Free CR-445 - Alaska

Exempt From VRA Certif.

IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA Plaintiff, vs. ) ) ) ) ) ) ) ) ) ) )

CASE NO. SENTENCING AFFIDAVIT

CR

Defendant.

INSTRUCTIONS Instructions to Defendant: Because you have been ordered to pay a fine as part of your sentence, you are required to provide the court with the information listed below. If you fail to pay your fine as ordered, a bench warrant may be issued for your arrest or your fine may be referred to the Department of Law for collection through civil execution procedures including but not limited to seizure of your bank accounts, permanent fund dividend, paycheck or other money or property. AFFIDAVIT I swear or affirm that the following facts are complete and true to the best of my knowledge. I understand that if I give false information in this affidavit I may be prosecuted for perjury. Please Print 1. True and full name (including middle name):

2.

Other names that I have used:

3. 4.

Date of Birth: Social Security No.: [It is not mandatory that you give your social security number. Your social security number may be used to identify assets which may be seized to collect your fine.] Residence address: Mailing address: Phone Numbers. Home: Work:
Administrative Bulletin No. 43

5. 6. 7.

Page 1 of 2 CR-445 (12/05) (st.2) SENTENCING AFFIDAVIT

8.

Employment information. blanks.

Check all boxes which apply to you and fill in the

Current employer's name: Employer's address: Self-employed. Type of business: Address of business: Employed on seasonal basis. Seasonal employer's name: Employer's address: Currently unemployed. Last employer's name: Employer's address: 9. I have accounts at the following banks, investment firms and other financial institutions:

10.

I own the following real property: Description of Property:

Location of Property:
(Street & house number, town & state)

(For example: house, land, condominium, etc.)

11.

I own the following motor vehicles (include type, year, model, and license numbers, if known):

Date

Signature of Defendant

Subscribed and sworn to or affirmed before me on , Alaska. at

,20

,

Judge/Clerk/Notary Public (SEAL) My Commission Expires:

Page 2 of 2 CR-445 (12/05) (st.2) SENTENCING AFFIDAVIT

Administrative Bulletin No. 43