Information Required on a Financial Statement

Adm 1003.02 Information Required on a Financial Statement. A financial statement shall contain the following information about the defendant: (a) His or her: (1) Name; (2) Address; (3) Telephone number; (4) Date of birth; and (5) Age; (b) His or her marital status, whether: (1) Single; (2) Married; (3) Divorced; (4) Separated; or (5) Widowed; (c) With respect to dependents personally supported by the defendant: (1) Their names; (2) Their addresses if different from that of the defendant; (3) Their relationship to the defendant; and (4) Their ages; (d) For both the defendant and a spouse of the defendant, the amounts of the following kinds of funds available to each of them, individually: (1) Cash on hand; (2) Money in checking accounts; (3) Money in savings accounts; (4) Funds in stocks, bonds, trusts, certificates of deposit and similar investments; and (5) The total sum of the amounts provided for (1) through (4), above; (e) For both the defendant and a spouse of the defendant, the amounts of the following received by each of them, individually, weekly, and monthly: (1) Take home pay in the form of wages or salary; (2) Alimony or maintenance received; (3) Child support received; and (4) The total sum of the amounts provided for (1) through (3), above; (f) For the defendant and a spouse of the defendant, the following employment information: (1) Name of employer; (2) Address of employer; and (3) Whether employment is full time, part time or seasonal; (g) The defendant's monthly housing costs in the form of: (1) Monthly rent or mortgage; (2) Utilities; and (3) The total sum of the costs provided for (1) and (2), above; (h) The defendant's monthly loan payments, including the following information about such payments: (1) The payee(s); (2) The purpose(s) of the loan(s) being repaid; (3) The balance(s) due on the loan(s); (4) The amount(s) of the monthly payment(s); and (5) The total of all monthly loan payments; (i) Additional monthly payments, such as alimony, child care and child support, including: (1) The payee(s); (2) The purpose(s) of the payment(s); (3) The sum(s) still owed; (4) The amount(s) of the monthly payment(s); and (5) The total of all such monthly payments; and (j) With respect to the defendant's ownership of real estate and personal property: (1) Whether the defendant owns a house or other real estate, and if so: a. Identification of the real estate; b. The market value of such real estate; c. The identity of the mortgage holder on such real estate, if applicable; and d. The amount of the mortgage on such real estate, if applicable; and (2) Whether the defendant has, within the last 6 months, sold or transferred real estate or personal property worth $200.00 or more, and if so: a. Identification of such real estate or property; b. The identity of the transferee of such real estate or property; c. The value of such real estate or property; and d. The amount received for such real estate or property. Source. (See Revision Note at chapter heading for Adm 1000) #8697, eff 8-3-06; ss by #9149, eff 5-1-08; ss by #10728, eff 11-25-14; ss by #13050, eff 7-1-20