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Affidavit Of Assets And Liabilities

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Affidavit Of Assets And Liabilities Form. This is a Illinois form and can be use in Cook Local County.

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Tags: Affidavit Of Assets And Liabilities, CCJP 0041, Illinois Local County, Cook

Print Form Clear Form (12/07/10) CCJP 0041 Af¿davit of Assets and Liabilities IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS DEPARTMENT OF JUVENILE JUSTICE AND CHILD PROTECTION CHILD PROTECTION DIVISION IN THE INTEREST OF ______________________________________________________ Petition No. ___________________________________ A Minor AFFIDAVIT OF ASSETS AND LIABILITIES I,_____________________________________________________ (Parent) of the minor respondent in this case, on oath state that I am ¿nancially unable to hire a lawyer and I am requesting to be represented by the Public Defender of Cook County. Address ___________________________________________________________________________________________________ City: ____________________________ State: ________________ Zip Code: _______________ I am: Married Single Divorced Telephone:_________________________ Separated Number of children I support by court order _________________ MOTHER Employed? FATHER Yes No Employed? Yes No If so, where? _____________________________________________ If so, where? ____________________________________________ Position _________________________________________________ Position ________________________________________________ Salary ___________________________________________________ weekly bi-weekly monthly other__________________ Any other income i.e.: child support, Social Security Disability, etc.? ____________________________________________________ Salary _________________________________________________ weekly bi-weekly monthly other________________ Any other income i.e.: child support, Social Security Disability, etc.? ___________________________________________________ ________________________________________________________ Do you own a car? Yes No If so, what model/make/year _______________________________ Do you own a home? Yes No ________________________________________________________ Do you own a car? Yes No If so, what model/make/year _______________________________ Do you own a home? Yes No If so, how long? __________________________________________ Do you have a savings account or any other investments? Yes No Total value ______________________________________________ List major debts: creditors and amounts. If so, how long? __________________________________________ Do you have a savings account or any other investments? Yes No Total value ______________________________________________ List major debts: creditors and amounts. Monthly payments: _______________________________________ Monthly payments: ______________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ TOTAL DEBTS/MORTGAGE/CAR PAYEMENT/PERSONAL DEBTS ____________________________________________________ DATED: _______________________________, ___________ ___________________________________________________ Parent or Guardian The undersigned certi¿es that the statements set forth in this instrument are true and correct and certi¿es under penalties of perjury as provided by law pursuant to 753 ILCS 5/1-109. __________________________________________________ Respondent-Parent DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS