Affidavit of Judgment Debtor (Form DC 87) American LegalNet, Inc. www.FormsWorkflow.com Original - Court 1st copy - Plaintiff 2nd copy - Defendant Approved, SCAO CASE NO. STATE OF MICHIGAN JUDICIAL DISTRICT AFFIDAVIT OF JUDGMENT DEBTOR Court address Court telephone no. Plaintiff's name and address Defendant's name and address v I swear that 1. I am a party in this case. 2. A judgment was entered against me in the amount of $ 3. The following is a true statement of my assets and financial obligations. . City, state, zip Address IDENTIFICATION Birth date Telephone no. Driver's license no. SSN Employer Employer telephone no. City, state, zip Address Net earnings Payday INCOME $ Weekly Checking Bi-weekly Account no. Monthly Savings ASSETS $ Name of bank or financial institution Account no. $ Branch location Year Make License plate no. Approximate value Automobile $ Amount owed Registered to: Lienholder $ Address Home Own City, state, zip Rent Monthly payment Value Owed $ $ $ Total money owed to you Specify below each amount of money owed to you, the due date, and the name of the individual, business, etc. who owes you money $ Amount Name of mortgage holder or landlord Due date Name who owes money Due date Name who owes money $ Amount $ (List additional assets on reverse side) I swear under penalties of perjury that this information is true, accurate, and complete. Signature Date Subscribed and sworn to before me on , Date My commission expires: Signature: County Michigan. Deputy court clerk/Notary public Notary public, State of Michigan, County of DC 87 (5/07) AFFIDAVIT OF JUDGMENT DEBTOR MCL 600.8410 American LegalNet, Inc. www.FormsWorkflow.com Original - Court 1st copy - Plaintiff 2nd copy - Defendant Approved, SCAO STATE OF MICHIGAN JUDICIAL DISTRICT CASE NO. AFFIDAVIT OF JUDGMENT DEBTOR Plaintiff's name and address v Defendant's name and address Other Assets: (continued) DC 87 (6/05) AFFIDAVIT OF JUDGMENT DEBTOR American LegalNet, Inc. www.FormsWorkflow.com