Judgment Information Form

Case number (if known): [field id="email"]
Name of the court: [field id="field_f9af82b"]
Court branch : [field id="field_a543579"]
Court County:  [field id="field_9613f59"]
Court Address: [field id="field_0f1c415"]
Court Phone Number: [field id="field_2469ca2"]
Amount of judgment:  [field id="field_d1ff46b"]
Amount collected to date:  [field id="field_18f7341"]
Date judgment was issued:  [field id="field_af054bf"]
State in which judgment was issued: [field id="field_cc81ed0"]
Were you represented by an attorney?  [field id="field_53a758d"]
Was your judgment awarded by default (defendant not present)?  [field id="field_1eacb07"]
Does judgment debtor (defendant) now reside in a different state?  [field id="field_450ada4"]
Name of judgment debtor:  [field id="field_e8870ca"]
Last known street address of judgment debtor:  [field id="field_73c279e"]
Last known city, state, & zip of judgment debtor:  [field id="field_357ad3a"]
Last known phone number(s) of judgment debtor:  [field id="field_1de1a74"]

Personal Information


Full name:  [field id="field_8f6eafb"]
Street address:  [field id="field_7853701"]
City, state & zip:  [field id="field_edd875b"]
Telephone no:  [field id="field_65d758e"]
E-mail address:  [field id="field_f57e576"]
Please describe how you heard of us:  [field id="field_b9cb582"]
Description of my case ( please be brief but thorough ):  [field id="field_89684d9"]
Copy of judgment (please make selection): [field id="field_774a659"]
[field id="field_0c966e0"]
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