Print Form Clear Form (Rev. 6/30/08) CCM 0124 A Citation to Discover Assets to a Third Party INTHE CIRCUIT COURT OF COOK COUNTY, ILLINOIS MUNICIPAL DEPARTMENT/ ___________________ DISTRICT ________________________________________________________________ Plaintiff, v. ________________________________________________________________ Defendant, ________________________________________________________________ Respondent. } No. _______________________________________ CITATION TO DISCOVER ASSETS TO A THIRD PARTY To: _________________________________ YOU ARE REQUIRED to either file your answer to this Citation on the form appearing on the reverse side or appear on ____________________________, ___________ before 9:30 a.m. in Courtroom ______________ located at: Richard J. Daley Center, 50 W. Washington, Chicago, IL 60602 District 3: 2121 Euclid, Rolling Meadows, IL 60008 th District 5: 10220 S. 76 Ave., Bridgeview, IL 60455 District 2: 5600 Old Orchard Rd., Skokie, IL 60077 District 4: 1500 Maybrook Dr., Maywood, IL 60153 � District 6: 16501S. Kedzie Pkwy., Markham, IL 60428 Judgment was entered on ________________________________, ___________ in favor of Plaintiff ____________________________ and against Defendant(s)__________________________________________ in this court under case number __________________ in the sum of $ _____________. There is now due, less credit and off-set, sum of $ ___________________ (Judgment Balance). Further sums may become due as costs and interest accrue. Your answer will inform the Court as to property you may hold belonging to _________________________________ (Judgment Debtor). You are PROHIBITED from making or allowing any transfer or other disposition of, or interfering with, any property not exempt from the enforcement of a judgment, a deduction order or garnishment, property belonging to the judgment debtor or to which s/he may be entitled or which may thereafter be acquired by or become due to him or her, and from paying over or otherwise disposing of any moneys not so exempt, which are due to the judgment debtor. This prohibition shall remain in effect until further order of court or termination of the proceeding. You are not required to withhold the payment of any monies beyond double the amount of the total sum due the judgment creditor. If the account consists solely of funds that can be identified as exempt under federal or state law, you are PROHIBITED from FREEZING THE ACCOUNT and YOU MUST RESPOND that the account consists solely of exempt funds. Deposited funds that are exempt under federal and state law include Social Security, SSI, veteran’s benefits, Railroad Retirement benefits, public assistance benefits, unemployment compensation benefits and/or circuit breaker property tax relief benefits. WARNING: Your failure to comply with the citation proceeding may result in a judgment being entered against you for the unsatisfied amount of this judgment. 735 ILCS 5/2-1402(f)(1). WARNING: YOUR FAILURE TO APPEAR IN COURT OR FILE YOUR ANSWER AS DIRECTED MAY CAUSE YOU TO 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 BY JUDGMENT CREDITOR OR ATTORNEY FOR JUDGMENT CREDITOR Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure (735 ILCS 5/1-109), the undersigned certifies that the above information regarding the amount of the judgment, the date of the judgment, or its revival date, the balance due thereon, the name of the Court and the number of the case is true and correct. Atty. No. ______________________ Name: _____________________________________________________ Address: ____________________________________________________ Signature: _______________________________________ City/State/Zip: ______________________________________________ Telephone:______________________ FAX: ______________________ Clerk of the Court _________________________________ Seal of Court (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (6/30/08) CCM 0124 B ANSWER OF THIRD PARTY RESPONDENT CITATION This first section must be filled out by the judgment creditor. Citation/Respondent: ________________________________________________________________ Court Date: _________________________ Defendant’s Name: _________________________________________SS No. xxx-xx-______________ Case No.____________________________ Judgment Balance: $______________________________ This is a Citation: Freeze up to double the Judgment Balance. INTERROGATORIES 1. On the date of service of the citation, did you have in your possession, custody or control any personal property or monies belonging to the judgment debtor? Yes No IF THE ANSWER IS “YES” GO TO NEXT QUESTION. IF “NO” GO TO INSTRUCTIONS. 2. Is this an IRA account? Or have all of the deposits made during the past 90 days been electronically deposited and identified as exempt Social Security, Unemployment Compensation, Public Assistance, Veteran’s Benefits, Pension or Retirement or by a source drawing from any other statutory exemptions? Yes No IF THE ANSWER IS “YES” GO TO NEXT QUESTION. IF “NO” GO TO INSTRUCTIONS. 3. Is/Are the account(s)’ current balance equal to or less than the total of the exempt deposits? Yes No IF YOU ANSWERED “YES” TO ALL 3 QUESTIONS AND FUNDS IN THE ACCOUNT(S) ARE EXEMPT, DO NOT FREEZE THE FUNDS AND GO TO “INSTRUCTIONS” BELOW. 4. ACCOUNT BALANCE $ $ $ $ ________________________ ________________________ ________________________ ________________________ AMOUNT WITHHELD A) B) C) D) Savings Account Check/MMA/Now Account Certificate of Deposit Trust Account/Other E) (Describe) _______________________________________________ Safety Deposit Yes No F) G) Land Trust No. ___________________________________________________________ Less Right of Offset for Loans $ __________________________ TOTAL AMOUNT FROZEN: 5. List all electronic deposits into account(s) and their source(s) except deposits: Account Number Source $ $ $ $ __________________________ __________________________ __________________________ __________________________ 0.00 $ __________________________ Monthly Amount ___________________ _____________________________________ $ __________________________ ___________________ _____________________________________ $ __________________________ ___________________ _____________________________________ 6. List all joint account holders or adverse claimants: $ __________________________ Name ______________________________ Name ____________________________ Name ____________________________________ Address ____________________________ Address __________________________ Address __________________________________ ____________________________ Account Type Checking CD Savings Account Number ___________________ __________________________ Account Type Checking CD Savings Account Number ___________________ __________________________________ Account Type Checking CD Savings Account Number ___________________ INSTRUCTIONS (1.) Fill out and sign the certification below. (2.) This Answer must be filed at least three (3) days before the court date to assure timely processing. (3.) Fax or mail a copy of this Answer to (i) the Court, (ii) Plaintiff’s attorney and (iii) Judgment Debtor. If filing in the First Municipal District, you may fax to (312) 603-6522 or mail to the Clerk of the Court, Richard J. Daley Center, 50 W. Washington street, Room 602, Chicago, IL 60602. (4.) You will receive a copy of a Court Order by fax or mail instructing you how to proceed and where to send any withheld funds. CERTIFICATION Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct and that I have mailed this Answer to Defendant(s). Date: ________________________________ Print Agent Name: ___________________________________________ Respondent Name: _________________________________________ Signature of Agent: __________________________________________ Address: __________________________________________________ Telephone: ________________________________________________ FAX: _____________________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS