______, 20__, in the amount of $_______ plus costs, of which
$_______ together with interest from _______, 20__, remains due and unpaid.
Attached to this Information Subpoena is a list of questions that court rules require you to answer
within 14 days from the date you receive this subpoena. If you do not answer the attached questions
within the time required, the opposing party may ask the court to conduct a hearing in order to
determine if you should be held in contempt. You will be compelled to appear at the hearing and
explain your reasons for your failure to answer.
If this judgment has resulted from a default, you may have the right to have this default judgment
vacated by making an appropriate motion to the court. Contact an attorney or the clerk of the court
for information on making such a motion. Even if you dispute the judgment you must answer all of
the attached questions.
You must answer each question giving complete answers, attaching additional pages if necessary.
False or misleading answers may subject you to punishment by the court. However, you need not
provide information concerning the income and assets of others living in your household unless you
have a financial interest in the assets or income. Be sure to sign and date your answers and return
them to the address in the upper left hand corner within 14 days.
Dated: _______, 20__
___________________________________ ___________________________________
Attorney for Clerk
QUESTIONS FOR INDIVIDUALS
1. Full name _______________________________________________________________
2. Address ________________________________________________________________
3. Birthdate ________________________________________________________________
4. Social Security # _________________________________________________________
5. Driver's license # and expiration date _________________________________________
_______________________________________________________________________
6. Telephone # _____________________________________________________________
7. Full name and address of your employer _______________________________________
_______________________________________________________________________
(a) Your weekly salary: Gross _______ Net _______
(b) If not presently employed, name and address of last employer. _________________
____________________________________________________________________
8. Is there currently a wage execution on your salary?
Yes ___ No ___
9. List the names, addresses and account numbers of all bank accounts on
which your name appears.
10. If you receive money from any of the following sources, list the amount,
how often, and the name and address of the source:
Type Amount & Frequency Name & Address of Sources
Alimony
Loan Payments
Rental Income
Pensions
Bank Interest
Stock Dividends
Other
11. Do you receive any of the following, which are exempt from levy? Any levy on
disclosed exempt funds may result in monetary penalties including reimbursement of
the debtor’s out-of-pocket expenses.
Social Security benefits Yes Amount per month No
S.S.I. benefits Yes Amount per month No
Welfare benefits Yes Amount per month No
V.A. benefits Yes Amount per month No
Unemployment benefits Yes Amount per month No
Workers’ compensation benefits Yes Amount per month No
Child support payments Yes _ Amount per month No
Attach copies of the three most recent bank statements for each account listed in
Question 9 that contains funds from these sources.
12. Do you own the property where you reside?
Yes ___ No ___ If yes, state the following:
(a) Name of the owner or owners ___________________________________ ____
(b) Date property was purchased ___ ________________________________ ____
(c) Purchase price _______________________________________________ _____
(d) Name and address of mortgage holder ____________________________ __
__________________________________________________________ _______
(e) Balance due on mortgage _____________________________________ ______
13. Do you own any other real estate?
Yes ___ No ___ If yes, state the following for each property:
(a) Address of property _____________________________________________ __
(b) Date property was purchased ___________________________________ ____
(c) Purchase price ________________________________________________ ____
(d) Name and address of all owners ________________________________ ____
__________________________________________________________ _______
(e) Name and address of mortgage holder ___________________________ ____
___________________________________________________________ ______
(f) Balance due on mortgage _______________________________________ ____
____________________________________________________________ _____
(g) Names and address of all tenants and monthly rental paid by each
tenant _____________________________________________________________
__________________________________________________________________
14. Does the present value of your personal property, which includes
automobiles, furniture, appliances, stocks, bonds, and cash on hand,
exceed $1,000?
Yes ___ No ___ If the answer is "yes," you must itemize all
personal property owned by you.
Cash on hand: $___________
Other personal property: (Set forth make, model and serial number. If
financed, give name and address of party to whom payments are made).
If Financed Present
Item Date Purchased Purchase Price Balance Still Due Value
15. Do you own a motor vehicle?
Yes ___ No ___ If yes, state the following for each vehicle owned:
(a) Make, model and year of motor vehicle ____________________________ _
________________________________________________________ _________
(b) If there is a lien on the vehicle, state the name and address of
the lienholder and the amount due to the lienholder _________ ____
_____________________________________________________________ ____
(c) License plate # ____________________________________________ _______
_________________________________________________________ ________
(d) Vehicle identification # _____________________________________ _____
___________________________________________________________ ______
16. Do you own a business?
Yes ___ No ___ If yes, state the following:
(a) Name and address of the business _______________________________ ___
________________________________________________________ _________
(b) Is the business a Corporation _______, sole proprietorship _______
or partnership _______?
(c) The name and address of all stockholders, officers and/or partners
_______________________________________________________ __________
________________________________________________________ _________
(d) The amount of income received by you from the business during the
last twelve months _________________________________________ _____
__________________________________________________________ _______
17. Set forth all other judgments that you are aware of that have been
entered against you and include:
Creditor's Creditor's Amount Name of
Name Attorney Due Court Docket #
I hereby certify that the foregoing statements made by me are true. I am aware that if any
of the foregoing statements made by me are willfully false, I am subject to punishment.
Date: ____________________ ___________________________________
QUESTIONS FOR BUSINESS ENTITY
1. Name of business including all trade names. _________________________ _____
_______________________________________________________________________
2. Addresses of all business locations. _______________________________ ______
_______________________________________________________________________
3. If the judgment-debtor is a corporation, the names and addresses of all
stockholders, officers and directors.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
4. If a partnership, list the names and addresses of all partners.
_______________________________________________________________________
_________________________________________________________________ ____
_______________________________________________________________________
5. If a limited partnership, list the names and addresses of all general
partners.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
6. Set forth in detail the name, address and telephone number of all
businesses in which the principals of the judgment-debtor now have an
interest and set forth the nature of the interest.
_______________________________________________________________________
7. For all bank accounts of the judgment-debtor business entity, list the
name of the bank, the bank's address, the account number and the name in
which the account is held.
_______________________________________________________________________
_______________________________________________________________________
8. Specifically state the present location of all books and records of the
business, including checkbooks. ____________________________________ ____
_______________________________________________________________________
9. State the name and address of the person, persons, or entities who
prepare, maintain and/or control the business records and checkbooks.
________________________________________________________________________
_______________________________________________________________________
10. List all physical assets of the business and their location. If any asset
is subject to a lien, state the name and address of the lienholder and
the amount due on the lien.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
11. Does the business own any real estate? Yes ___ No ___
If yes, state the following for each property:
(a) Name(s) in which property is owned ____________________________ ______
(b) Address of property _______________________________________ __________
(c) Date property was purchased ____________________________________ _____
(d) Purchase price _______________________________________________ _______
(e) Name and address of mortgage holder ___________________________ ______
__________________________________________________________ _________
(f) Balance due on mortgage _____________________________________ ________
(g) The names and addresses of all tenants and monthly rentals paid by
each tenant.
NAME AND ADDRESS OF TENANT MONTHLY RENTAL
12. List all motor vehicles owned by the business, stating the following for
each vehicle:
(a) Make, model and year ____________________________________________ ____
_______________________________________________________________ ____
(b) License plate number _____________________________________________ ___
(c) Vehicle identification number ____________________________________ ___
(d) If there is a lien on the vehicle, the name and address of the
lienholder and the amount due on the lien
___________________________________________________________ ________
____________________________________________________________ _______
13. List all accounts receivable due to the business, stating the name,
address and amount due on each receivable.
NAME AND ADDRESS AMOUNT DUE
14. For any transfer of business assets that has occurred within six months
from the date of this subpoena, specifically identify:
(a) The nature of the asset __________________________________________ ___
___________________________________________________________________
(b) The date of transfer ____________________________________________ __ __
(c) Name and address of the person to whom the asset was transferred ___ _
___________________________________________________________________
(d) The consideration paid for the asset and the form in which it was
paid (check, cash, etc.) ____________________________________ ______
(e) Explain in detail what happened to the consideration paid for the
asset ________________________________________________________ _____
___________________________________________________________________
15. If the business is alleged to be no longer active, set forth:
(a) The date of cessation _________________________________________ ______
(b) All assets as of the date of cessation ___________________________ ___
___________________________________________________________________
(c) The present location of those assets ____________________________ ____
___________________________________________________________________
(d) If the assets were sold or transferred, set forth:
(1) The nature of the assets _________________________________ ______
_____________________________________________________ _________
(2) Date of transfer _________________________________________ ______
(3) Name and address of the person to whom the assets were
transferred _______________________________________________ ___
___________________________________________________________ ___
(4) The consideration paid for the assets and the form in which it
was paid ____________________________________________ _________
______________________________________________________ ________
(5) Explain in detail what happened to the consideration paid for
the assets ______________________________________________ _____
______________________________________________________ _ ______
16. Set forth all other judgments that you are aware of that have been entered
against the business and include the following:
Creditor's Creditor's Amount Due Name of Docket
Name Attorney Court Number
17. For all litigation in which the business is presently involved, state:
(a) Date litigation commenced ______________________________________ ____
(b) Name of party who started the litigation _______________________ _____
_________________________________________________________________
(c) Nature of the action ____________________________________________ ____
__________________________________________________________________
(d) Names of all parties and the names, addresses and telephone numbers
of their attorneys ____________________________________________________
__________________________________________________________________
__________________________________________________________________
(e) Trial date __________________________________________________________
(f) Status of case _______________________________________________________
(g) Name of the court and docket number ___________________________________
__________________________________________________________________
18. State the name, address and position of the person answering these
questions. ____________________________________________________________
____________________________________________________________________
I hereby certify that the foregoing statements made by me are true. I am aware
that if any of the foregoing statements made by me are willfully false, I am
subject to punishment.
Date: ________________________ _________________________________
[Note: Former Appendix XI-K adopted June 29, 1990, effective September 4, 1990;
amended July 14, 1992, effective September 1, 1992; redesignated as Appendix XI-L and
amended July 13, 1994, effective September 1, 1994; amended July 28, 2004 to be effective
September 1, 2004.]
