STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT CLINTON COUNTY, CARLYLE, ILLINOIS ) Plaintiff ) vs. ) Case No.: ) ) IF YOU FAIL TO APPEAR AT THIS HEARING A Defendant ) WARRANT MAY BE ISSUED FOR YOUR ARREST Citation to Discover Assets To: (NAME AND ADDRESS OF DEFENDANT OR RESPONDENT) YOU ARE COMMANDED to appear before the Judge presiding in Room of the Clinton County Courthouse, 850 Fairfax Street, Carlyle, Illinois on at to be examined under oath to discover assets or income, not exempt from the enforcement of the judgment. A Judgment against (Judgment Debtor) was entered on and $ remains unsatisfied. YOU ARE COMMANDED to produce at the examination: All books, papers or records in your possession or control which may contain information concerning the property or income of, or indebtedness due judgment debtors and: YOU ARE PROHIBITED from making or allowing any transfer or other disposition of, or interfering with any property not exempt from execution or garnishment belonging to the judgment debtor or to which the judgment debtor may be entitled or which may be acquired by or become due to the judgment debtor and from paying over or otherwise disposing of any money not so exempt, which is due or becomes due to the judgment debtor, until the further order of court or termination of the proceedings. You are not required to withhold the payment of any money beyond double the amount of the balance due. WARNING: IF YOU FAIL TO APPEAR IN COURT AS DIRECTED IN THIS NOTICE, YOU MAY BE ARRESTED AND BROUGHT BEFORE THE COURT TO ANSWER TO A CHARGE OF CONTEMPT OF COURT, WHICH MAY BE PUNISHABLE BY IMPRISONMENT IN THE COUNTY JAIL. CERTIFICATION OF ATTORNEY OR JUDGMENT CREDITOR Judgment Amount: $ Balance Due: $ Date of Judgment/Revival: Case No.: Name of Court entering Judgment: The undersigned certifies, under penalties provided by law pursuant to 735 ILCS 5/1-109, that the information contained herein is true and correct. Name: Attorney for: Address: City, State, Zip: Telephone: WITNESS: Clerk of Court American LegalNet, Inc. www.FormsWorkFlow.com Income and Asset Form To Judgment Debtor: Please complete this form and bring it with you to the hearing referenced in the enclosed citation notice. You should also bring to the hearing any documents you have to support the information you provide in this form, such as pay stubs and account statements. The information you provide will help the court determine whether you have any property or income that can be used to satisfy the judgment entered against you in this matter. The information you provide must be accurate to the best of your knowledge. IF YOU FAIL TO APPEAR AT THS HEARING, YOU COULD BE HELD IN CONTEMPT OF COURT AND POSSIBLY ARRESTED. In answer to the citation and supplemental proceedings served upon the judgment debtor, he or she answers as follows: Name: Phone No.: Address: Date of Birth: Marital Status: I have dependents. Do you have a job? [ ] Yes [ ] No JOB: I earn $ per If self employed, list here your business name and address: Income from self employment is $ per year. I have the following benefits with my employer: I do not have a job, but I support myself through: Government Assistance $ per month SSI $ per month Unemployment $ per month Pension $ per month Social Security $ per month Other $ per month REAL ESTATE: Do you own any real estate? [ ] Yes [ ] No I own real estate at: with names of other owners: Additional real estate I own: I have a beneficial interest in a land trust. The name and address of the trustee is: The beneficial interest is listed in my name and: parcel of real estate owned: An assignment of beneficial interest in the land trust was signed to secure a loan from: I have the following accounts: Checking at: Checking account balance $ Savings at: Savings account balance $ Money market or certificate of deposit at: Safe deposit box at: Other accounts (please identify): I OWN: A vehicle (state year, make, model, and VIN): Jewelry (please specify): Personal Computer: Stocks/Bonds: Television: DVD player: Microwave: Business equipment: Stove: Work tools: Farm equipment: Other property (please specify): The undersigned certifies, under penalties provided by law pursuant to 735 ILCS 5/1-109, that the information contained herein is true and correct. Signature: Date: American LegalNet, Inc. www.FormsWorkFlow.com