Fill and Sign the Justia Appearance Alaska Criminal Statewide Form

Exempt From VRA Certif. Page 1 of 2 CR -445 ( 5/17 ) ( cs) SENTENCING AFFIDAVIT Administrative Bulletin No. 43 IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA ) ) ) Plaintiff, ) ) vs. ) ) ) ) CASE NO. CR Defendant. ) ) SENTENCING AFFIDAVIT INSTRUCTIONS Instructions to Defendant: Because y ou 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 transferred 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. Find payment instructions at www.courts.alaska.gov/trialcourts/ payments.htm , or contact your local court clerk. 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. Date of Birth : 4. 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.] 5. Residence address: 6. Mai ling address: 7. Phone Numbers. Home: Work: Page 2 of 2 CR -445 ( 5/17 ) (cs ) SENTENCING AFFIDAVIT Administrative Bulletin No. 43 8. Employment information. Check all boxes which apply to you and fill in the blanks. Current employer's name: Employe r's address: Self -employed. Type of business: Address of business: Employed on seasonal basis. Seasonal employer's name: Employer’s ad dress: Currently unemployed. L ast 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: Descriptio n of Property : Location of Property : (For example: house, land, condominium, etc.) (Street & house number, town & state) 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 ,20 , at , Alaska. Judge/Clerk/Notary Public (SEAL) My Co mmission Expires: