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Information Subpoena

All information MUST be filled out in its entirety.  You are required by law to answer all questions.  If the answer to the question is "none" write in "none" or "0."  You may fill the form out online and then print the completed form or print a blank copy and fill in the answers yourself.  Mail the completed form with your signature at the bottom to:  
                                                                        Hoffman Law Office
                                                                        713 Landis Ave.
                                                                        Vineland, NJ 08360
 Any falsification of information contained herein is punishable by law.

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  1. Personal Information

    Name
    Street Address
    Address (cont.)
    City            State/Province    
    Zip/Postal Code
  2. Date of Birth                  -- mm/dd/yy                  Social Security #     

  3. Drivers License # and expiration date:    (if no Driver's License, write "none")

      Expiration date:  --mm/dd/yy

  4. Full Name and address of employer:     (if not employed, write "none")

    Employer Name
    Street Address
    Address (cont.)
    City            State/Province    
    Zip/Postal Code
  5. Weekly salary (if none, write "none"): 
            Gross:           Net: 

  6. If not presently employed, name and address of last employer.  If never employed, write "none"

     Employer Name
    Street Address
    Address (cont.)
    City            State/Province    
    Zip/Postal Code
  7. Is there currently a wage execution on your salary?

    Yes No

  8. List the names, addresses, and account numbers of all bank accounts on which your name appears.  If none, write "none."


  9. Check any of the following sources of income from which you receive money:

    Alimony
    Loan Payments
    Rental Income
    Pensions
    Bank Interest
    Stock Dividends
    None of the above

  10. For any of the income sources you checked above, list the amount, how often, and the name and address of the source of income:


  11. Do you receive Social Security benefits?

    Yes No

  12. Do you own the property where you reside?

    Yes No
    a. Name of the property owner or owners       
    b. Date property was purchased                         -- mm/dd/yy
    c. Purchase price                                                $
    d. Name and address of mortgage holder
                    Name:                 
                    Address:            
                    City/State/Zip: 
    e. Balance due on mortgage                            $

  13. Do you own any other real estate?

    Yes No
    a. Address of property   
    b. Date property was purchased                   -- mm/dd/yy
    c. Purchase price                                            $
    d. Name and address of all owners:

    e. Name and address of mortgage holder
                    Name:                      
                    Address:                  
                    City/State/Zip:      
    e. Balance due on mortgage                            $
    f. Names and address of all tenants and monthly rental paid by each tenant:

  14. If you answered "yes" to either questions 12 or 13, 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 "yes" you must itemize all property owned by you:
        a. Cash on hand:  $
        b. Other personal property: (Set forth make, model, and serial number.  If financed, give name and address 
            of party to whom payments are made)

  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.  If No vehicles owned, write "none" 
               
    b. If there is a lien on the vehicle, state the name and address of the lien holder and the amount due to the leinholder:
               
    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
         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:
    a) Creditor's name
    b) Creditor's attorney
    c) Amount due
    d) Name of Court
    e) 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.

Signature:________________________________________ Date: ___________

Mail this completed form to:
Hoffman Law Office
713 Landis Ave.
Vineland, NJ 08360

 

Hoffman Law Office.
Copyright 2003 Colleen Milner. All rights reserved.
Revised: March 23, 2003