NYC 9/11 Public Portal Document
1 ?. Q. Is judgment debtor(s) a member of a union? A. If yes, give name and address of union, union number, status of
membership and social security number. A.
12. Q. State the name and address ofjudgment debtor(s) present employer. A.
13. Q. State the name and address ofjudgment debtor(s) last known employer. A.
14. Q. What is the name ofjudgment debtor(s) children, their ages and the schools they attend? A.
15. Q. Does the judgment debtoifs) own or rent a home? A. If rented, the name and address of the landlord. A.
16. Q. Are you the owner or managing agent of premises located at
A.
17. Q. Are either of the judgment debtor(s) cooperative tenants of said premises? A. If yes, give apartment number,
number of shares held, by whom, in whose name, purchase price and present value. A.
18. Q. What is the monthly rental or canying charges paid by judgment debtor(s)? A. If paid by check, state date of last
payment due and upon which bank and branch said check was drawn. A.
19. Q. Prior to the judgment debtor(s) taking possession and occupancy of said premises did they make application to you for said
apartment? A. If yes, attach^ a true copy of said application.
20. Q. Are you related to judgment debtor(s) either by blood ties or through marriage? A. If yes, state said relationship. A.
21. Q. Is the judgment debtor(s) your landlord? A. If no, give name and address of landlord. A.
22. Q. How many rooms do you occupy and how much rent do you pay? A.
State the date of last payment and if paid by check where was same deposited? A.
23. Q. Are you a tenant under a lease and do you have any security on a deposit with landlord? A. If yes, name the bank and branch
in which the money is deposited. A.
24. Q. Do you represent this judgment debtor in any capacity? If so, state details in full as to the representation. Where, against
whom, and who represents the opposition. A.
25. Q. Do you or any member of your company or firm maintain an escrow account with any assets, stocks, bonds, promissory
notes or funds including but not limited to monies due to or containing monies deposited by or put up by or m judgment
debtor’s favor or name? A. If so, provide the name and address of the bank or escrow agent, the account number
and balance thereof. A.
26. Q. Do you or any member of your company or firm know of the existence of any escrow accounts containing any assets,
stocks, bonds, promissory notes or funds including but not limited to monies due to or containing monies deposited by or
put up by or in judgment debtor’s favor or name? A. If so, provide the name and address of the bank or escrow
agent, the account number and balance thereof. A.
The name signed must be printed beneath
Sworn to before me this
day of ,20
Notary Public
NYC-WTC_000159313
OCR can misread numbers and units. Confirm readings against the page image before using them.