Fill and Sign the Defendants Statement of Assets California Courts Cagov Form

CR-117 INSTRUCTIONS: DEFENDANT'S STATEMENT OF ASSETS A. Name of Victim The name of the victim who will receive restitution goes here. B. Superior Court of California Ask the clerk of your court or defendant’s attorney for this information. C. Name of Defendant Write defendant’s name in the space provided. D. Case Number Fill in the criminal case number assigned in the space provided. E. Personal Information a. Defendant’s name. b. If defendant has previously used another name, provide that name in the space provided. c. Defendant’s date of birth. d. Defendant’s social security number. e. Defendant’s marital status. f. Defendant’s driver license number and the state of issuance. g. Defendant’s home address. h. Defendant’s home telephone number. i. Defendant’s employer's telephone number. F. Income and Occupation List defendant’s sources of income and occupation. Include defendant’s job title and the name of the division or office where defendant works or worked. G. Address of Employer a. Write the name and address of defendant’s business or employer. b. If defendant is not employed, write the names and addresses of all sources of income. H. Pay Period Specify how often defendant is paid, that is, daily, weekly, monthly. I. Gross Pay Specify defendant’s gross pay each pay period. J. Take-Home Pay Specify defendant’s take-home, that is, after-taxes pay for each pay period. K. Spouse’s Income If defendant is married and defendant’s spouse is employed, specify the name and address of his or her employer, job title, and division or office. L. Other Sources of Income If defendant has additional sources of income that have not been listed, write them here. M. Cash Write the amount of money defendant has in cash. N. Accounts Complete the required information regarding any money held in defendant’s name in accounts in banks and any other financial institutions. O. Automobiles Complete the required information regarding any automobiles and boats defendant owns or jointly owns. Page 1 of 2 www.courtinfo.ca.gov Form Approved for Optional Use Judicial Council of California CR-117 [New January 1, 2004] INSTRUCTIONS: DEFENDANT’S STATEMENT OF ASSETS P. Real Estate List all real estate owned in defendant’s name or jointly Q. Other Personal Property List any valuable property that has not already been mentioned that defendant holds in his or her name or jointly. R. Assets List all other assets, including stocks, bonds, and mutual funds. S. Assets Held for You If anyone is holding any assets for defendant, check the “yes” box and describe the assets along with the name and address of each person or entity holding the assets. T. Transfer of Assets List any disposal or transfer of assets that defendant has made since his or her arrest on this matter. U. Loans If defendant has any outstanding loans, list them here. Give the details of the loan including why the loan was taken and to what institution defendant owes money. V. Taxes If defendant owes any past taxes, give the details here. W. Support Arrearages If defendant owes child or spousal support, attach copies of the orders and statements to this form. X. Credit Cards If defendant owes money on any credit cards, list the name of each creditor and the account number. Y. Other Debts If defendant has any additional debts that have not yet been listed, write them down in the space provided. Z. Date and Signature Indicate the date and defendant’s name and have defendant sign in the spaces provided. AA. Interpreter If an interpreter was used to complete the document, he or she must print his or her name, include his or her signature, and indicate the date. Page 2 of 2 CR-117 [New January 1, 2004] INSTRUCTIONS: DEFENDANT’S STATEMENT OF ASSETS