Free Order on Motion for Miscellaneous Relief - District Court of Connecticut - Connecticut

Case 3:03-cr—00025-PCD Document 11 Filed 11/28/2006 Page 1 of 4 {’jy';é;(`
UNITED STATES DISTRICT COURT §:f§.lg?£i
DISTRICT OF CONNECTICUT
UNITED STATES OF AMERICA, : ml NEW 28 P 3* G5
V- = DOCKET NO= 3=O3CR@?s. EH€¥?‘?%;Q.»
Melanie A. Miller, : NEwEi{F{wJCT
O R D E R _
Plaintiff having filed a Motion to Examine Judgment Debtor
and for a hearing on defendant's ability to pay the judgment
rendered against defendant, it is hereby:
ORDERED that the defendant, Melanie A. Miller, appear before
the District Court igiéiialéga-om Number; at {Vu C!\"r¤·h~ 5*4}-fftkjg Nm Hx
Connecticut on the _EiE; day of ~)>v¤;b , 200%, at i:$°
o'clock in the'f*fn. noon, and then and there be examined under
oath concerning her assets and her ability to pay the judgment.
The Court may make such orders at the hearing or thereafter that
it determines to be reasonably calculated to facilitate payment
of the judgment. It is further ORDERED that defendant bring with
her and produce at the hearing all documents sought by
plaintiff's Request for Production Served on or about August BI,
2006, as well as a completed copy of the financial statement
attached hereto as Exhibit "A" to facilitate the Court's
examination of the defendant.
The defendant is advised that failure to appear before the
Court at the scheduled time and place and produce the
aforementioned documents as ordered above, may subject the
defendant to being held in Contempt of Court and having a Capias
issued for the arrest of the defendant.

Case 3:03-cr—00025-PCD Document 11 Filed 11/28/2006 Page 2 014
Dated this 23*-T` day 0f Nude , 2006,
at N ew H”·—-·· , Connecticut.
T . —>~m—¤ c. rm {1 Mw
UNITED STA DISTRICT JUDGE

Case 3:03-cr—00025-PCD Document 1 1 Filed 1 1/28/2006 Page 3 of 4
FINANCIAL AFFIDAVITtplease type or print)
SECTION 1. eenson/te DATA
Mr. Mrs. Ms. Miss.
last name first middle initial social security date ofbirth
complete address (including city/state/zip code) home phone work phone
Martial status (please check) License N0.
single married widowed divorced __ separated
name ofspouse social security number date ofbirth
age(s) of dependents (ifolder than 21 please list dcpcndant's name and reason for dependency)
SECTION 11. HISTORY or EMPLOYMENT
name/address of current employer occupation years/months employed
spouse eivipeovmenr
name/address of current employer occupation years/months employed
aveeace M0NT111sv nospam) wtre MoNTH1sY AMOUNT
mcoivte expenses
MONTHLY onoss SALARY s neism Monroaoe
before a roll deductions PAYMENT
DEDU OHONS _- FOOO -
reoemtLxsTATexLocA1. UTILITIES/HEAT
mcome TAXES
Q_ T OLOOO _
SO¤·OtSm·w -2 OOSORONOE _
TOTAL neoucrions MEDICAL (Non
REIMBURSABLE
wer TAKE Home pay s Aero Repaim
OTHER L1v1NG
expenses
Combined monthly income: How much of the balance can you apply
to your debt to the U.S. on a monthly basis? S
If total monthly expenses exceed monthly income,
how do you pay the difference?
Total monthly expenses:
"Exhibit A"

Case 3:03-cr—00025-PCD Document 1 1 Filed 1 1/28/2006 Page 4 of 4
SECTION III ASSETS
NAME/ADDRESS OF BANK INSTITUTION:
Do you own: (please circle)
1. U.S. savings bonds? Yes No
bank account balance: $ $ 2. stocks and other bonds? Yes No
checking savings other
3. Do you own any property? Yes No
(if not continue)
complete address of property:
cash value of fumiture
and household goods: $
(current value) $
aut0mObile(s): (estimate value of each vehicle)
make year model
trailcrfboats/campers (resale value):$
I.
2.
SECTION IV. INSTALLMENT CONTRACTS/OTHER DEBTS
**Show here all debts which ou are re uired to a in re ular month] installments. Do not include livin ex enses.**
NAME OF CREDITOR PURPOSE OF DEBT ORIGINAL UNPAID BALANCE AMOUNT DUE AMOUNT
AMOUNT OF DEBT MONTHLY PAST DUE
**NOTE: IF REPAYMENT OF DEBT IS NOT ON A MONTHLY BASIS, PLEASE EXPLAIN WHEN PAYMENT IS DUE**
Have you ever been in bankruptcy? lf yes, date discharged location of court (city/state) docket number
Are you currently in the military? yes no U
ll` applicable, what is your present unit assigned? total years active duty
***PLEASE USE ADDITIONAL SHEETS, IF NECESSARY TO SUPPLY ANY OTHER PERTINENT INFORMATION ABOUT YOUR
FINANCIAL STATUS.*** .
With knowledge of the penalties for false statements provided by 18 U.S.C. § 1001, $250,000 line and five years imprisonment and with
knowledge that this financial statement is submitted by me to affect action by the Department of Justice, I certify that I believe the above
statement is true and that it is a complete statement of all income and assets, real and personal, whether held in my name or be any other.
I hereby certify that this financial statement is made to affect action by the Department of Justice regarding a debt $24,004.10 as of
October 16, 2006, which I acknowledge is due and owing to the United States.
signature of debtor date signed