COURT COUNTY OF Index No. : : : Plaintiff(s) QUESTIONS in Connection With an INFORMATION SUBPOENA Regarding : : (Judgment Debtor) : -against- (Address) : Defendant(s) State of New York, County of (City, State, Zip Code) : ss.: , being duly sworn, deposes and says: (Name of Deponent) I am the of (Title) Information Subpoena naming copy of questions accompanying that subpoena. , and acknowledge receipt of an (Name of Organization) as Judgment Debtor and of the original and a The Answers below are based upon information contained in the records of the recipient. 11. Q. What are the Debtor’s full name(s), social security number, home address and home telephone number as indicated in your records? A. 12. Q. What is the last-known address and telephone number for the Debtor's residence if different from above? A. 13. Q. What is the name and address of the Debtor’s most recent employer and the Debtor’s salary as indicated in your records, and is this employment current? A. 14. Q. Do your records indicate that as of the date of the accompanying subpoena, or within a year prior to it, the Debtor has or had any account with your organization, under the Debtor’s name or a trade or corporate name, or in association with others? A. 15. Q. If so, what is/are the exact title(s) of the account(s), the account number(s), the amount(s) on deposit (currently or when closed), and if closed, on what date? A. 16. Q. Do your records indicate that as of the date of the accompanying subpoena, or within a year prior to it, the Debtor has/had a lease of any safe deposit box, or interest in a safe deposit box, from your organization? A. 17. Q. If so, what is/are the exact title of the lessee(s), what is/are the name(s) of any who have access, on what date was the lease begun and, if applicable, on what date was the lease discontinued? A. 18. Q. Does your organization hold collateral belonging to the Debtor or in which the Debtor has or may have an interest? Questions in Connection With an Information Subpoena Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com A. 19. Q. If so, what is the description and value of each such item, and what interest do your records show the Debtor to have in each such item? A. 10. Q. Is the Debtor is indebted to your organization? A. 11. Q. If so, what is original amount of that debt, the date it was taken on, the amount of it repaid, and the date of that payment? A. 12. Q. Does your organization hold any lien(s) (mortgage or otherwise) against any property of the Debtor? A. 13. Q. If so, for each such lien, what is the lien’s nature, the full description(s) of the property (properties) affected by it, the location/identity of the office of the lien’s filing/recording, and the recording’s indexing information (book and page number)? A. 14. Q. Are any assets of the debtor that are in your organization’s possession or care subject to any liens, attachments or other encumbrances? A. 15. Q. If so, what are the full details of each such asset’s encumbrance(s)? A. 16. Q. Does your organization have any transactions with the Debtor, directly or indirectly, as a result of which the Debtor may now be, or may in the future become, entitled to money or credit? A. 17. Q. If so, what are the full details of each such transaction? A. 18. Q. Has the Debtor given your organization a statement of his financial circumstances? A. 19. Q. If so, what if any assets are disclosed in that statement [or alternatively, attach a copy of that statement]? A. Sworn to on this 28th day of November, 20 Signature (print or type name beneath) Attorney(s) for Judgment Creditor: (Address) Questions in Connection With an Information Subpoena Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com