Small Claims Court _________________________ County, Colorado Court Address: PLAINTIFF(S): _______________________________________________ Address: ____________________________________________________ City/State/Zip: ________________________________________________ Phone: Home _______________________ Work ___________________ v. DEFENDANT(S): ____________________________________________ COURT USE ONLY Case Number: Address: ____________________________________________________ City/State/Zip: _________________________________________________ Phone: Home _______________________ Work ___________________ Division Courtroom MOTION AND ORDER FOR INTERROGATORIES – LONG FORM The judgment creditor, ______________________________, requests this Court to issue an order requiring the judgment debtor, ___________________________________________, to appear and answer completely all of the INTERROGATORIES attached within ten days after receipt, because: 1. On (date)_________________________, judgment was entered in favor of the ___________________________________. and against the ________________________________________________ in the amount of $ _____________________, with court costs in the amount of $ _________________________, for a total award of $ ___________________________; 2. There remains due on this judgment the amount of $ ____________________, interest to date of $ __________________, additional costs of $ _______________________, for a balance of $ _______________________; 3. Execution may presently issue on this judgment; and 4. Pursuant to C.R.C.P. 517 and 518, the judgment creditor is entitled to an order requiring the judgment debtor to appear and answer these interrogatories concerning the debtor’s financial condition. Dated: _____________________________________ ___________________________________________ Judgment Creditor Subscribed under oath before me on: Dated: _____________________________________ ___________________________________________ Clerk/Deputy IT IS ORDERED: 1. That the judgment debtor, ________________________________________________________, APPEAR and ANSWER completely all of the INTERROGATORIES attached, pursuant to C.R.C.P. 517 and 518. 2. That these INTERROGATORIES be signed by the judgment debtor in full legal name, under penalty of perjury, in the presence of a notary public or clerk of court. 3. That these INTERROGATORIES be filed with the Clerk, and that the judgment debtor appear on (date) ______________ (time) _______________ at (location) ____________________________________________. 4. That service of these INTERROGATORIES and this order be made by mailing copies to the judgment debtor, by certified mail, or as provided by C.R.C.P. 304. Dated: _____________________________________ ___________________________________________ ! Judge ! Magistrate I certify that a copy of this form and interrogatories were mailed to the judgment debtor on: Dated: _____________________________________ ___________________________________________ Clerk/Deputy JDF 252B R9/01 MOTION AND ORDER FOR INTERROGATORIES – LONG FORM PAGE 1 OF 6 American LegalNet, Inc. www.FormsWorkflow.com INTERROGATORIES TO JUDGMENT DEBTOR Name of Judgment Debtor: _______________________________________. THESE INTERROGATORIES MUST BE COMPLETELY ANSWERED AND FILED WITH THE CLERK OF THE ______________________COUNTY COURT AT THE ADDRESS STATED ON PAGE 1 OF THIS FORM ON (date)_________________(time) ______________. YOU MUST APPEAR ON THIS DATE. WARNING: FAILURE TO TRUTHFULLY AND COMPLETELY ANSWER ALL OF THESE QUESTIONS AND RETURN THEM WITHIN TEN DAYS TO THE CLERK OF COUNTY COURT, SMALL CLAIMS DIVISION, SHALL CAUSE A CITATION TO BE ISSUED FOR CONTEMPT OF COURT. A FINDING OF CONTEMPT MAY BE CAUSE FOR A FINE OR JAIL SENTENCE. NOTE: YOU MAY PAY $__________________ (THE AMOUNT OF THE JUDGMENT TOGETHER WITH ANY INTEREST AND COSTS) TO THE CLERK OF THE COURT WITHIN TEN DAYS INSTEAD OF ANSWERING THESE QUESTIONS. IF YOU MAKE THE PAYMENT, THIS CASE WILL BE CLOSED. 1. What is your full legal name: _________________________________________________________________________ List any other names you have been known by: __________________________________________________________ Home address: ____________________________________________________________________________________ Home phone number:__________________________ Work phone number: ____________________________________ Date of birth: ______________________________ Social Security Number: ___________________________ Drivers license number: _____________________ State: _______________ 2. State your full and correct business address: _____________________________________________________________ _________________________________________________________________________________________________ a. Do you rent or own the premises? _________ b. State the full and correct name and address of your landlord. ____________________________________________ _____________________________________________________________________________________________ c. On what day of the month do you pay your rent? ______________________ d. What is the amount of the deposit with your landlord? ___________________ 3. State your full and correct home address: _______________________________________________________________ _________________________________________________________________________________________________ a. Do you own or rent the premises? ______________________ b. State the full and correct name and address of your landlord. ____________________________________________ _____________________________________________________________________________________________ c. On what day of the month do you pay your rent? ___________________ d. What is the amount of the deposit with your landlord? ________________ 4. State the full and correct address of all real estate you own or have an interest in. ______________________________________________________________________________________ Address City/County State ______________________________________________________________________________________ Address City/County State ______________________________________________________________________________________ Address City/County State ______________________________________________________________________________________ Address 5. City/County State State the book and page number and other recording numbers of the deed or other instruments of such property. ________________________________________________________________________________________________ Book page number of deed ________________________________________________________________________________________________ Book page number of deed 6. Are there any liens, mortgages, or encumbrances against any of the property referred to in No. 4? If so, give the full and correct name and address of the creditor of, and balance due on each. _________________________________________________________________________________ $_____________ Name Address City/State Amount owed _________________________________________________________________________________ $_____________ Name Address City/State Amount owed _________________________________________________________________________________ $_____________ Name JDF 252B R9/01 Address City/State MOTION AND ORDER FOR INTERROGATORIES – LONG FORM Amount owed PAGE 2 OF 6 American LegalNet, Inc. www.FormsWorkflow.com 7. Employment information: The employer’s/company’s name: _____________________________________________________________________ Address of employer: _______________________________________________________________________________ Phone number: ____________________________ Supervisor’s name: _______________________________________ You are paid: ! hourly $ _____________ ! monthly $ _______________ ! or your annual rate of pay you earn $ __________________ ! you are paid commissions, the manner in which commissions are calculated are: ________________________________________________________________________________________________ The days or days of the month on which you are paid: ___________________________________________ 8. If self-employed, do you own or have any interest in any inventory, supplies, machinery, equipment, or tools? If so, list each of them and whether they are paid for. If you owe money for any item, indicate how much for each item. ______________________________________________________________________________________________ Type of Item Paid YES or NO If No Amount owed ________________________________________________________________________________________________ Type of Item Paid YES or NO If No Amount owed ________________________________________________________________________________________________ Type of Item Paid YES or NO If No Amount owed ________________________________________________________________________________________________ Type of Item 9. Paid YES or NO If No Amount owed List the full and correct name and address of all banks and savings institutions you have: ______________________________________________________________________________________ Name of Bank Saving & Loan/Credit Union Address/Location City/State Account Number ______________________________________________________________________________________ Name of Bank Saving & Loan/Credit Union Address/Location City/State Account Number ______________________________________________________________________________________ Name of Bank Saving & Loan/Credit Union Address/Location City/State Account Number 10. Do you have any life, health, or other insurance with a cash surrender value or from which money is or will be due to you? If so, state the name and number of the policy and full and correct name and address of the insuring company. ______________________________________________________________________________________ Name of Insurance Company – Name of Agent Address/Location City/State Policy Number ______________________________________________________________________________________ Name of Insurance Company – Name of Agent Address/Location City/State Policy Number 11. Have you received any money judgments from any court within the past 12 months? If so, state the nature of the action court location, case number, amount received and date judgment entered. ______________________________________________________________________________________ Nature of Action Court Location Case Number Amount of Judgment Date Ordered ______________________________________________________________________________________ Nature of Action Court Location Case Number Amount of Judgment Date Ordered ______________________________________________________________________________________ Nature of Action Court Location Case Number Amount of Judgment Date Ordered 12. Are you entitled to any refund on either or both of your last federal or state income tax returns? a. If so, what is the amount of the refund on each? _____________________ b. Have you received any of this money as of this date? _________________ 13. State the description, amount, and location of any and all stocks, bonds, U.S. Savings Bonds, debentures, or other securities which you own or in which you have an interest. _____________________________________________________________________ $ ________________ Type of Stock/Bond/Us Saving Bond Location Amount _____________________________________________________________________ $ ________________ Type of Stock/Bond/Us Saving Bond Location Amount _____________________________________________________________________ $ ________________ Type of Stock/Bond/Us Saving Bond Location Amount _____________________________________________________________________ $ ________________ Type of Stock/Bond/Us Saving Bond 14. Location Amount State the amount and location of any cash you have on hand. _____________________________________________________________________ $ _______________ Location of Cash Amount _____________________________________________________________________ $ _______________ Location of Cash JDF 252B R9/01 MOTION AND ORDER FOR INTERROGATORIES – LONG FORM Amount PAGE 3 OF 6 American LegalNet, Inc. www.FormsWorkflow.com 15. List and describe any and all automobiles, trucks or other motor vehicles owned by you, or vehicles in which you have an interest. _____________________________________________________________________________$ ________________ Type of Vehicle a. b. Estimated Value Are any of these vehicles used daily in your work? If so, identify ________________________________________ Are any of these vehicles mortgaged? If so, state for what amount and the full and correct name and address of the mortgagee. ______________________________________________________________________________________ Name of Bank Saving & Loan/Credit Union Address/Location City/State Account Number ______________________________________________________________________________________ Name of Bank Saving & Loan/Credit Union 16. Address/Location City/State Account Number List and describe any and all livestock and crops you own or have an interest in, giving the location and present market value of each. _____________________________________________________________________________$ ________________ Type of Livestock/Crops Location Estimated Value _____________________________________________________________________________$ ________________ Type of Livestock/Crops 17. Location Estimated Value State the amount, description, and location of any and all other personal property you own or have an interest including household furniture and fixtures, motorcycles, boats, photographic and electronic equipment, jewelry, and any other moveable property. If any of this property is mortgaged, state for what amount and the full and correct name and address of the mortgagee(s). (Use last page if necessary.) _____________________________________________________________________________$ ________________ Description Location Estimated Value _____________________________________________________________________________$ ________________ Description Location Estimated Value _____________________________________________________________________________$ ________________ Description 18. Location Estimated Value State the full and correct name and address of any and all persons, firms, and/or corporations to whom you owe any money. _____________________________________________________________________________$ _______________ Name and address Amount _____________________________________________________________________________$ _______________ Name and address Amount _____________________________________________________________________________$ _______________ Name and address 19. Amount List and describe any and all rents, notes receivable, and accounts receivable, on an open account or otherwise, due or payable to you or in which you have an interest. State the full and correct name and address of the debtor and the amount due as of this date. _____________________________________________________________________________$ _______________ List of Debtor Address Amount _____________________________________________________________________________$ _______________ List of Debtor Address Amount _____________________________________________________________________________$ _______________ List of Debtor Address Amount _____________________________________________________________________________$ _______________ List of Debtor Address Amount _____________________________________________________________________________$ _______________ List of Debtor 20. Address Amount State the full and correct address of the location of your financial books and records and, if you employ the services of a bookkeeper or accountant, the full correct name and address of such person. _________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 21. What is the amount of your deposit with any utility company (gas, electric, water and sewer)? _____________________________________________________________________________$ ________________ Description Location Estimated Value _____________________________________________________________________________$ ________________ Description JDF 252B R9/01 Location MOTION AND ORDER FOR INTERROGATORIES – LONG FORM Estimated Value PAGE 4 OF 6 American LegalNet, Inc. www.FormsWorkflow.com 22. What is the amount of your deposit with any telephone company? __________________________________________ 23. For a period of one full year prior to the commencement of this legal action against you until the present, have you or your agents or employees, if any, closed out any savings, commercial, or other financial account which was in your name, individually or together with other people or business, in any bank or other financial institution? If so, for each of such closed accounts, state: a. The full and correct name and address of the bank or institution(s). _______________________________________ _______________________________________________________________________________________________ b. c. The account number(s). _________________________________________________________________________ d. The date on which the account(s) was/were opened. ___________________________________________________ e. 24. The names on the account(s). _____________________________________________________________________ The date on which the account(s) was/were closed. ____________________________________________________ Supply a copy of your last federal income tax return. I affirm/swear under the penalty of perjury that the above answers to these INTERROGATORIES are true, complete, and correct. FALSE STATEMENT ARE PUNISHABLE AS PERJURY WHICH IS A FELONY. Dated: ________________________________ ___________________________________________ Judgment Debtor Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______. My commission expires: ________________________ ___________________________________ Notary Public /Deputy Clerk JDF 252B R9/01 MOTION AND ORDER FOR INTERROGATORIES – LONG FORM PAGE 5 OF 6 American LegalNet, Inc. www.FormsWorkflow.com Case Name _____________________ v. ______________________ Case Number: _______________ AFFIDAVIT OF SERVICE (Must be returned to Court) I served a copy of the foregoing Interrogatories, on the following: Name Date Place If the person on whom service was made is not the named party to be served, I served the Interrogatories: ! At the regular place of abode of the person to be served, by leaving the Notice with a person over the age of 18 years who regularly resides at the place of abode. (Identify relationship to defendant _____________________________.) ! At the regular place of business of the person to be served, by leaving the Notice with that person’s secretary, bookkeeper, chief clerk, office receptionist/assistant or partner. (Circle title of person who was served.) ! By leaving the Notice with a partner, limited partner, associate, manager, elected official, receptionist/assistant, bookkeeper or general agent of the partnership, limited liability company, or other non-corporate entity, that was to be served. (Circle title of person who was served.) ! By leaving the Notice with an officer, manager, receptionist/assistant, legal assistant, paid legal advisor or general agent, registered agent for service of process, stockholder or principal employee of the corporation, that was to be served. (Circle title of person who was served.) I am over the age of 18 years, and I am not an interested party in this matter. I have charged the following fees for my services in this matter: ! Private process server ! Sheriff, ____________________________County Fee $ ______________ ___________________________________ Signature of Process Server Mileage $ _____________ ____________________________________ Name (Print or type) Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______. My commission expires: ________________________ ___________________________________ Notary Public CERTIFICATE OF SERVICE BY MAILING (To be performed by Clerk within three days of filing) I hereby certify that on (date)__________________________, I mailed a true and correct copy of the MOTION AND ORDER FOR INTERROGATORIES – LONG FORM, by placing it in the United States Mail, postage pre-paid to the Defendant(s) at the address(es) listed above. Dated: ________________________________ ________________________________________ Clerk of Court/Deputy Clerk ! (If applicable) Plaintiff notified of non-service on (date)___________________________. Clerk’s Initials _______________ JDF 252B R9/01 MOTION AND ORDER FOR INTERROGATORIES – LONG FORM PAGE 6 OF 6 American LegalNet, Inc. www.FormsWorkflow.com