Small Claims Court _________________________ County, Colorado Court Address: PLAINTIFF(S): ______________________________________________ Address: ____________________________________________________ City/State/Zip: ______________________________________________________ Phone: Home _______________________ Work ___________________ v. DEFENDANT(S): ____________________________________________ Address: ____________________________________________________ COURT USE ONLY Case Number: City/State/Zip: ______________________________________________________ Phone: Home _______________________ Work ___________________ Division Courtroom MOTION AND ORDER FOR INTERROGATORIES – SHORT FORM MOTION Judgment was entered on: (date) ____________________. Plaintiff Defendant By: Default After trial Against the: The judgment remains unsatisfied. Pursuant to Rule 518(a), C.R.C.P., the judgment creditor requests or the Court finds that the judgment debtor should be required to answer the following interrogatories. Dated: _____________________________________ ___________________________________________ Judgment Creditor’s Signature ORDER Pursuant to Rule 518(a), at the request of the judgment creditor or on the Court’s review of the above Motion IT IS ORDERED: That the judgment debtor shall answer the following questions and file the answers with the Court immediately within ten days after service of these interrogatories upon the judgment debtor, or in lieu there of, pay the judgment in full. or That the judgment debtor answer the questions and appear in Court at (date)________________________ at (time)____________. FAILURE TO TRUTHFULLY AND COMPLETELY ANSWER ALL OF THESE QUESTIONS AND RETURN THEM WITHIN TEN DAYS TO THE CLERK OF THE COURT, SMALL CLAIMS COURT, SHALL CAUSE A CITATION TO BE ISSUED FOR CONTEMPT OF COURT. A FINDING OF CONTEMPT BY THE COURT MAY RESULT IN A FINE OR JAIL SENTENCE. Dated: ____________________________ ________________________________ Judge Magistrate INTERROGATORIES 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. As to your employment, complete the following: The employer’s/company’s name: ____________________________________________________________ Address of employer: _____________________________________________________________________ Phone number: ____________________________ Supervisor’s name: ______________________________ JDF 252A R4/04 MOTION AND ORDER FOR INTERROGATORIES – SHORT FORM Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com 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: ___________________________________________ 3. As to your bank accounts, complete the following: List the name and address and account number of every bank, saving and loan, credit union or other financial institution holding any funds which you have deposited or which you are allowed to withdraw without obtaining another person’s signature. ______________________________________________________________________________________ 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 ______________________________________________________________________________________ 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 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 City/County State 5. As to debts owed to you, complete the following. List the name and address of every person who owes you money and the amount owed to you: _______________________________________________________________________ $_____________ Name Address City/State Amount owed ______________________________________________________________________ $ ____________ Name Address City/State Amount owed _______________________________________________________________________ $_____________ Name Address City/State Amount owed _______________________________________________________________________ $_____________ Name Address City/State Amount owed 6. As to insurance coverage, complete the following: List the name and address of any insurance company, including policy numbers with agent’s name providing liability coverage. ______________________________________________________________________________________ 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 ______________________________________________________________________________________ Name of Insurance Company – Name of Agent Address/Location City/State Policy Number UNDER PENALTIES OF PERJURY, I DECLARE THAT THESE STATEMENTS ARE TRUE AND CORRECT. Dated: ___________________________ ______ ________________________________ Judgment debtor’s signature Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______. My commission expires: ________________________ ___________________________________ Notary Public/Clerk of the Court/Deputy Clerk JDF 252A R4/04 MOTION AND ORDER FOR INTERROGATORIES – SHORT FORM Page 2 of 3 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 that was served). By leaving the Notice with a partner, limited partner, associate, manager, elected office, receptionist/assistant, bookkeeper or general agent of the partnership. Limited Liability Company, or other non-corporate entity, which was to be served. (Circle title of person that 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, which was to be served. (Circle title of person that 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 $ ______________ Mileage $ _____________ ___________________________________ Signature of Process Server ____________________________________ 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 – SHORT 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 252A R4/04 MOTION AND ORDER FOR INTERROGATORIES – SHORT FORM Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com