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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA CIVIL DIVISION – SMALL CLAIMS BRANCH DATE: ____________________________________ QUESTIONS FOR ORAL EXAMINATION SMALL CLAIM CASE NUMBER: ____________________________________ 1. NAME (First, Last, MI): 2. DATE OF BIRTH ___________________________________________________ ____________________________________ 3. ADDRESS: 4. TELEPHONE NUMBER: ___________________________________________________ ____________________________________ ___________________________________________________ 5. MORTGAGE HOLDER OR LANDLORD: 6. SOCIAL SECURITY NUMBER: ___________________________________________________ ____________________________________ 7. PLACE OF EMPLOYMENT: 8. SALARY:__________________ PER:__________ ___________________________________________________ 9. WHEN PAID: ____________________________ 10. OTHER INCOME: _____________________________________________________________________________________________ 11. CHECKING ACCOUNT NO. & NAME OF BANK: 12. SAVINGS ACCOUNT NO. & NAME OF BANK: ______________________________________________ ___________________________________________ 13. AUTOMOBILE (Make and Model) 14. YEAR: 15. SERIAL NUMBER: ______________________________________________ __________ ____________________________ 16. FINANCED BY: 17. BALANCE DUE: ___________________________________________________ ____________________________________ 18. MAJOR APPLIANCES OWNED BY YOU: _____________________________________________________________________________________________ 19. OTHER ASSETS (Stocks, Bonds, etc.): _____________________________________________________________________________________________ 20. OTHER ACCOUNTS (if any): _____________________________________________________________________________________________ 21. OFFER OF SETTLEMENT (if any): _____________________________________________________________________________________________ _____________________________________________________________________________________________ 22. PLAINTIFF (S): 23. DEFENDANT (S): ____________________________________ ____________________________________ ____________________________________ ____________________________________

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