1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 1 of 7 Name Address City, State, Zip Phone Check your email. You will receive information and documents at this email address. Email I am [ ] Plaintiff/Petitioner [ ] Defendant/Respondent [ ] Plaintiff/Petitioner [ ] Defenda nt/Respondent Attorney (Utah Bar #: ) In the [ ] District [ ] Justice Court of Utah Judicial District County Court Address Plaintiff /Petitioner v. Defendant /Respondent Answers to Questions A bout Judgment ( Utah Rule of Civil Procedure 64) Do not file this form with the court Case Numb er Judge Commissioner (domestic cases) Instructions: The court has scheduled a hearing at which you must appear and answer under oath questions about your property. If you fail to appear, you might be held in contempt of court and the court might enter a warrant for your arrest. If you answer the following questions in writing and serve the completed form on the judgment creditor at least 3 business days before the hearing as described on the last page of this form, the creditor might cancel the hearing and notify you. The hearing is canceled only if the creditor is satisfied that you have answered the questions fully and truthfully and notifies you that you do not have to appear. Otherwise, you must appear at the hearing. Attach additional pages to complete number on the additional page. American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 2 of 7 1. Identifying information My f ull n ame Address c ity, s tate, z ip Phone n umber Date of b irt h Social s ecurity n umber l icense n umber 2. Income from employment [ ] I am employed. (List all employers.) Name of e mployer ( legal name and doing business as (dba) ) Address of e mployer Name of person i ssuing p aycheck Phone n umber of p erson i ssuing p aycheck Gross salary (before taxes and deductions) $ [ ] Hourly [ ] Weekly [ ] Bi - weekly [ ] Semi - monthly [ ] Monthly Name of Employer ( legal name and doing business as (dba) ) Address of e mployer Name of p erson i ssuing p aycheck Phone n umber of p erson i ssuing p aycheck Gross salary (before taxes and deductions) $ [ ] Hourly [ ] Weekly [ ] Bi - weekly [ ] Semi - monthly [ ] Monthly [ ] I am self-employed. American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 3 of 7 Business n ame ( legal name and doing business as (dba) ) Business a ddress Name of p erson i ssuing p aycheck Phone n umber of p erson i ssuing p aycheck Gross salary (before taxes and deductions) $ [ ] Hourly [ ] Weekly [ ] Bi - weekly [ ] Semi - monthly [ ] Month ly [ ] I am unemployed. 3. Other income I have the following income other than salary and wages. (Include periodic payments of non-exempt money, such as rental income, trust payments, etc.) Describe Annual a mount Source $ $ 4. Financial assets I have an ownership interest in the following financial assets. Asset Holder (Name & a ddress) Co - o wner (Name & a ddress) Current v alue Bank, c redit u nion or s avings and l oan a ccount A cc ount number: $ Bank, c redit u nion or s avings and l oan a ccount Account number: $ American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 4 of 7 Asset Holder (Name & a ddress) Co - o wner (Name & a ddress) Current v alue Stocks, b onds, s ecurities, m oney m arket f und Account number: $ Stocks, b onds, s ecurities, m oney m arket f und Account number: $ Profit s haring p lan Account number : $ Profit s haring p lan Account number: $ Money o wed to m e $ Cash $ Other (Describe . ) $ Other (Describe . ) $ 5. Business interests I have an ownership interest in the following businesses. Name (legal name and doing business as (dba)) Federal Employer Identification Number (FEIN) Address of m ain o ffice Mailing a ddress, if different American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 5 of 7 Kind of business (C heck one . ): [ ] Proprietorship [ ] Corporation [ ] Partnership [ ] Limited Liability Company [ ] Other (describe) Name (legal name and doing business as (dba)) Federal Employer Identification Number (FEIN) Address of m ain o ffice Mailing a ddress, if different Kind of business (C heck one . ): [ ] Proprietorship [ ] Corporation [ ] Par tnership [ ] Limited Liability Company [ ] Other (describe) 6. Real property I have an ownership interest in the following real property. (Include your home, vacation home and investment property.) Property Mortgage or l ien h older (Name & a ddress) C o - o wner (Name & a ddress) Current v alue Amount o wed Home (Address) $ $ Other r eal p roperty (Address) $ $ Other r eal p roperty (Address) $ $ American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 6 of 7 7. Personal property I have an ownership interest in the following property. (Includes vehicles, boats, trailers, equipment, etc.) Property Lien h older (Name & a ddress) Co - o wner (Name & a ddress) Current v alue Amount o wed Vehicle (Year, m ake, m odel, l icense n umber) $ $ Vehicle (Year, m ake, m odel, l icense n umber) $ $ Other (Describe) $ $ Other (D escribe) $ $ 8. Other property I have an ownership interest in the following property not identified above. (List any non-exempt property not identified above. For a list of exempt property, see Utah Exemptions Act, Utah Code 75B-5-501 to 513). I declare under criminal penalty under the law of Utah that everything stated in this document is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com 1303DC J Approved April 16, 2018 / Revised May 1, 2019 Page 7 of 7 Notice: If you serve the creditor with the completed form at least 3 business days before the hearing and if they are satisfied that you have answered the questions fully and truthfully, they will notify you and the court to cancel the hearing. Otherwise, you must appear at the hearing. File and Serve: 1. Send this completed form and a copy of the Certificate of Service of Answers to to: Creditor Name ( O r , if they have one, their Attor ney or Licensed Paralegal Practitioner) Mailing Address City, State, Zip 2. File with the court a copy of the Certificate of Service of Answers to Questions showing when and how you served this completed form on the creditor. 3. Do not send this completed form to the court. American LegalNet, Inc. www.FormsWorkFlow.com