1. PAGE 1 Be sure to check all answers I have provided all the way to the end. The blanks I left must
be answered correctly. I see that this document did not contain any miranda notice. The lawyer is a debt
collector and is liable under FDCPA even though they have a judgment and they are attempting to
collect on the debt. You should seriously consider filing a federal case on them over this violation. You
don't need a lawyer to do that and learning how to prepare the paperwork is not difficult. You probably
will never actually have to go to court. Such federal cases are done on the internet, by mail, phone and
sometimes by email. You apparently have perfect proof of the violation right here and so what will
happen once you get them to federal court and have your case all properly prepared you will get a
flurry of paperwork and they will try to convince you that you can't win. Just hang tough and the court
will order you to discovery which is known as Rule 26(F) under the federal rules of civil procedure.
The court will instruct both parties that they are to hold meetings to see if a settlement can be reached
and if not the case will go to trial. In the process the defendant (lawyer) will probably realize that he
can't win and will want to settle. You would demand that the judgment be vacated and that they go
away and leave you alone. You will also want them to pay your court costs of $350.00 plus attorney
fees at the rate of $125 per hour for case preparation. Then you want $10,000 damages. You probably
won't get that much but why not try? What have you got to lose? It is either that or pay up or learn how
to play real hardball with them and how to keep them from even getting a garnishment in the first
place. The choice is up to you.
In the District Court of _________, County, State of Oklahoma
NO. ____________
Date. _________________
QUESTIONS ANSWERED UNDER OATH TITILE 12 O.S. s 842
THIS IS AN ATTEMPT TO COLLECT A DEBT BY A DEBT COLLECTOR

2. ANY AND ALL INFORMATION WILL BE USED FOR THAT PURPOSE
INSTRUCTIONS: ANSWER EACH QUESTION. DO NOT LEAVE ANY BLANKS.
Name: First _________________________ Middle ____________ Last _________________
Circle if it applies: Jr. Sr. II III IV Rev. Dr.
Other names you have used including maiden names: __None____________________________
Date of Birth: __Irrelevant__________________________
Current Street Address: _______________________________
How long at this addr: ____________________irrelevant________
Addr. PO Boxes Used: ____None_______________________________
If you expect to move in the near future what will be your new address:
___________________________none__________________________________
Phone/Cell Numbers: __Plaintiff already has that information from defendant's filed
documents________________________________
_________________________________
Social Security Number: __Refused Privacy concerns and plaintiff already has that
information_____________________________

3. If Renting:
Name of Landlord: _____Irrelevant______________________________
Addr of Landlord: ______________irrelevant______________________
Is landlord a relative: ____irrelevant___________________
Amount of Rent: ________Give correct amount of rent or mortgage
payment_____________________________
Rent Payments Current: yes no
Previous Address: __Irrelevant__________________________________
____________________________________
Other Income, Benefits, or Money you receive:

4. Soc Sec: _Refused for privacy reasons______________________
SSI: ______answer all the rest of these truthfully__________________
Disab: _______________________
Rents: _________________________
Dividends: ______________________
Royalty: ________________________
Alimony: ________________________
Child Support: ___________________
Commissions: ____________________
Business etc: ____________________
Food Stamps: ____________________
TANIF: __________________________
Retirement: ______________________
Insurance: _______________________
Other*: _________________________
*describe: _______________________________________
INCOME CONTRIBUTED BY FAMILY
Attorney Notes: _____________________________________

5. PAGE 2:
Current or Most Recent Employer(s):
Name as shown on pay stub or W-2 form Employer Name:
__________________________________________________
Addr: _____________________________________________
Tele: _____________________________________________
Gross Pay: $______________
Items Ded:
Fed Tax: $_____________
State Tax: $___________
Child Sup: $____________

6. Other Garn: $___________
Med Ins: $_____________
Other: ______ $_________
401k/retirement $___________
Net Pay: $_________________
weekly/biweekly/semi mo/monthly
Rate: $_______ per _________
Position: ___________________
Licenses Held: ______________
Union Membership: __________
IF UNEMPLOYED STATE REASON AND DATE YOU EXPECT TO BE EMPLOYED
_____________________________________________________________
DO YOU HAVE MORE THAN ONE JOB? YES NO

7. ARE YOU SELF EMPLOYED OR AN INDEPENDENT CONTRACTOR
FOR ANYONE? YES NO
IF YES:
Name: __________________________________________
NAME OF PERSON YOU REPORT OR ANSWER TO
Addr: ___________________________________________
Tele: ____________________
Gross Pay: $______________
DESCRIBE NATURE OF WORK
__________________________________________________
Business owned or operated by you:
Name of Business: __________________________________

8. Address: __________________________________________
Type of business: __________________________________
Legal form: Corp/LLC/DBA/Partnership
Others holding an interest in the business:
_________________________________________________
_________________________________________________
Banking affiliations of the business:
Checking: ________________________________
Loans: ___________________________________
Assets: Inventory: _________________________
Equipment: _______________________________
Real Estate: ______________________________
Contracts: _______________________________
Expenses:

9. Mtg/Rent $______________________
Utilities:
Nat Gas/Prop: $________________
Electricity: $________________
Water: $________________
Tele: $________________
Cable: $________________
Food: $___________________
Child Care $___________________
Gasoline $___________________
Auto Ins: $___________________
Medical Ins*: $___________________
Medicine: $___________________
Charity: $___________________
Child Supp** $___________________
Internet $___________________

10. Other*** $___________________
*Is this already deducted from wages?
yes/no
** Describe (child age/divorce case no/amounts/whether deducted
by employer):
____________________________________________
____________________________________________
*** Describe: ________________________________
____________________________________________
PAGE 3

11. Bank, Savings, and Credit Union Accounts:
Bank Name #1
_________________________________________
Bank Address:
_________________________________________
Account Number: __________________________
Who is listed as owners on the account:
_________________________________________
Balance Most Recent Stmt: $_________________
Amount of Deposits most recent month:
$_________________________________________

12. Bank Name #2: checking/savings
__________________________________________
Bank Address:
__________________________________________
Account Number: ___________________________
Who is listed as the owners on the account:
__________________________________________
Balance Most recent Stmt: $__________________
Nature of deposits made: _____________________
Amount of Deposits most recent month:
___________________________________________
Bank #3? yes/no
Vehicles:
#1 Make/Model/Year
___________________________________________
Loan paid to:
___________________________________________

13. Addr: ______________________________________
Amt Owed/pmt $___________ $________________
Current? yes/no Payoff date: _________________
#2 Make/Model/Year
___________________________________________
Loan paid to:
___________________________________________
Addr: ______________________________________
Amt Owed/pmt $___________ $________________
Current? yes/no Payoff date: _________________
#3 Make/Model/Year
___________________________________________
Loan paid to:
___________________________________________
Addr: ______________________________________
Amt Owed/pmt $___________ $________________
Current? yes/no Payoff date: _________________

14. NAMES OF MEMBERS OF HOUSEHOLD LIVING WITH YOU:
Spouse: ___________________
Children: __________________
Roommates: ________________
Child support payments:
Spouses Income
$______________ per ________________
Is this from a business owned or operated by your spouse? yes/no
If yes, describe: ________________________________
______________________________________________
Domestic Partner: ______________________________
______________________________________________
Did you bring:
1 Record of salary or other income for the past 2 months?
yes/no If no the reason for not bringing ___NO!_I don't keep such records______________________

15. 2. Bank statements for the past 2 months;
yes/no. If no the reason for not bringing: ___No. I don't keep old bank
statements______________________
3. Income tax returns for the past 2 years;
yes/no. If no the reason for not bringing: __No I don't keep old income tax
records._______________________
4. All financial statements presented to any banks or lending institutions for the past 2 years;
yes/no. If no the reason for not bringing: _________________________If possible then say no.
5. Legal descriptions of all real estate owned, leased, or possessed;
yes/no. If no the reason for not bringing: _________________________
6. All vehicle titles, copies of information relating to oil and gas royalty payments;
yes/no. If no the reason for not bringing: _________________________Don't take actual titles. Take
copies only.
7. Accounting books of all businesses owned for the last 12 months;
yes/no. If no the reason for not bringing: _________________________
8. Stock certificates, corporate books, stocks, bonds, and all other securities owned or possessed fot he
last years;

16. yes/no. If no the reason for not bringing: _________________________
9. Safe deposit box information;
yes/no. If no the reason for not bringing: _________________________
PAGE 4
Circle all that apply and describe:
Personal Property:

17. Stock/Bonds/Mutual Funds:
Retirement (IRA/401K):
Safety Deposit Boxes:
RVs/Trailers/Boats/Motorcycles:
Musical Instruments:
Jewelery:
Livestock or Farm Equip:
Agriculture products:
Coin or Stamp Collections:
Artwork:
Items being sold on consignment:
Judgements against others:
Annuities:
Life Insurance:
Inventory:
Office equipment:
Cash on hand today: $________________________
Describe:
___________________________________________
___________________________________________
Inheritance:

18. Is there any cases planned or pending including cases closed within the last 5 years
where you were/are an heir, administrator, administratrix, or personal representative?
yes/no Describe:
Do you expect an inheritance in the near future? yes/no Describe:
Have you transferred any business, land, or personal property within the past 2 years?
yes no Describe:
Have you transferred any property to a trust or trustee? yes no Describe:
Are you the beneficiary under any trust? yes no

19. Are you a trustee of any trust? Yes No
Land owned/Contract for Deed:
What County _____________________________________
Addr: ___________________________________________
Name on title: ____________________________________
Yr purch: ____________
Purch. Price: $_______________
Amt Owed: $________________
1st Mtg Holder:
Name: ____________________________
Addr: _____________________________
No. Acres: ___________________________
Legal Descrip: _________________________
2nd Mtg Holder:

20. Name: ____________________________
Addr: _____________________________
No Acres: ____________________________
Legal Description:
______________________________________
______________________________________
Additional Land, (lake properties, timeshares) owned
or being bought by you:
_____________________________________________
_____________________________________________
Other Debts:
Name Address Pmt Amt/Amt Owed
______________________________________________List all that you have. Be honest

21. PAGE 5
Title 12 O.S. s 850 states:
The judge after the hearing provided herein may order any property of the judgement debtor, not
exempt by law,
in his possession or under his control to be applied toward the satisfaction of the judgement and may
enforce the same by proceedings for contempt in case of refusal or disobedience.
The judge may further order the judgment debtor to pay to the judgment creditor or apply on the
judgment installments, such portion of his nonexempt income, however or wherever earned
or aquired, as the court may deem proper after due regard for any payments required to be made by the
judgement debtor by virtue of law or prior order of a court under wage assignments outstanding.
Where the judgement debtor claims or is proved to be rendering services or employed by a relative or
other person or by a corporation owned or controlled by a relative or other person, without salary or

22. compensation, or at a salary or compensation so inadequate as to satisfy that such a salary or
compensation is merely colorable and designed to defraud impede the creditors of such debtor, the
court may direct such debtor to make payments on account of the judgment, in installments, based on a
reasonable value of the services rendered by such judgement debtor under said employment or upon
said debtor's then earning ability. The court may, from time to time, modify an order made under this
section upon application of either party upon notice to the other. A failure or neglect to comply with an
order of direction of the court shall be punished as for comtempt.
WITH THIS IN MIND HOW DO YOU INTEND TO RESOLVE THIS DEBT?:
___________________________________________________________________________________
____________
Are you aware that it is standard procedure for a judgement creditor to file a judgment lein against your
real estate?
yes no
NOTICE: THIS HEARING DOES NOT DISCHARGE OR SATISFY THIS DEBT.
A judgment creditor may resort to remedies allowed by law including requiring you to appear again at
a later date.
Interest as stated in the judgement continues to run on the account.
I hereby certify upon my oath that the answers and information provided above are true and correct to
the best of my ability:

23. SIGN HERE_______________________________ DATE:
________________________________________
PAGE 6