EFTA00592941.pdf

Note: Fed.R.Civ.P. Rule 33(a) limits interrogatories to 25 in number, including subparts. These will need to be reduced to those pertinent to your case. Some of the requested information may be obtained thru the Request For Production Of Documents To Judgment Debtor. IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UNITED STATES OF AMERICA, ) ) Plaintiff ) ) vs. ) ) CIVIL NO. ) ) Defendants ) ) UNITED STATES' INTERROGATORIES TO JUDGMENT DEBTOR [ 1 UNITED STATES OF AMERICA, a judgment creditor herein and pursuant to Rules 69 and 33 of the Federal Rules of Civil Procedure, submits the following interrogatories to judgment debtor Each interrogatory is to be answered fully and under oath or under the penalty of perjury, with such answers returned to the undersigned at his address listed below on or before EXHIBIT 10 EFTA00592941  INSTRUCTIONS I. If the answer to any interrogatory is fully and fairly contained in a document, from which the answer can without unreasonable difficulty be extracted, you may answer the interrogatory by attaching a copy of such document. 2. The answers to these interrogatories shall be supplied by mailing a copy of such to the undersigned trial attorney at the following address: U.S. Department of Justice, Trial Attorney, Tax Division, P.O. Box 227, Ben Franklin Station, Washington, D.C. 20044. DEFINITIONS The term "you," "yourself," and "your" shall refer to [the judgment debtor) and any attorneys or agents who acted behalf on his behalf. The phrase "period in question" shall refer to to present. INTERROGATORIES 1. State the full name, address and telephone number of all your employers or businesses during the period in question, and state the nature of your present occupation. RESPONSE: EFTA00592942  2 2. Identify each person or entity for whom you performed services during the period in question and state the amount you were paid for your services or the amount you are owed for your services. RESPONSE: 3. Do you have any interest in a corporation, partnership, or trust? If so, state the name and address of each such corporation, partnership, or trust, and include the names, addresses and telephone numbers of all other shareholders, partners, settlors, trust protectors, trustees, and beneficiaries. RESPONSE: EFTA00592943  3 4. Identify by name, address and telephone number each and every domestic and foreign bank and/or financial institution in which you have an account or over which you have signatory authority or other such control, and provide the account number, type of account, and account balance from to present. In addition, identify the record owner or title of the account. RESPONSE: 5. State whether you rent or have access to a safety deposit box titled in your name or in any other name. If so, state the name and address of the bank or other financial institution at which the safety deposit box is maintained, the name and address of the person under whose name the box is rented, and list and describe in detail the contents of the box as of the date that these interrogatories were served as set forth on the attached certificate of service. RESPONSE: EFTA00592944  4 6. Furnish the following financial information with respect to yourself as of Fair Market Assets Cost ($) Value ($) (1) cash (2) cash surrender value of insurance (3) accounts receivable (4) notes receivable (5) merchandise inventory (6) real estate (7) furniture and fixtures (8) machinery and equipment (9) trucks and delivery equipment (10) automobiles (11) stocks, bonds, or other securities (12) pensions or annuities (13) gold (14) silver (15) jewelry EFTA00592945  5 Fair Market b. Liabilities Amount ($1 Value (S1 (1) loans on insurance (2) accounts payable (3) notes payable (4) mortgages (5) accrued real estate taxes (6) judgments (7) reserves EFTA00592946  6 7. Provide the following information relating to insurance policies now in force and owned directly or indirectly by you: Present Cash Number Name Amount Surrender Value of Policy of Company of Policy Accumulated Dividends (1) (2) (3) (4) (5) (6) Automatic Premium Policy Loan Date Made Payments Date Made (1) (2) (3) (4) (5) (6) EFTA00592947  7 8. If any of the policies listed in your answer to the preceding interrogatory are assigned or pledged on indebtedness, except with insurance companies, provide the following information about each policy: Policy Number Name & Address of Amount of Date Pledged Assigned or Pledged Pledgee or Assignee Indebtedness or Assigned EFTA00592948  8 9. Do you have any accounts receivable or notes receivable? If so, set forth the name, address and telephone number of the person or entity that is indebted to you, and provide the amount of each account or note receivable. RESPONSE: EFTA00592949  9 10. Do you currently own, claim an interest in, or possess any real property? If your answer to this interrogatory is in the affirmative, state or identify: (a) the property's address; (b) the type of property (i.e., house, condominium, etc.); (c) the cost of the property at the time purchased; (d) present fair market value of the property; (e) any encumbrances against the property and the balance, if any, of the encumbrance mortgage, etc.); (0 how you titled the property upon its purchase or acquisition (i.e. grantee); (g) how the property is currently titled. RESPONSE: EFTA00592950  10 II. If you do not own the property where you currently reside, set forth the name, address and telephone number of the person(s) who owns the residence, the amount of your rent, and the frequency with which your rent must be paid. RESPONSE: EFTA00592951  11 12. Do you own or use any fixtures, furniture, machinery, equipment, trucks or automobiles? If your answer is in the affirmative, please set forth the following information: Amount of Liquidation Indebtedness Date Descriptions Cost Value if pledged Pledged Owner (a) Furniture/ fixtures (business) (b) furniture (household) (c) machinery/ equipment (specify) (d) Trucks (specify make, model, VIN, year) (e) Automobiles (specify make, model, VIII, year) EFTA00592952  12 13. Set forth the following information regarding all stocks, bonds, or securities (including, but not limited to, any interest in money market or other mutual funds) owned by you or held on your behalf from to present (and indicate if you sold or otherwise transferred any stock): Amount of Record Number of Fair Market Indebtedness Name of Company Owner Units Cost Value if pledged (a) if you receive any dividends or interest on any stocks, bonds or securities, set forth the date the dividends or interest is payable, and the amount received in the last year. EFTA00592953  13 14. Identify all sources of income for the following years: (a) salaries, wages, or commissions: (b) dividends: (c) interest: (d) income from business/profession: (e) partnership income: (0 capital gains: (g) annuities and pensions: (h) rents and royalties: (i) income from estates and trusts: (j) disposition of precious metals. EFTA00592954  14 15. With respect to each of the items set forth in the preceding interrogatory, state the name, address, and telephone number of the source from which the income was received (and provide account numbers where applicable). RESPONSE: EFTA00592955  15 16. Have you directly or indirectly transferred, conveyed or disposed of any cash, assets or other items of value with a cost or fair market value of $1,000.00 or more during the period of to present. If your answer to this interrogatory is in the affirmative, provide the following information for each such item: Name, address Description of of transferee Property or Date of Fair Market Value Consideration and your Asset Transfer When Transferred Received relation EFTA00592956  16 17. Do you have any life interest or remainder interest, either vested or contingent, in any trust or estate, or are you a beneficiary of any trust? If so, please furnish the following information and identify all supporting documentation: Amounts Name of Trust Present Value Value Of Received or Estate Of Assets Your Interests from this source 18. Do you own or have an interest in any Individual Retirement Accounts, Stock Option Plans, pension or profit sharing plans, or any other savings or retirement plans other than those listed in response to previous interrogatories. If your answer is yes, state the name, address and telephone number of the custodian of all such assets and state the amount. RESPONSE: EFTA00592957  17 19. Have you any other assets or an interest in assets, either actual or contingent, other than those listed in the previous interrogatory requests (i.e., antiques, stamp collections, boat, musical instruments, etc.)? If so, please describe the assets in detail, identify the location of the asset, and state the current fair market value of each such asset. RESPONSE: 20. Have you prepared a financial statement within the last five years? If so, state: (a) to whom the statement was given; (b) the reason the statement was prepared; (c) the date of the statement; (d) the name, address and telephone number of all persons who have a copy of such statement. RESPONSE: EFTA00592958  18 21. Identify every legal action in which you have been a party during the period in question, including, but not limited to the title of the action, the name of the court, the docket number or date the action was filed, a brief description of the nature of the action, and the result of the legal action (e.g. judgment against a certain amount). RESPONSE: EFTA00592959  19 22. Identify every loan made to you or was outstanding from you during the period in question, including, but not limited to name of the lender, date of the loan, maturity dates, principal amount, rate of interest, collateral or security interest given by you, your purpose in borrowing funds, and date and amount of each repayment. RESPONSE: EFTA00592960  20 23. Identify all credit, debit, and/or automatic teller ("ATM") cards which you use or control, regardless of whether such cards are titled in your name, during the period in question, and for each such card, identify, state or describe: (a) the name and address of the financial institution that issued the card (i.e. VISA, MasterCard, American Express, bank, etc.); (b) the account number; and (c) the name(s) on the card. RESPONSE: EFTA00592961  21 24. State whether you established a trust for any purpose during the period in question. If your answer is yes, state, describe or identify: (a) the location of the trust; (b) the name and address of the trustee, trust protector and the beneficiaries of the trust; (c) the assets of the trust and the location of such assets; (d) all documents that support your answer to this interrogatory. RESPONSE: 25. Identify each country you have traveled to from to present by providing the name of the country, date(s) of trip, purpose of trip, and the name and address of the persons visited. RESPONSE: EFTA00592962  22 26. State whether you currently have a will? RESPONSE: 27. State whether you have filed with the Internal Revenue Service Federal Form 1040 income tax returns for the years and ? If your anser is affirmative. state: (a) the date that each return was filed; (b) the address or location of the IRS Service Center where the return was filed. RESPONSE: 28. State whether you have filed State income tax returns for and If your answer is affirmative, state or identify: (a) the date that each return was filed; (b) the state with whom the return was filed; (c) the address where the state return was filed. RESPONSE: EFTA00592963  23 Dated: 200_. Respectfully submitted, United States Attorney Trial Attorney, Tax Division U.S. Department of Justice P.O. Box 227 Ben Franklin Station Washington, D.C. 20044 (202) - EFTA00592964  CERTIFICATE OF SERVICE IT IS HEREBY CERTIFIED that service of the foregoing UNITED STATES' INTERROGATORIES TO JUDGMENT DEBTOR has been made this day of , 200_, by placing a true copy thereof in the U.S. mail, postage prepaid, addressed to: TRIAL ATTORNEY EFTA00592965  DECLARATION , come and declare under the penalties of perjury, pursuant to 28 U.S.C. § 1746(2), that the foregoing Answers to the United States' Interrogatories are true and correct. Executed on this day of , 200_, in EFTA00592966