Fill and Sign the Defendants Statement of Assets Formdunkmulque

DEFENDANT'S STATEMENT OF ASSETS EMPLOYMENTWhat are your sources of income and occupation? (Provide job title and name of division or office in which you work.) Name and address of your business or employer (include address of your payroll or human resources department, if diff\ erent) : How often are you paid (for example, daily, weekly, biweekly, monthly)\ ? (specify): What is your gross pay each pay period? $ What is your take-home pay each pay period? $ If your spouse earns any income, give the name of your spouse, the name \ and address of the business or employer, job title, and division or office (specify): (Continued on reverse) DEFENDANT'S STATEMENT OF ASSETS Adopted for Mandatory Use Judicial Council of California CR-115 [New July 1, 2000] CR-115 2. 3. If not employed, names and addresses of all sources of income (specify): 7. FOR COURT USE ONLY STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT: CASE NUMBER: NAME OF VICTIM ON WHOSE BEHALF RESTITUTION IS ORDERED: vs. NAME OF COURT: CASH, BANK DEPOSITS How much money do you have in cash? $ How much other money do you have in banks, savings and loans, credit uni\ ons, and other financial institutions either in your own name or jointly (list): Individual or joint? Account number Balance Name and address of financial institution PROPERTY List all automobiles, other vehicles, and boats owned in your name or jo\ intly: Legal owner if different Value Make and year Amount owed from registered owner $ $ b. $ $ $ $ c. a. 10. 9. a. $ b. $ $ c. PERSONAL INFORMATION 1. a. Name: b. AKA: c. Date of birth: d. Social security number: f. Driver license number: g. Home address: State of issuance: Penal Code, § 1202.4(f) (Attach additional sheets if the space provided below for any item is n\ ot sufficient.) h. Home telephone no.: 11. 4. 5. 6. a. b. Other sources of income (specify):8. e. Marital status: i. Employer's telephone no.: It is a misdemeanor to make any willful misstatement of material fact in\ completing this form (Pen. Code, § 1202.4(f)(4).) Except for attorney fees in this matter and ordinary and routine househo\ ld expenses, have you disposed of or transferred any assets since your arrest on this matter? If yes, give the name and address of each person or entity who received \ any asset and describe each asset (specify): DEFENDANT'S STATEMENT OF ASSETS OTHER PERSONAL PROPERTY ( Do not list household furniture and furnishings, appliances, or clothing\ .) List anything of value not listed above owned in your name or jointly (continue on attached sheet if necessary): Description Value Address where property is located $ $ $ Date: CR-115 [New July 1, 2000] Page two (SIGNATURE) (TYPE OR PRINT NAME) a. b. c. Is anyone holding assets for you? \ If yes, describe the assets and give the name and address of the person or entity holding each asset (specify): Yes. No.15. Yes. No. 16. PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: CASE NUMBER: Loans (give details) : Taxes (give details) : Support arrearages (attach copies of orders and statements) : Credit cards (give creditor's name and address and the account number) : Other debts (specify): 17. 18. 19. 20. 21. ASSETS DEBTS I, (name) : , a certified i\ nterpreter, having been duly sworn, truly translated this form to the de\ fendant in the (specify language) : language. The \ defendant indicated that he/she understood the contents of the form and he/she completed the form. Date: (SIGNATURE) (TYPE OR PRINT NAME) List all other assets, including stocks, bonds, mutual funds, and other \ securities (specify): 14. 13. Address of real estate a. List all real estate owned in your name or jointly: Fair market value Amount owed $ $ $ $ b. 12.