Free County Court __________________________ County, Colorado - Colorado

County Court __________________________ County, Colorado Court Address:

Plaintiff(s)/Petitioner(s): v. Defendant(s)/Respondent(s): Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

PATTERN INTERROGATORIES UNDER C.R.C.P. 369(g) - BUSINESS
The following Pattern Interrogatories are propounded to __________________________________ (name of Judgment Debtor) pursuant to C.R.C.P. 369(g).

Answer all of the questions and each and every part thereof fully and completely. Your answers must be filed with the Court and a copy mailed to the sender no later than 10 days after you receive them. Use a separate sheet of paper, if necessary. Do not use Post Office boxes for any address provided in your answers unless you request and receive permission from the Court.

1. State the name, business address , home address, business phone, home phone, and date of birth of the person answering these questions, and the relationship to the Business: Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________ Date of Birth: ___________________________

2. If the Business is a corporation, list the name, home address, business address, home phone, business phone, and date of birth and the title of each officer, direction and shareholder owning 5% or more of the outstanding shares. Name: ______________________________________ Title: ________________ Date of Birth: __________ Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________ Name: ______________________________________ Title: ________________ Date of Birth: __________ Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________

FORM 7A

JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS

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3. If the Business is not a corporation, state the form of entity (sole proprietorship, partnership, limited liability company, or otherwise) and list the name, homes address, business address, home phone, business phone, and date of birth and the title of each owner, general or limited partner, or member owning 5% or more of the Business. Name: ______________________________________ Title: ________________ Date of Birth: __________ Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________ Name: ______________________________________ Title: ________________ Date of Birth: __________ Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________ Name: ______________________________________ Title: ________________ Date of Birth: __________ Home address: __________________________________________________________________________ Business address: ________________________________________________________________________ Home phone: _______________________________ Business phone: ______________________________ 4. Provide the EIN and/or Federal Tax Id Number of the Business. EIN: ______________________________ Federal Tax Id: ________________________________

5. List by year, make, model, purchase price, VIN, loan balance, if any, and current location of any and all cars, trucks, motorcycles, boats, trailers, and other motor vehicles owned, used by or titled in the Business during the last four years. If the property is not owned by the Business, list the name and address of the owner. If the property has been transferred to another person or entity, list the name, address and telephone number of the transferee, the date of transfer, and the amount paid by transferee. Make: ________________ Model: _____________ Year: _______ VIN: ____________________________ Purchase Date: _________________Price: _______________ Loan Balance, if any: ___________________ Current Location: ________________________________________________________________________ Name of Owner if not you: _________________________________________________________________ Address of Owner: _______________________________________________________________________ Name of Person Property Transferred to: ______________________________________________________ Address: ____________________________________________________ Phone Number: ______________ Make: ________________ Model: _____________ Year: _______ VIN: ____________________________ Purchase Date: _________________Price: _______________ Loan Balance, if any: ___________________ Current Location: ________________________________________________________________________ Name of Owner if not you: _________________________________________________________________ Address of Owner: _______________________________________________________________________ Name of Person Property Transferred to: ______________________________________________________ Address: ____________________________________________________ Phone Number: ______________

FORM 7A

JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS

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6. List each and every financial institution, including banks, savings and loan associations, credit unions, brokerage houses, or otherwise, where the Business is named on an account or has signature authority, including the name, address and telephone number of the institution, the account number, and the current balance of each account. Name: _______________________________________________Telephone Number: _________________ Address: _______________________________________________________________________________ Type of Account: ______________ Current Balance: _____________ Account Number (last 4-digits): ______ Name: _______________________________________________Telephone Number: _________________ Address: _______________________________________________________________________________ Type of Account: ______________ Current Balance: _____________ Account Number (last 4-digits): ______ Name: _______________________________________________Telephone Number: _________________ Address: _______________________________________________________________________________ Type of Account: ______________ Current Balance: _____________ Account Number (last 4-digits): ______

7. List any and all real or personal property owned by the Business during the last four years, or in which the Business has an interest, where the purchase price or present value exceeds $500.00, including a detailed description, purchase price, current value, amount of any loan balance against the property, and the location including the county. If the property has been transferred to another person or entity, list the name, address and telephone number of the transferee, the date of transfer, and the amount paid by transferee. Description of Property: ___________________________________________________________________ Purchase Date: _____________________Price: _______________ Current Value: ____________________ Loan Balance: _______________________________ Location (including the County: __________________ Transfer Date: _________________Price Paid: _____________ Name: _____________________________ Address of Purchaser: _____________________________________________________________________ Telephone Number: ______________________________________________________________________ Description of Property: ___________________________________________________________________ Purchase Date: _____________________Price: _______________ Current Value: ____________________ Loan Balance: _______________________________ Location (including the County: __________________ Transfer Date: _________________Price Paid: _____________ Name: _____________________________ Address of Purchaser: _____________________________________________________________________ Telephone Number: ______________________________________________________________________ Description of Property: ___________________________________________________________________ Purchase Date: _____________________Price: _______________ Current Value: ____________________ Loan Balance: _______________________________ Location (including the County: __________________ Transfer Date: _________________Price Paid: _____________ Name: _____________________________ Address of Purchaser: _____________________________________________________________________ Telephone Number: ______________________________________________________________________

FORM 7A

JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS

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8. If the Business owns any property which is leased to another person or entity, identify the property and provide the lessee's name, address, and phone number, the term of the lease, the amount of lease payments, and the dates that the payments are due. Type of Property: _____________________________________ Lessee's Name: ______________________ Address: _______________________________________________________________________________ Telephone Number: ___________________________________ Term of Lease: ______________________ Lease Payment Amount: ______________________Payment Due Dates: ____________________________ Type of Property: _____________________________________ Lessee's Name: ______________________ Address: _______________________________________________________________________________ Telephone Number: ___________________________________ Term of Lease: ______________________ Lease Payment Amount: ______________________Payment Due Dates: ____________________________ 9. List every person or entity which owes money to the Business in excess of $500.00, including the name, address and phone number, the amount owed, if payments are due, the amount and dates they are due, and the reason the moneys are owed. Name: ___________________________ Telephone Number: ______________ Amount Owed: __________ Address: _______________________________________________________________________________ Payment Amount: ______________________Payment Due Dates: _________________________________ Reason(s) the moneys are owed: ____________________________________________________________ Name: ___________________________ Telephone Number: ______________ Amount Owed: __________ Address: _______________________________________________________________________________ Payment Amount: ______________________Payment Due Dates: _________________________________ Reason(s) the moneys are owed: ____________________________________________________________ Name: ___________________________ Telephone Number: ______________ Amount Owed: __________ Address: _______________________________________________________________________________ Payment Amount: ______________________Payment Due Dates: _________________________________ Reason(s) the moneys are owed: ____________________________________________________________ 10. List every person or entity currently using the services or products of the Business averaging more than $100.00 per month, including the address and phone number, the amount billed or purchased each month, and the billing dates. Name: ______________________________________ Telephone Number: ______________________

Address: _______________________________________________________________________________ Amount Billed or Purchased each Month: ______________________Billing Dates: ____________________ Name: ______________________________________ Telephone Number: ______________________

Address: _______________________________________________________________________________ Amount Billed or Purchased each Month: ______________________Billing Dates: ____________________ Name: ______________________________________ Telephone Number: ______________________

Address: _______________________________________________________________________________ Amount Billed or Purchased each Month: ______________________Billing Dates: ____________________
FORM 7A JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS Page 4 of 6

11. Produce and attach to your answers, copies of the following documents for the last four years: a. b. c. d. For corporations, the articles of incorporation, bylaws, and corporate minutes. For partnerships, the partnership agreement. For limited liability companies, the articles of organization and operating agreement. For all entities, annual: i. Federal and state tax returns. ii. Profit and loss statements. iii. Balance sheets. iv. Inventory lists.

12. If the Business wishes to propose an arrangement to pay the judgment, state the proposed terms. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

If the Business is not longer in business, answer the following questions:
13. State the date and exact reasons the Business went out of business. Date: ______________________________ Reason(s): _____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 14. If the Business disposed of any of its assets when it went out of business, describe each item which was disposed of, the name, address and telephone number of the person or entity which took possession of the item, any amounts paid for the item, and the reason for the disposition. Description: _____________________________________ Amount Paid: ___________________________ Name: ______________________________________ Telephone Number: ______________________

Address: _______________________________________________________________________________ Reason for Disposition: ___________________________________________________________________ Description: _____________________________________ Amount Paid: ___________________________ Name: ______________________________________ Telephone Number: ______________________

Address: _______________________________________________________________________________ Reason for Disposition: ___________________________________________________________________ 15. If the Business has any remaining assets, describe each item, including the current value, location and amount of the loan against that item, if any. Description: ____________________________________________________________________________ Location: _____________________Current Value: _______________ Loan Balance: __________________ Description: ____________________________________________________________________________ Location: _____________________Current Value: _______________ Loan Balance: __________________ Description: ____________________________________________________________________________ Location: _____________________Current Value: _______________ Loan Balance: __________________
FORM 7A JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS Page 5 of 6

16. If the Business is in receivership or a trustee has been appointed, provide the name, address and phone number of the receiver or trustee. Name: _________________________________________ Telephone Number: _______________________ Address: _______________________________________________________________________________ 17. If there are any documents associated with the Business going out of business (e.g., bill of sale, deed in lieu of foreclosure, articles of dissolution), produce and attach them to your answers.

Failure to respond fully, accurately and timely to these interrogatories could result in a citation for contempt of court.
I do hereby affirm under penalty of perjury that I have read each of the above questions and answered them fully and truthfully.

Dated: ________________________________

___________________________________________

Judgment Debtor

Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20______.

My Commission Expires: ________________________

______________________________________ Notary Public /Deputy Clerk

CERTIFICATE OF SERVICE BY MAILING
(To be performed by Clerk within three days of filing)
I hereby certify that on ______________________(date), I mailed a true and complete copy of the PATTERN INTERROGATORIES UNDER C.R.C.P. 369(g) - BUSINESS by placing them in the United States Mail, postage pre-paid to the Defendant at the address listed below.

To:

_________ _ _ __________________________________________ Clerk of Court/Deputy Clerk

FORM 7A

JDF 108 R1/08 PATTERN INTERROGATORIES UNDER CRCP 369(g) ­ BUSINESS

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