| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| State: |
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| Zip Code: |
(5 digits) |
| Daytime Phone: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| Judgment Debtor Name(s): |
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| State & County where judgment was rendered: |
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| Briefly explain why you took your debtor to court: |
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| Briefly explain why you took your debtor to court: |
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| What attempts have you made to collect on the judgment so far?: |
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| Please list your debtor's last known address: |
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| Please list your debtor's SSN, if you know it: |
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| Does judgment debtor currently reside in the state where judgment was rendered? |
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| If not, has the case been domesticated into the debtor's current state of residence: |
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| Is your judgment debtor currently a renter? |
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| If your judgment debtor is a business, is it still operational?: |
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| Is your debtor currently in bankruptcy proceedings?: |
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