Free $$WRK1$$ - Illinois

3116

(Rev. 3/7/01) CCM 0128

ANSWER TO CITATION PROCEEDING
Case: ________________________________ vs. ________________________________________ No.: _________________________________ In answer to the citation and supplemental proceedings served upon ____________________________________________ he/she answers under oath as follows: Name: ____________________________________________________________ Home Phone # _____________________________________ Home Address _____________________________________________________________________________________________________________ Driver's License __________________________________________________ Date of Birth: ____________________________ I am Do you have a job? q No q Yes q Married Social Security # _____________________________________ q Divorced I have _______ dependents q Single

Company's name I work for: ______________________________________________ Their address: ___________________________________________________________ Job:_____________________________________________ I earn $_______________ per _______________ If self-employed, check here q and list business name and address: ________________________________________________________________________ Income from self-employment $ ______________________ per year I have the following benefits with my employer: _____________________________ ___________________________________________________________________________

I do not have a job, but I support myself through: Public Aid $ _______________ per month Unemployment $ ___________ per month Social Security $ ___________ per month SSI $ ______________________ per month Pension $ ___________________ per month Other $ ____________________ per month q I do not own any real estate.

q I own property at ____________________________________________________________, with ____________________________________. q I have a beneficial interest in a land trust. The name and address of the trustee are: ____________________________________ ______________________________________________________________________________________________. The beneficial interest is listed in my name and _____________________________________________________________________________________________. q There is a mortgage on my property. The mortgage company's name and address are: ____________________________________ _____________________________________________________________________________________________________________________. q An assignment of beneficial interest in the land trust was signed to secure a loan from ____________________________________ _____________________________________________________________________________________________________________________. q I have no money in bank accounts, savings & loans, credit unions, money markets, or mutual funds. q I have the following accounts: q checking account at ________________________________________________________ account balance $____________________ q savings account at _________________________________________________________ account balance $____________________ q money market or certificate of deposit at ________________________________________________________________________________ q safe deposit box at ___________________________________________________________________________________________________ q I own: q a car __________________________________________________________ VIN: _______________________________________
(make/model)

q jewelry: (specify) _________________________________________________________________________________________ q other property described as: __________________________________________________________________________________ Stocks VCR Refrigerator Bonds Stove TV set Microwave Work Tools ____________________________________________________ Signature
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS