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.]
Thursday, August 27, 2009
APPENDIX XI-L. INFORMATION SUBPOENA AND WRITTEN QUESTIONS
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.]
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.]
4:86-9. Guardians for Mentally Incapacitated Persons Under Uniform Veterans Guardianship Law
(a) Complaint for Appointment. An action for the appointment of a guardian under N.J.S.A. 3B:13-1 et seq. for a ward alleged to be a mentally incapacitated person shall be brought in the Superior Court by any person entitled to priority of appointment. If there is no person so entitled or if the person so entitled fails or refuses to commence the action within 30 days after the mailing of notice by a federal agency to the last known address of such person entitled to priority of appointment, indicating the necessity for the appointment, the action may be brought by any person residing in this State, acting on the ward's behalf.
(b) Complaint. The complaint shall state (1) the name, age and place of residence of the ward; (2) the name and place of residence of the nearest relative, if known; (3) the name and address of the person or institution, if any, having custody of the ward; (4) that such ward is entitled to receive money payable by or through a federal agency; (5) the amount of money due and the amount of probable future payments; and (6) that the ward has been rated a mentally incapacitated person on examination by a federal agency in accordance with the laws regulating the same.
(c) Proof of Necessity for Guardian of Mentally Incapacitated Person. A certificate by the chief officer, or his or her representative, stating the fact that the ward has been rated a mentally incapacitated person by a federal agency on examination in accordance with the laws and regulations governing such agency and that appointment is a condition precedent to the payment of money due the ward by such agency shall be prima facie evidence of the necessity for making an appointment under this rule.
(d) Determination of Mental Incapacity. Mental incapacity may be determined on the certificates, without other evidence, of two medical officers of the military service or of a federal agency, certifying that by reason of mental incapacity the ward is incapable of managing his or her property, or certifying to such other facts as shall satisfy the court as to such mental incapacity.
(e) Appointment of Guardian; Bond. Upon proof of notice duly given and a determination of mental incapacity, the court may appoint a proper person to be the guardian and fix the amount of the bond. The bond shall be in an amount not less than that which will be due or become payable to the ward in the ensuing year. The court may from time to time require additional security. Before letters of guardianship shall issue, the guardian shall accept the appointment in accordance with R. 4:96-1.
(f) Termination of Guardianship When Ward Regains Mental Capacity. If the court has appointed a guardian for the estate of a ward, it may subsequently, on due notice, declare the ward to have regained mental capacity on proof of a finding and determination to that effect by the medical authorities of the military service or federal agency or based on such other facts as shall satisfy the court as to the mental capacity of the ward. The court may thereupon discharge the guardian without further proceedings subject to the settlement of his or her account.
(g) Complaint in Action to Have Guardian Receive Additional Personalty. The complaint in an action to authorize the guardian, pursuant to law, to receive personal property from any source other than the United States Government shall set forth the amount of such property and the name and address of the person or institution having actual custody of the ward.
(h) Definitions. Definitions contained in N.J.S.A. 3B:13-2 shall apply to the terms of this rule.
(b) Complaint. The complaint shall state (1) the name, age and place of residence of the ward; (2) the name and place of residence of the nearest relative, if known; (3) the name and address of the person or institution, if any, having custody of the ward; (4) that such ward is entitled to receive money payable by or through a federal agency; (5) the amount of money due and the amount of probable future payments; and (6) that the ward has been rated a mentally incapacitated person on examination by a federal agency in accordance with the laws regulating the same.
(c) Proof of Necessity for Guardian of Mentally Incapacitated Person. A certificate by the chief officer, or his or her representative, stating the fact that the ward has been rated a mentally incapacitated person by a federal agency on examination in accordance with the laws and regulations governing such agency and that appointment is a condition precedent to the payment of money due the ward by such agency shall be prima facie evidence of the necessity for making an appointment under this rule.
(d) Determination of Mental Incapacity. Mental incapacity may be determined on the certificates, without other evidence, of two medical officers of the military service or of a federal agency, certifying that by reason of mental incapacity the ward is incapable of managing his or her property, or certifying to such other facts as shall satisfy the court as to such mental incapacity.
(e) Appointment of Guardian; Bond. Upon proof of notice duly given and a determination of mental incapacity, the court may appoint a proper person to be the guardian and fix the amount of the bond. The bond shall be in an amount not less than that which will be due or become payable to the ward in the ensuing year. The court may from time to time require additional security. Before letters of guardianship shall issue, the guardian shall accept the appointment in accordance with R. 4:96-1.
(f) Termination of Guardianship When Ward Regains Mental Capacity. If the court has appointed a guardian for the estate of a ward, it may subsequently, on due notice, declare the ward to have regained mental capacity on proof of a finding and determination to that effect by the medical authorities of the military service or federal agency or based on such other facts as shall satisfy the court as to the mental capacity of the ward. The court may thereupon discharge the guardian without further proceedings subject to the settlement of his or her account.
(g) Complaint in Action to Have Guardian Receive Additional Personalty. The complaint in an action to authorize the guardian, pursuant to law, to receive personal property from any source other than the United States Government shall set forth the amount of such property and the name and address of the person or institution having actual custody of the ward.
(h) Definitions. Definitions contained in N.J.S.A. 3B:13-2 shall apply to the terms of this rule.
4:86-8. Appointment of Guardian for Nonresident Mentally Incapacitated Person
An action for the appointment of a guardian for a nonresident who has been or shall be found to be an incapacitated person under the laws of the state or jurisdiction in which the incapacitated person resides shall be brought in the Superior Court pursuant to R. 4:67. The plaintiff shall exhibit and file with the court an exemplified copy of the proceedings or other evidence establishing the finding. If the plaintiff is the duly appointed guardian, trustee or committee of the incapacitated person in the state or jurisdiction in which the finding was made, and applies to be appointed guardian in this State, the court may forthwith appoint that person without issuing an order to show cause.
4:86-7. Regaining Mental Capacity
On the commencement of a separate summary action by the incapacitated person or an interested person on his or her behalf, supported by affidavit and setting forth facts evidencing that the previously incapacitated person no longer is incapacitated or has returned to partial capacity, the court shall, on notice to the persons who would be set forth in a complaint filed pursuant to Rule 4:86-1, set a date for hearing, take oral testimony in open court with or without a jury, and may render judgment that the person no longer is fully or partially incapacitated, that his or her guardianship be modified or discharged subject to the duty to account, and that his or her person and estate be restored to his or her control, or render judgment that the guardianship be modified but not terminated.
4:86-6. Hearing; Judgment
(a) Trial. Unless a trial by jury is demanded by or on behalf of the alleged incapacitated person, or is ordered by the court, the court without a jury shall, after taking testimony in open court, determine the issue of incapacity. If there is no jury, the court, with the consent of counsel for the alleged incapacitated person, may take the testimony of a person who has filed an affidavit pursuant to R. 4:86-2(b) by telephone or may dispense with oral testimony and rely on the affidavits submitted. Telephone testimony shall be recorded verbatim.
(b) Motion for New Trial. A motion for a new trial shall be served not later than 30 days after the entry of the judgment.
(c) Appointment of General or Limited Guardian. If a guardian of the person or of the estate or of both the person and the estate is to be appointed, the court shall appoint and letters shall be granted to the incapacitated person's spouse, if the spouse was living with the incapacitated person as husband or wife at the time the incapacity arose, or to the incapacitated person's next of kin, or the Office of the Public Guardian for Elderly Adults for adults within the statutory mandate of that office, or if none of them will accept the appointment or if the court is satisfied that no appointment from among them will be in the best interests of the incapacitated person or estate, then the court shall appoint and letters shall be granted to such other person who will accept appointment as the court determines is in the best interests of the incapacitated person including registered professional guardians or surrogate decision-makers chosen by the incapacitated person before incapacity by way of a durable power of attorney, health care proxy, or advanced directive.
(d) Duties of Guardian. Before letters of guardianship shall issue, the guardian shall accept the appointment in accordance with R. 4:96-1. The judgment appointing the guardian shall fix the amount of the bond, unless dispensed with by the court. The order of appointment shall require the guardian of the estate to file with the court within 90 days of appointment an inventory specifying all property and income of the incapacitated person's estate, unless the court dispenses with this requirement. Within this time period, the guardian of the estate shall also serve copies of the inventory on all next of kin and such other interested parties as the court may direct. The order shall also require the guardian to keep the Surrogate continuously advised of the whereabouts and telephone number of the guardian and of the incapacitated person, to advise the Surrogate within 30 days of the incapacitated person's death or of any major change in his or her status or health and to report on the condition of the incapacitated person and property as required by N.J.S.A. 3B:12-42.
(b) Motion for New Trial. A motion for a new trial shall be served not later than 30 days after the entry of the judgment.
(c) Appointment of General or Limited Guardian. If a guardian of the person or of the estate or of both the person and the estate is to be appointed, the court shall appoint and letters shall be granted to the incapacitated person's spouse, if the spouse was living with the incapacitated person as husband or wife at the time the incapacity arose, or to the incapacitated person's next of kin, or the Office of the Public Guardian for Elderly Adults for adults within the statutory mandate of that office, or if none of them will accept the appointment or if the court is satisfied that no appointment from among them will be in the best interests of the incapacitated person or estate, then the court shall appoint and letters shall be granted to such other person who will accept appointment as the court determines is in the best interests of the incapacitated person including registered professional guardians or surrogate decision-makers chosen by the incapacitated person before incapacity by way of a durable power of attorney, health care proxy, or advanced directive.
(d) Duties of Guardian. Before letters of guardianship shall issue, the guardian shall accept the appointment in accordance with R. 4:96-1. The judgment appointing the guardian shall fix the amount of the bond, unless dispensed with by the court. The order of appointment shall require the guardian of the estate to file with the court within 90 days of appointment an inventory specifying all property and income of the incapacitated person's estate, unless the court dispenses with this requirement. Within this time period, the guardian of the estate shall also serve copies of the inventory on all next of kin and such other interested parties as the court may direct. The order shall also require the guardian to keep the Surrogate continuously advised of the whereabouts and telephone number of the guardian and of the incapacitated person, to advise the Surrogate within 30 days of the incapacitated person's death or of any major change in his or her status or health and to report on the condition of the incapacitated person and property as required by N.J.S.A. 3B:12-42.
4:86-5. Proof of Service; Appearance of Mentally Incapacitated Person at Hearing; Answer
Prior to the hearing, the plaintiff shall file proof of service of the notice, order for hearing, complaint and affidavits and proof by affidavit that the alleged incapacitated person has been afforded the opportunity to appear personally or by attorney, and that he or she has been given or offered assistance to communicate with friends, relatives, or attorneys. The plaintiff or appointed counsel shall produce the alleged incapacitated person at the hearing, unless the plaintiff and the court-appointed attorney certify that the alleged incapacitated person is unable to appear because of physical or mental incapacity and the court finds that it would be prejudicial to the health of the alleged incapacitated person or unsafe for the alleged incapacitated person or others to do so. If the alleged incapacitated person or any person receiving notice of the hearing intends to appear by an attorney, such person shall, not later than five days before the hearing, serve and file an answer, affidavit, or motion in response to the complaint
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