______________ County, Colorado
County Court
Court Address:
Telephone: )
PLAINTIFF(S)/PETITIONER(S):
DEFENDANT(S)/RESPONDENT(S): COURT USE ONLY
Attorney or Party Without Attorney (Name and Address):
Phone #: E-mail
Atty.Reg.#: Case Number:
Division Courtroom
DEBTOR INTERROGATORIES
NOTICE TO THE ABOVE NAMED DEFENDANT(S):
1. These interrogatories are served on you as the judgement debtor pursuant to:
G C.R.C.P. Rule 69. You must file an answer with the clerk of the above named Court not
later than twenty (20) days from the date this document was served.
G C.C.R.C.P. Rule 369. You must file an answer with the clerk of the above named Court
not later than ten (10) days from the date this document was served.
2. The following Interrogatories must be answered by you in writing and under oath, and filed with
the clerk of the above referenced court at the address set forth above, and a copy thereof must be
mailed to the Plaintiff = s attorney.
3. If you fail to answer these interrogatories within the time set forth above, the Plaintiff may move
for an order to answer these questions or show cause why you should not be held in contempt of
this court.
4. You may avoid answering these questions by paying the judgement you owe in full before the
date your answers are due by contacting Plaintiff = s attorney.
DATED THIS ____ DAY OF _________________, 200____.
______________________________________
INSTRUCTIONS TO PERSON SERVED (CHECK ONE):
G You are answering these questions on behalf of your self as an individual judgment-debtor: you
are required to answer only questions 1 through 28.
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
G You are answering these questions on behalf of an entity: you are required to answer only
questions 29 through 40.
G You are answering these questions on behalf of both yourself and an entity: you are required to
answer questions 1 through 40.
PART A: QUESTIONS FOR INDIVIDUAL JUDGEMENT-DEBTORS:
1. Please provide the following information about yourself:
a. Your full legal name:
b. List any other names, aliases or
nicknames you use:
c. Your current physical address: ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
d. Your current mailing address: ________________________ _________
Street or Box No. Unit or Apt No.
________________________ _________ ________
City State Zip
e. Your social security number: ______-_____-_________
f. Your date of birth: ______/_______/________ (DD/MM/YYYY)
g. State your home, cell and other
telephone numbers where you may
be contacted. (______) _______-_____________ Home
(______) _______-_____________ Cell
(______) _______-_____________ Other
h. Indicate if you reside in a house,
apartment, or mobile home: G House; G Apartment; G Mobile Home;
G Other (specify): ___________________________
2. Do you own the home you live in? __________ (Yes/No) If A Yes @ please answer the following:
a. The address of that home: ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
b. The current market value:
c. The balance due on any
mortgages: 1 st
Mortgage: _____________________
2 nd
Mortgage: _____________________
d. The name and address of each
mortgage holder: 1 st
Mortgage:
_________________________________________
2 nd
Mortgage: _________________________________________
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
e. List the name and address of any
person or business to whom you
lease or rent all or any portion of
this property (including oil and gas
leases.) Provide amount of rent. _________________________________ _________________
Name of tenant Amount of monthly rent
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
f. State the name and address of
any person who owns an interest in
your home with you. _________________________________
Name of tenant
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
3. How many other tracts of real property (including but not limited to fee interests, mineral interests,
transferable development rights, time shares, and contingent interests) do you have an ownership
interest in (whether held individually or with another, and whether mortgaged or not)? ____________.
For each such property, please answer the following (attach additional pages as necessary):
a. The address: ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
b. The current market value:
c. The balance due on any
mortgages: 1 st
Mortgage: _____________________
2 nd
Mortgage: _____________________
d. The name and address of each
mortgage holder: 1 st
Mortgage: ________________________________________
2 nd
Mortgage: _________________________________________
e. List the name and address of any
person or business to whom you
lease or rent all or any portion of
this property (including oil and gas
leases.) Provide amount of rent. _________________________________ _________________
Name of tenant Amount of monthly rent
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
f. State the name and address of
any person who also owns an
interest in this property. _________________________________
Name of tenant
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
4. If you lease or rent property, provide the following information:
a. The name of your landlord
b. The address of your landlord ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
City State Zip
c. The amount of your deposit
5. Are you employed? _______ (Yes/No). If A yes @ please answer the following:
a. The name of your employer
b. The address of your employer ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
c. The amount you earn per month
(including salary, wages, overtime,
incentive pay, benefits,
commissions, tips, and bonuses):
6. Do you have other employment besides that listed above? __________ (yes/no). If A yes @ , for each
such additional employment, please provide the following (attach the additional pages as necessary):
a. The name of your employer
b. The address of your employer ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
c. The amount you earn per month
(including salary, wages, overtime,
incentive pay, benefits,
commissions, tips, and bonuses):
7. Are you self-employed, own an interest in a closely held corporation, are a member of a limited
liability company, are a partner in any kind of a partnership, or a member of a nonprofit corporation?
_______ (yes/no). If yes, how many such entities do you have an ownership interest in? ________.
For each such business, please provide the following information (attach additional pages as necessary):
a. Name of this business or entity:
b. Address of the business or
entity:
c. State the average monthly gross
income of the business or entity for
the past six months.
d. List all personal property and
intangible property owned by the
business or entity (including by
way of example: tools, machinery,
automobiles, inventory, supplies,
equipment, trade names and trade
marks). Indicate whether each is
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
encumbered by a lien and where it
is located. (Attach additional
pages as necessary).
e. List all accounts receivable of
the business or entity, including the
name and address of each debtor
and the amount owed (attach
additional pages as necessary). __________________________ __________________
Name of debtor Amount owed
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________ __________________
Name of debtor Amount owed
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
f. List all real property in which
the business has an ownership
interest.
g. State the amount of cash
reserves, retained earnings and
capital accounts of the business.
h. List the name of the bank,
account number and balance of
each checking or other bank
account held by the business or
entity (attached additional pages as
necessary). _______________________ ______________________
Name of Financial Institution Account Number
_______________________
Account Balance
_______________________ ______________________
Name of Financial Institution Account Number
_______________________
Account Balance
i. List the names, addresses and
telephone numbers of any person
besides yourself who has an
ownership interest in this business
or entity and describe the
percentage of their ownership
interest. __________________________ __________________
Name of Co-Owner % Ownership
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________ __________________
Name of Co-Owner % Ownership
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
City State Zip
j. How much of this business or
entity do you own?
k. What type of entity is this
business (ie: corporation, sole
proprietorship, LLC, partnership?)
l. What does this business do?
8. Are you (or do you expect that you will be in the next 12 months) the beneficiary of any decedent = s
estate, trust, annuity, class action lawsuit settlement, or insurance policy proceeds? _____ (yes/no). If
A yes @ please state the following for each (attach additional pages as necessary):
a. Describe the nature of each
interest in which you are a
beneficiary. (For example, if you
expect to inherit money form a
decedent = s estate, please state the
name of the decedent, the court in
which the estate is probated, and
the amount you expect to inherit).
b. State the name and address of
the of personal representative,
trustee, insurer, or other
administrator involved in each
interest. __________________________
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
9. Presently, or in the next twelve months, do you expect to perform services in any of the building
trades, work as a consultant in any field, or perform contract labor or services of any kind? ______
(yes/no). If A yes @ please answer the following questions (attach additional pages as necessary).
a. Provide the name and address
of each and every person or entity
with whom you currently have (or
expect to have) a bid, contract, or
other agreement to perform work
for as a builder, tradesman,
consultant, or contract laborer in
the next twelve months. _________________________ [Project 1]
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
_________________________ [Project 2]
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
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Judgment Debtor Interrogatories
b. For each project (the person or
entity you identified above) state
the manner of payment, how much,
and when you expect to be paid. Project 1: G Time and materials; G Contract or bid price;
G Other manner of payment (specify)______________________
Dates/amount of payment:_______________________________
____________________________________________________
Project 2: G Time and materials; G Contract or bid price;
G Other manner of payment (specify) _____________________
Dates/amount of payment:_______________________________
____________________________________________________
c. For each project (the person or
entity you identified above)
identify the name and address of
the person or entity who will be
paying you (for example, identify
the bank or general contractor who
will make payments directly to you
on a building project). _________________________ [Project 1]
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
_________________________ [Project 2]
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
10. Do you have any other sources of income, including, but not limited to: gifts, royalties, contest or
lottery winnings, yard sales, hobbies, or Ebay 7 trades; or government benefits such as workman = s
compensation, disability, old age pension, Medicare, Medicaid, means-tested welfare, or
unemployment)? _____ (yes/no). If A yes @ , for each, state the following (attach additional pages as
necessary):
a. Description of source of income:
b. Name and address of person or
entity paying you this income: __________________________
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
c. Ave. monthly amount paid from
this source of income:
11. Does anyone owe you money, or have possession of anything of value that is yours (including for
example, someone you loaned money to, someone you are suing, people who are holding or storing
property that belongs to you, and utilities who are holding refundable deposits)? ______ (Yes/no). If
A yes @ , state the following for each (attach additional pages as necessary):
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
a. Description and amount or
value:
b. Name and address of person
who owes this to you: __________________________
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________
Name
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
12. What is the amount of the income tax refund you expect to receive this year: ______________.
13. What were the gross earnings you reported on your last Federal Tax Return: ______________.
14. Do you own an interest in any of the following: stocks (whether publicly or privately traded),
bonds, mutual funds, brokerage accounts, trusts, limited partnerships, certificates of deposits, securities,
promissory notes, deeds of trust, or other investments? _______ (yes/no). If A yes @ , for each, state
the following (attach additional pages as necessary).
a. Description of each investment
described above, including amount.
b. Name and address of person or
entity involved (for example, the
name of company in which you
own stock or the brokerage or
investment firm holding these
investments) and value of each __________________________ ___________________
Name Value
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________ ___________________
Name Value
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
15. What is the dollar amount of cash you have on hand: ____________________________________.
16. How many bank accounts (including checking, savings and money market accounts) do you have an
interest in or are authorized to sign checks for (whether individually or with another)? _______. For
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
each state the following (attach additional pages as necessary):
a. Description of your interest in
each such account: 1 st
Account: __________________________________________
2 nd
Account: __________________________________________
3 rd
Account: __________________________________________
b. Name and address of the
financial institution holding the
account, the balance of each such
account and the account number: _______________________ ______________________
Name of Financial Institution Account Number
Address:
_______________________
Account Balance
_______________________ ______________________
Name of Financial Institution Account Number
Address:
_______________________
Account Balance
_______________________ ______________________
Name of Financial Institution Account Number
Address:
_______________________
Account Balance
17. Do you own or have an interest in any IRA, 401(k), retirement plan, pension, credit union, or profit
sharing plans? _________ (Yes/no). If A yes @ , please state the following:
a. Name and address of the
financial institution or other entity
holding or managing these funds,
the balance of each such account
and the account number: _______________________ ______________________
Name of Financial Institution/Entity Account Number
Address:
_______________________
Account Balance/Value
_______________________ ______________________
Name of Financial Institution/Entity Account Number
Address:
_______________________
Account Balance/Value
_______________________ ______________________
Name of Financial Institution/Entity Account Number
Address:
_______________________
Account Balance/Value
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Judgment Debtor Interrogatories
18. Describe all insurance policies which you own, or have an interest in, and which have a cash
surrender value, including the name and address of the insurer and the value.
19. List and describe all copyrights, published or unpublished writings or works, inventions, patents,
trade names, trademarks, internet domain names, and other intellectual or intangible property in which
you own or have an interest in.
20. How many motor vehicles (cars, trucks, vans, motorcycles), boats, snowmobiles, water craft,
aircraft, all terrain vehicles or off highway vehicles (ATVs or OHVs), mobile homes, manufactured
homes, motor homes, camping trailers, utility trailers, livestock trailers, or like vehicles, trailers, or
recreational vehicles do you own or have an interest in (whether individually or with another person)?
___________. For each, state the following information (attach additional pages as necessary):
a. Describe each and state the year,
make, model, VIN or serial
number, value, location, and name
and address of any lien holder: _______________________________ ____________
Description Year
_____________ ___________ ___________________
Make Model VIN or Serial Number
________________________ ___________________________
Value Location
____________________________________________________
Name and address of lien holder (if any)
_______________________________ ____________
Description Year
_____________ ___________ ___________________
Make Model VIN or Serial Number
________________________ ___________________________
Value Location
____________________________________________________
Name and address of lien holder (if any)
_______________________________ ____________
Description Year
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
_____________ ___________ ___________________
Make Model VIN or Serial Number
________________________ ___________________________
Value Location
____________________________________________________
Name and address of lien holder (if any)
_______________________________ ____________
Description Year
_____________ ___________ ___________________
Make Model VIN or Serial Number
________________________ ___________________________
Value Location
____________________________________________________
Name and address of lien holder (if any)
21. Describe and provide the location of all jewelry, lawfully possessed Native American antiquities,
precious metals, rare coins, antiques, art, sporting goods, firearms, mountain or road bicycles, skis,
snow boards, Native American rugs or folk art, horse tack, electronics, tools, and other collectibles and
like property, in which you have an ownership interest (attach additional pages as necessary):
22. Describe and state the location of all horses, cattle, and other livestock, registered brands, farm and
ranch machinery tools and equipment, grazing permits, agricultural leases, and crops in which you have
an ownership interest.
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
23. Describe and list the location of all of your furnishings and appliances.
24. Describe and provide the location of any bank safe deposit box or storage units which you own or
lease and describe the contents of each.
25. Describe all other real, personal, or intangible assets which you have not listed elsewhere.
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
26. Have you given, sold, transferred, or assigned to any person or entity any money, real property,
personal property, intangible property, or anything else of value during the past 36 months? _______
(yes/no). If so, for each, state the following (attach additional pages as necessary):
Using the form on the right answer
these questions:
a. Describe separately all property
and things of value that you have
given, sold, transferred or assigned.
b. Provide the name and address of
the person or entity to whom it was
transferred.
c. The date transferred.
d. The value of the property
transferred.
e. The amount you where paid for
the property.
f. Describe how the person or
entity who received the property is
related to you. In doing so,
indicate if that person or entity falls
into one of the following three
categories:
(i) Creditor: The person or entity
is a creditor (someone you owed
money to);
(ii) Relative: The person to whom
you transferred the property is a
relative of yours by blood or
marriage. In which case, describe
how you are related. ____________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
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Judgment Debtor Interrogatories
(iii) Insider/Affiliate: The entity to
which you transferred the property
is a business entity (partnership,
LLC, corporation, etc.) in which
you are an officer, director, owner,
or otherwise have control over. ______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
27. State the name and current address of your spouse and/or former spouse:
28. How many pages have you attached to these interrogatories? ________________.
PART B: SMALL BUSINESS DEBTOR INTERROGATORIES:
29. Please state the following information about the person answering these interrogatories on behalf of
a corporate debtor (defined as any corporation, limited liability company, partnership, limited
partnership, limited liability partnership, or non profit corporation):
a. Your name:
b. Your address: ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
c. Your telephone number: (______) _______-_____________
d. Your title and relationship to
the debtor company
30. If corporate debtor leases real property, provide the following information:
a. The name of landlord
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
b. The address of landlord ________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
c. The amount of security deposit
31. Answer all of the following questions about the corporate debtor (attach additional pages as
necessary):
a. All names and trade names used
by this business:
b. Addresses of all business
locations:
c. State the average monthly gross
income of the business for the past
twelve months.
d. List all personal property and
intangible property owned by the
corporate debtor (including by way
of example: tools, machinery,
automobiles, inventory, supplies,
equipment, trade names and trade
marks). Indicate which property
is encumbered by a lien. Describe
the location of each. (Attach
additional pages as necessary).
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
e. List all accounts receivable of
the debtor, including the name,
address, and phone number of each
debtor (attach additional pages as
necessary). __________________________ __________________
Name of debtor Amount owed
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________ __________________
Name of debtor Amount owed
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
f. List all real property in which
the debtor has an ownership
interest.
g. State the amount of cash
reserves, capital accounts and
retained earnings of the debtor.
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
h. List the bank, account number
and balance of each checking or
other bank account held by the
debtor (attached additional pages
as necessary). _______________________ ______________________
Name of Financial Institution Account Number
_______________________
Account Balance
_______________________ ______________________
Name of Financial Institution Account Number
_______________________
Account Balance
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
i. List the names, addresses and
telephone numbers of every person
who has an ownership interest in
the debtor entity (shareholders,
members, partners, etc.) __________________________ __________________
Name of Co-Owner % Ownership
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
__________________________ __________________
Name of Co-Owner % Ownership
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
j. What type of entity is this
business (ie: sole proprietorship,
LLC, partnership, non profit
corporation?)
k. What is the EIN or tax ID
number for this business?
l. List the names and addresses of
the mangers, directors, or partners
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
of the debtor
m. List the names and addresses
of the president, secretary,
treasurer, CEO, CFO and other
officers of the debtor.
n. State the dates the members or
shareholders of the debtor have
met during the past 36 months.
o. State the dates the managers or
directors of the debtor have met
during the past 36 months
p. Provide the name and address
of the person who has possession
of the minutes other corporate
records of the debtor.
q. Provide the name and address
of the person who has possession
of the books and financial records
of this business.
32. What type of entity is corporate debtor taxed as for Federal Tax purposes?: ______________
33. State the amount of gross income reported for corporate debtor on its last Federal Tax return:
__________________.
34. List all other assets for the corporate debtor which have not already listed.
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
35. How many employees does this debtor have? __________________________________________
36. What kind of business is this debtor engaged in?
_________________________________________
37. If any single contract, customer or client of the debtor company is expected to be the source of
more than 10% of its total gross income over the next twelve months, please describe nature of the
products to be sold or services to be performed and state the name and address of each such customer or
client.
38. Except in the usual course of its business, has the debtor sold, given, transferred, or assigned to
any person or entity any of its assets, capital, or other property (including money, real property,
personal property or other thing of value) during the past 36 months? _______ (yes/no). If A yes @ , for
each, state the following (attach additional pages as necessary):
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
Using the form on the right answer
these questions:
a. Describe separately all property
and things of value that debtor has
given, sold, transferred or
assigned.
b. Provide the name and address
of the person or entity to whom it
was transferred.
c. The date transferred.
d. The value of the property
transferred.
e. The amount debtor was paid for
the property.
f. Describe how the person or
entity who received the property is
related to the debtor. In doing so,
indicate if that person or entity
falls into one of the following
categories:
(i) Creditor: The person or entity
is a creditor of the debtor;
(ii) Insider: The person to whom
debtor transferred the property is a
relative by blood or marriage of
any director, partner, manger,
officer or person having control of
the debtor. In which case, describe
how they are related.
(iii) Affiliate: The entity to which
the property was transferred is
controlled by the debtor or any of
its directors, managers, partners,
officers, or other persons who have
control of the debtor. ____________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
___________________________________________________
Description of property transferred
____________________________________________________
Name and Address of Person to Whom Property Transferred
________________________ _________
Street Unit or Apt No.
________________________ _________ ________
City State Zip
______________________ ____________________________
Date of Transfer Value of Property Transferred
______________________ ____________________________
Amount You Were Paid Description of relationship
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Judgment Debtor Interrogatories
39. List and describe debtor = s other debts and liabilities:
40. How many pages have you attached to these interrogatories on behalf of corporate debtor?
________________.
STATE OF COLORADO )
)ss.
COUNTY OF _________________ )
I swear under penalty of perjury that the forgoing answers to these interrogatories when
are true and complete, to the best of my knowledge, information and belief as of this date.
_____________________________________
Signature of Defendant/Judgement Debtor
Subscribed and sworn to before me this _____ day of ________, 200___, by
____________________.
Witness my hand and official seal. My commission expires: _________________.
____________________________________
Notary Public
Address:
8 Jon Lewis Kelly 2005
Judgment Debtor Interrogatories
AFFIDAVIT OF SERVICE
STATE OF COLORADO )
)ss.
COUNTY OF _________________ )
I ___________________________, being first duly sworn do hereby declare to the
undersigned authority that I personally served a true and correct copy of the forgoing RULE
69/369 DEBTOR INTERROGATORIES on _________________________________, by
_____________________________________________________________ on the ______ day
of ________________________, 200____.
I state that I am over the age of 18 years and that I am not a party to this case.
I have charged the Plaintiff the sum of $_______ for service and $______ for millage for
a total of $_______________.
_____________________________________
Signature of Process Server
Subscribed and sworn to before me this _____ day of ________, 200___, by
____________________.
Witness my hand and official seal. My commission expires: _________________.
____________________________________
Notary Public
Address:
