CIVIL COURT OF THE CITY OF NEW YORK County of Part Index No. QUESTIONS In connection with an INFORMATION SUBPOENA regarding C la i m an t(s)/Plain tiff(s) VS (Judgment debtor) (Address) Defendant(s) (City, State, Zip Code) State of New York, County of ss,: , being duly sworn, deposes and says: , (Name of Deponent) I am the (Title) of (Name of organization) and acknowledge receipt of an as Judgment Debtor. Information Subpoena naming The Answers below are based upon information contained in the records of the recipient. 1. Q. Please provide the Debtor's full name(s) as indicated in your records. A. 2. Q. Please set forth the last known home address and telephone number for the Debtor's residence, if different from the address above. A. 3. Q. Does the Judgment Debtor have an account with your organization and/or are you currently holding any deposits and/or security? If so, what is the account number, and what is/are the amount(s) on deposit? A. 4. Q. Do your records indicate that the Debtor is employed? If so, please list the name and address of the employer and the salary as indicated in your records. A. 5. Q. Did the Debtor list any bank references on his/her application? If so, set forth the name and address of said bank(s) and account number(s), if available. A. 6. Q. Do your records indicate the location of any other assets of the Debtor? if so, please give the location and description of any other assets. A. The answers given to the above questions are true and complete to the best of my knowledge. Sworn to before this day of 20 Notary Public Signature (before a Notary Public) WHEN COMPLETED, RETURN THE ORIGINAL COPY OF THIS FORM TO: Judgment Creditor's Name DO NOT RETURN THIS FORM TO THE CIVIL COURT Address CIV-SC-61 (Revised 11/06) American LegalNet, Inc. www.FormsWorkflow.com