Preview
Filed in District Court
State of Minnesota
06/24/2024
State of Minnesota District Court
Dakota County First Judicial District
Court File Number: 19HA-CV-24-2883
Case Type: Transcript Judgment
Karen Dawson vs Right Choice
Construction Order for Disclosure
THIS IS AN OFFICIAL COURT ORDER, WHICH REQUIRES YOU TO PROVIDE CERTAIN
INFORMATION. READ IT CAREFULLY.
TO: Right Choice Construction, Judgment Debtor
Within 10 days after service of this order, you must:
1. Fill out the attached Financial Disclosure Form describing your personal finances.
2. Mail this completed form to the JUDGMENT CREDITOR at the address stated in the box below (NOTE: Certified
mail is required unless the case began in conciliation court. Minnesota Statute §550.011).
WARNING: IF YOU DO NOT COMPLETE AND MAIL THE DISCLOSURE FORM TO THE JUDGMENT
CREDITOR WITHIN 10 DAYS AFTER SERVICE OF THIS ORDER, THE JUDGMENT CREDITOR MAY ASK
THIS COURT TO HOLD YOU IN “CIVIL CONTEMPT OF COURT”. IF THE COURT DECIDES THAT YOU
INTENTIONALLY DISOBEYED THIS ORDER, THE COURT MAY FINE YOU, PUT YOU IN JAIL, OR BOTH.
This order was issued because:
1. The JUDGMENT CREDITOR has won a Judgment in the lawsuit against you;
2. The Case began in District Court and the Court Administrator docketed the Judgment more than thirty (30) days ago
OR the case began in Conciliation Court and the Court Administrator has docketed the judgment;
3. You have not paid the JUDGMENT CREDITOR all of the money which the Judgment says you owe; and
4. You and the JUDGMENT CREDITOR have not agreed to some other way to settle the debt you owe.
Dated: June 24, 2024 Maria King
Court Administrator
Mail the Financial Disclosure Form to: 2024.06.24
Karen Dawson 13:06:32 -05'00'
By: ______________________________________
1045 Syndicate Ave #1
South Saint Paul, MN 55075 Deputy Court Administrator
Judgment Creditor
Dakota County District Court
1560 Highway 55
Hastings MN 55033
651-377-7180
Distribution:
Original for file
Copy for Debtor ( x mailed 6/24/24 delivered on )
x mailed 6/24/24 delivered on
Copy for Creditor ( )
MNCIS‐JGM‐113 STATE Order for Disclosure JGM304 ENGRev: 7/09
C-DSC-ORD UCF-21 (SCAO 9/04) Minn. Stat.§§ 491A.02, subd. 9, 550.011
SUMMARY OF EXEMPT PROPERTY (MINN. STAT. §§ 510.02, 550.37)
“Exempt property” means property or money that by law cannot be taken from you to pay a judgment or debt. This summary is
provided to help you claim your exemptions on the Financial Disclosure Form. Most exemptions apply only to debtors who are
individuals (not corporations). Because this is only a summary, you may find that a specific piece of your property or type of income
is not covered. If you have any questions about whether something is exempt, seek legal advice.
PENALTIES: IF THE COURT FINDS THAT YOU CLAIMED AN EXEMPTION IN BAD FAITH, YOU MAY BE ASSESSED
COSTS, REASONABLE ATTORNEYS FEES, AND AN AMOUNT NOT TO EXCEED $100. (Minn. Stat. § 550.135, subd. 12)
1. Homestead (residence owned and occupied by the debtor) is exempt to a value of $420,000, or if used primarily for
agricultural purposes, $1,050,000.
a. The Homestead may include up to 160 acres of land if located in a rural area. If located in the laid out or platted portion
of a city, the exempt area cannot exceed one-half acre.
b. The proceeds of a sale of a homestead are exempt for one year after sale; does not apply to child support and maintenance
arrearages.
c. A mobile home that you live in as a home is exempt.
d. The Homestead exemption does not apply to mortgages, tax liens, mechanics liens, and certain claims against an estate.
(See Minn. Stat. § 510.05)
2. Wages and Earnings
a. All of your after tax earnings below 40 times the federal minimum wage or seventy-five percent (75%) of your after tax
earnings, whichever is greater. For child support judgments, the exemption is based on the date of the judgment and other
support obligations. (See Minn. Stat. § 571.922) This money remains exempt for 20 days after deposit in a bank or other
financial institution.
b. Earnings of your minor child and any child support paid to you.
c. All of your earnings if you receive or have received public assistance based on need within the past six months, or if you
have been an inmate of a correctional institution within the last six months. These funds remain exempt for 60 days after
deposit in a bank or other financial institution.
3. Business Assets (combined value of property in a and b not to exceed $13,000)
a. Farm equipment, livestock, produce, and standing crops, if your main occupation is farming, not exceeding $13,000.
b. Tools, machines, office furniture, and inventory reasonably necessary in your trade or business, not to exceed $12,000.
c. (Builders) Proceeds of payments received by a person for improvements to real estate within meaning of Minn. Stat. §§
514.01.
4. Various benefits, pensions, and insurance
a. Relief based on need (this includes programs like MFIP, Work First, General Assistance, Supplemental Social Security
Income, Medical Assistance, and Minnesota Supplemental Assistance).
b. Social Security benefits (Old Age, Survivors, or Disability Insurance).
c. Reemployment compensation, workers’ compensation, veteran’s benefits (remain exempt for one year after receipt), and
benefits payable for accident or disability.
d. A stock bonus, pension, individual retirement account, or annuity or similar plan or contract received on account of
illness, disability, death, age, or length or service to the extent your aggregate interest under all plans and contracts does
not exceed a present value of $72,000 plus an additional amount reasonably necessary for the support of the debtor or
debtor’s dependents. (Note: ERISA qualified benefits are not exempt after disbursement or if withdrawn prior to
retirement, and exemptions in paragraph d. do not apply to support orders. Minn. Stat. § 518A.26,, subd. 21.)
e. Insurance money received by surviving spouse or child as a result of the death of a spouse or parent, not exceeding
$48,000. Add $12,000 for each additional dependent. Debtor’s value in unmatured life insurance contract not exceeding
$9,600.
f. Rights to sue for personal injury.
g. Health Savings Account not exceeding a present value of $25,000.
h. Medical Savings Account not exceeding a present value of $25,000.
5. Personal Property (Note: personal goods are not exempt from secured claims to collect the purchase price.)
a. One motor vehicle not exceeding $4,800 in value, or $48,000 if the vehicle has been modified at a cost of not less than
$3,600 to accommodate a physical disability making a disabled person eligible for a parking certificate under Minn. Stat.
§ 169.345.
b. All money received on a claim on account of damage to or destruction of exempt property.
c. All wearing apparel, one watch, utensils and foods stuffs without regard to value. Household furniture, appliances and
furnishings not exceeding $10,800.
d. A pew in church and a burial plot.
MNCIS‐JGM‐113 STATE Summary of Exempt Property JGM402 ENG Rev 08/18
Minn. Stat. §§ 491A.02, subd. 9, 550.011 Financial Disclosure Form
The purpose of this Financial Disclosure Form is to tell the JUDGMENT CREDITOR what money and property you have which may
be used to pay the judgment the creditor obtained against you in the lawsuit. It also allows you to tell the creditor that some or all of
your property and money is “exempt,” which means that it cannot be taken to pay the judgment. You must answer all questions on
this form. If you need more space, attach additional sheets if necessary. If you have questions about this form, you may contact your
local court administrator, call the Statewide Self-Help Center at 651-435-6535, or contact an attorney.
WARNING: IF YOU CLAIM AN EXEMPTION IN BAD FAITH, OR IF THE JUDGMENT CREDITOR WRONGLY
OBJECTS TO AN EXEMPTION IN BAD FAITH, THE COURT MAY ORDER THE PERSON WHO ACTED IN BAD
FAITH TO PAY COSTS, ACTUAL DAMAGES, ATTORNEY FEES, AND AN EXTRA $100.
1. JUDGMENT DEBTOR Name 2. Individual Partnership
Corporation Other __________
3. Street Address 4. City 5. State 6. Zip
7. Date of Birth 8. If Married, Spouse’s Full Name 9. Home Telephone Number
( )
10. Employer or Business 11. Work Telephone Number
( )
12. Street Address 13. City 14. State 15. Zip
16. What are your total wages, salary, or commissions per 17. How often are you paid? Daily Weekly
pay period? $____________________________________ Twice a Month Monthly Other ________
18. Do you have income from any other source? Yes No If yes, give the source and amount of the income:
19. By answering this question, you will be able to claim the exemptions you have for wages and income.
The first exemption is already checked for you, check all others that apply:
I claim that 75% of my disposable (after-tax) earnings or 40 times the federal minimum wage (now equals $290 for 40-hour
week) is exempt (whichever is greater), unless the judgment is for child support.
If the Judgment is for child support, I claim that the following percentage of my after-tax earnings is exempt:
50% (I am supporting a spouse and/or dependent child, and the child support judgment is 12 weeks old or less.)
55% (I am supporting a spouse and/or dependent child, and the child support judgment is more than 12 weeks old.)
60% (I am not supporting a spouse and/or dependent child, and the child support judgment is 12 weeks old or less.)
65% (I am not supporting a spouse and/or dependent child, and the child support judgment is more than 12 weeks old.)
I am presently receiving or have received relief based on need in the past 6 months so all my wages are exempt.
Type of relief you receive _______________________________________________________________________________
I have been an inmate in a correctional institution within the past 6 months so all my wages are exempt.
Name institution and release date _________________________________________________________________________
My income is exempt because it is: Unemployment Comp. Worker’s Comp. V.A. Benefits
Social Security Accident or Disability Benefits Retirement Benefits Other (Specify)______________
20. Do you have a checking or savings account? (This includes any account whether you have it by yourself or with someone
else, or whether it is in your name or any other name) Yes No For each, provide the following information:
Name and address of bank, Credit Union or Financial Institution Type of Account Account Number
21. If you claimed an exemption for your wages or income, you may claim an exemption when your money is deposited in a bank.
Claim your exemptions by checking the boxes that apply to you:
The money in my account is from exempt wages, income, or benefits.
The money in my account is from the exempt sale of my homestead within the past year.
The money in my account is from exempt life insurance received on the death of a spouse or parent.
The money in my account is from other exempt property (specify) _________________________________________
22. Do you have any stocks, bonds, securities, certificates of deposit, mutual funds, money market account, etc.? (This includes any
whether owned by you alone or with any other person, or whether it is in your name or any other name.
Yes No If yes, itemize these and the location of each.
MNCIS‐JGM‐113 STATE Financial Disclosure Form JGM301 ENG 4/21
23. Do you own your home? Yes No Your homestead (house owned and occupied by you) is exempt up to a
Value of $420,000 or if used primarily for agricultural purposes, $1,050,000. Do you own any other houses, land, or real estate?
Yes No For each, give the following:
Location Estimated Value Amount Owed (if any) To Whom
24. Do you own any motor vehicles, motorcycles, boats, snowmobiles, trailers, etc.? Yes No
For each, provide the following:
Make Model Year Lic. Plate No. Market Value Amount You Owe (if any)
One motor vehicle worth up to $4,800 (or $48,000 if the vehicle has been modified at a cost of at least $3,600 to accommodate a
physical disability making a disabled person eligible for a parking permit under Minn. Stat. § 169.345) after subtracting what you
owe is exempt. Which vehicle do you want to claim as exempt?
25. Do you own any of the follow property?
Farm supplies, implements, livestock, grain
Cash or travelers checks Yes No worth more than $13,000 Yes No
Household goods, furnishings, and personal Business equipment, tools, machinery worth
effects that are worth more than $10,800 more than $12,000 total
total Yes No Yes No
Jewelry Yes No Inventory Yes No
Coins or stamp collections Yes No Accounts receivable/claims Yes No
Are you the owner or partner in any business
Firearms/Guns Yes No not already listed Yes No
Life insurance policy with a cash Health Saving Account not exceeding a
(surrender) value more than $9,600 Yes No present value of $25,000 Yes No
Any property that you are selling on a Medical Savings Account not exceeding a
contract for deed Yes No present value of $25,000 Yes No
Any other property (specify)
__________________________________ Yes No
If you answered yes to any item in question 25, provide the following information:
Description and location of property (if not at residence) Estimated Value Amount Owed (if any) To Whom
If you need additional space to answer the questions, continue your answers here. Indicate the question number you are answering.
Attach additional sheets if necessary.
The above information is true and correct to the best of my knowledge.
Date: _________________________________ Signature: __________________________________________________
NOTICE: FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM TO THE JUDGMENT CREDITOR WITHIN
10 DAYS MAY RESULT IN A CITATION FOR CIVIL CONTEMPT OF COURT.
MNCIS‐JGM‐113 STATE Financial Disclosure Form JGM301 ENG 4/21
Preview
Filed in District Court State of Minnesota 06/24/2024 State of Minnesota District Court Dakota County First Judicial District Court File Number: 19HA-CV-24-2883 Case Type: Transcript Judgment Karen Dawson vs Right Choice Construction Order for Disclosure THIS IS AN OFFICIAL COURT ORDER, WHICH REQUIRES YOU TO PROVIDE CERTAIN INFORMATION. READ IT CAREFULLY. TO: Right Choice Construction, Judgment Debtor Within 10 days after service of this order, you must: 1. Fill out the attached Financial Disclosure Form describing your personal finances. 2. Mail this completed form to the JUDGMENT CREDITOR at the address stated in the box below (NOTE: Certified mail is required unless the case began in conciliation court. Minnesota Statute §550.011). WARNING: IF YOU DO NOT COMPLETE AND MAIL THE DISCLOSURE FORM TO THE JUDGMENT CREDITOR WITHIN 10 DAYS AFTER SERVICE OF THIS ORDER, THE JUDGMENT CREDITOR MAY ASK THIS COURT TO HOLD YOU IN “CIVIL CONTEMPT OF COURT”. IF THE COURT DECIDES THAT YOU INTENTIONALLY DISOBEYED THIS ORDER, THE COURT MAY FINE YOU, PUT YOU IN JAIL, OR BOTH. This order was issued because: 1. The JUDGMENT CREDITOR has won a Judgment in the lawsuit against you; 2. The Case began in District Court and the Court Administrator docketed the Judgment more than thirty (30) days ago OR the case began in Conciliation Court and the Court Administrator has docketed the judgment; 3. You have not paid the JUDGMENT CREDITOR all of the money which the Judgment says you owe; and 4. You and the JUDGMENT CREDITOR have not agreed to some other way to settle the debt you owe. Dated: June 24, 2024 Maria King Court Administrator Mail the Financial Disclosure Form to: 2024.06.24 Karen Dawson 13:06:32 -05'00' By: ______________________________________ 1045 Syndicate Ave #1 South Saint Paul, MN 55075 Deputy Court Administrator Judgment Creditor Dakota County District Court 1560 Highway 55 Hastings MN 55033 651-377-7180 Distribution: Original for file Copy for Debtor ( x mailed 6/24/24 delivered on ) x mailed 6/24/24 delivered on Copy for Creditor ( ) MNCIS‐JGM‐113 STATE Order for Disclosure JGM304 ENGRev: 7/09 C-DSC-ORD UCF-21 (SCAO 9/04) Minn. Stat.§§ 491A.02, subd. 9, 550.011 SUMMARY OF EXEMPT PROPERTY (MINN. STAT. §§ 510.02, 550.37) “Exempt property” means property or money that by law cannot be taken from you to pay a judgment or debt. This summary is provided to help you claim your exemptions on the Financial Disclosure Form. Most exemptions apply only to debtors who are individuals (not corporations). Because this is only a summary, you may find that a specific piece of your property or type of income is not covered. If you have any questions about whether something is exempt, seek legal advice. PENALTIES: IF THE COURT FINDS THAT YOU CLAIMED AN EXEMPTION IN BAD FAITH, YOU MAY BE ASSESSED COSTS, REASONABLE ATTORNEYS FEES, AND AN AMOUNT NOT TO EXCEED $100. (Minn. Stat. § 550.135, subd. 12) 1. Homestead (residence owned and occupied by the debtor) is exempt to a value of $420,000, or if used primarily for agricultural purposes, $1,050,000. a. The Homestead may include up to 160 acres of land if located in a rural area. If located in the laid out or platted portion of a city, the exempt area cannot exceed one-half acre. b. The proceeds of a sale of a homestead are exempt for one year after sale; does not apply to child support and maintenance arrearages. c. A mobile home that you live in as a home is exempt. d. The Homestead exemption does not apply to mortgages, tax liens, mechanics liens, and certain claims against an estate. (See Minn. Stat. § 510.05) 2. Wages and Earnings a. All of your after tax earnings below 40 times the federal minimum wage or seventy-five percent (75%) of your after tax earnings, whichever is greater. For child support judgments, the exemption is based on the date of the judgment and other support obligations. (See Minn. Stat. § 571.922) This money remains exempt for 20 days after deposit in a bank or other financial institution. b. Earnings of your minor child and any child support paid to you. c. All of your earnings if you receive or have received public assistance based on need within the past six months, or if you have been an inmate of a correctional institution within the last six months. These funds remain exempt for 60 days after deposit in a bank or other financial institution. 3. Business Assets (combined value of property in a and b not to exceed $13,000) a. Farm equipment, livestock, produce, and standing crops, if your main occupation is farming, not exceeding $13,000. b. Tools, machines, office furniture, and inventory reasonably necessary in your trade or business, not to exceed $12,000. c. (Builders) Proceeds of payments received by a person for improvements to real estate within meaning of Minn. Stat. §§ 514.01. 4. Various benefits, pensions, and insurance a. Relief based on need (this includes programs like MFIP, Work First, General Assistance, Supplemental Social Security Income, Medical Assistance, and Minnesota Supplemental Assistance). b. Social Security benefits (Old Age, Survivors, or Disability Insurance). c. Reemployment compensation, workers’ compensation, veteran’s benefits (remain exempt for one year after receipt), and benefits payable for accident or disability. d. A stock bonus, pension, individual retirement account, or annuity or similar plan or contract received on account of illness, disability, death, age, or length or service to the extent your aggregate interest under all plans and contracts does not exceed a present value of $72,000 plus an additional amount reasonably necessary for the support of the debtor or debtor’s dependents. (Note: ERISA qualified benefits are not exempt after disbursement or if withdrawn prior to retirement, and exemptions in paragraph d. do not apply to support orders. Minn. Stat. § 518A.26,, subd. 21.) e. Insurance money received by surviving spouse or child as a result of the death of a spouse or parent, not exceeding $48,000. Add $12,000 for each additional dependent. Debtor’s value in unmatured life insurance contract not exceeding $9,600. f. Rights to sue for personal injury. g. Health Savings Account not exceeding a present value of $25,000. h. Medical Savings Account not exceeding a present value of $25,000. 5. Personal Property (Note: personal goods are not exempt from secured claims to collect the purchase price.) a. One motor vehicle not exceeding $4,800 in value, or $48,000 if the vehicle has been modified at a cost of not less than $3,600 to accommodate a physical disability making a disabled person eligible for a parking certificate under Minn. Stat. § 169.345. b. All money received on a claim on account of damage to or destruction of exempt property. c. All wearing apparel, one watch, utensils and foods stuffs without regard to value. Household furniture, appliances and furnishings not exceeding $10,800. d. A pew in church and a burial plot. MNCIS‐JGM‐113 STATE Summary of Exempt Property JGM402 ENG Rev 08/18 Minn. Stat. §§ 491A.02, subd. 9, 550.011 Financial Disclosure Form The purpose of this Financial Disclosure Form is to tell the JUDGMENT CREDITOR what money and property you have which may be used to pay the judgment the creditor obtained against you in the lawsuit. It also allows you to tell the creditor that some or all of your property and money is “exempt,” which means that it cannot be taken to pay the judgment. You must answer all questions on this form. If you need more space, attach additional sheets if necessary. If you have questions about this form, you may contact your local court administrator, call the Statewide Self-Help Center at 651-435-6535, or contact an attorney. WARNING: IF YOU CLAIM AN EXEMPTION IN BAD FAITH, OR IF THE JUDGMENT CREDITOR WRONGLY OBJECTS TO AN EXEMPTION IN BAD FAITH, THE COURT MAY ORDER THE PERSON WHO ACTED IN BAD FAITH TO PAY COSTS, ACTUAL DAMAGES, ATTORNEY FEES, AND AN EXTRA $100. 1. JUDGMENT DEBTOR Name 2. Individual Partnership Corporation Other __________ 3. Street Address 4. City 5. State 6. Zip 7. Date of Birth 8. If Married, Spouse’s Full Name 9. Home Telephone Number ( ) 10. Employer or Business 11. Work Telephone Number ( ) 12. Street Address 13. City 14. State 15. Zip 16. What are your total wages, salary, or commissions per 17. How often are you paid? Daily Weekly pay period? $____________________________________ Twice a Month Monthly Other ________ 18. Do you have income from any other source? Yes No If yes, give the source and amount of the income: 19. By answering this question, you will be able to claim the exemptions you have for wages and income. The first exemption is already checked for you, check all others that apply: I claim that 75% of my disposable (after-tax) earnings or 40 times the federal minimum wage (now equals $290 for 40-hour week) is exempt (whichever is greater), unless the judgment is for child support. If the Judgment is for child support, I claim that the following percentage of my after-tax earnings is exempt: 50% (I am supporting a spouse and/or dependent child, and the child support judgment is 12 weeks old or less.) 55% (I am supporting a spouse and/or dependent child, and the child support judgment is more than 12 weeks old.) 60% (I am not supporting a spouse and/or dependent child, and the child support judgment is 12 weeks old or less.) 65% (I am not supporting a spouse and/or dependent child, and the child support judgment is more than 12 weeks old.) I am presently receiving or have received relief based on need in the past 6 months so all my wages are exempt. Type of relief you receive _______________________________________________________________________________ I have been an inmate in a correctional institution within the past 6 months so all my wages are exempt. Name institution and release date _________________________________________________________________________ My income is exempt because it is: Unemployment Comp. Worker’s Comp. V.A. Benefits Social Security Accident or Disability Benefits Retirement Benefits Other (Specify)______________ 20. Do you have a checking or savings account? (This includes any account whether you have it by yourself or with someone else, or whether it is in your name or any other name) Yes No For each, provide the following information: Name and address of bank, Credit Union or Financial Institution Type of Account Account Number 21. If you claimed an exemption for your wages or income, you may claim an exemption when your money is deposited in a bank. Claim your exemptions by checking the boxes that apply to you: The money in my account is from exempt wages, income, or benefits. The money in my account is from the exempt sale of my homestead within the past year. The money in my account is from exempt life insurance received on the death of a spouse or parent. The money in my account is from other exempt property (specify) _________________________________________ 22. Do you have any stocks, bonds, securities, certificates of deposit, mutual funds, money market account, etc.? (This includes any whether owned by you alone or with any other person, or whether it is in your name or any other name. Yes No If yes, itemize these and the location of each. MNCIS‐JGM‐113 STATE Financial Disclosure Form JGM301 ENG 4/21 23. Do you own your home? Yes No Your homestead (house owned and occupied by you) is exempt up to a Value of $420,000 or if used primarily for agricultural purposes, $1,050,000. Do you own any other houses, land, or real estate? Yes No For each, give the following: Location Estimated Value Amount Owed (if any) To Whom 24. Do you own any motor vehicles, motorcycles, boats, snowmobiles, trailers, etc.? Yes No For each, provide the following: Make Model Year Lic. Plate No. Market Value Amount You Owe (if any) One motor vehicle worth up to $4,800 (or $48,000 if the vehicle has been modified at a cost of at least $3,600 to accommodate a physical disability making a disabled person eligible for a parking permit under Minn. Stat. § 169.345) after subtracting what you owe is exempt. Which vehicle do you want to claim as exempt? 25. Do you own any of the follow property? Farm supplies, implements, livestock, grain Cash or travelers checks Yes No worth more than $13,000 Yes No Household goods, furnishings, and personal Business equipment, tools, machinery worth effects that are worth more than $10,800 more than $12,000 total total Yes No Yes No Jewelry Yes No Inventory Yes No Coins or stamp collections Yes No Accounts receivable/claims Yes No Are you the owner or partner in any business Firearms/Guns Yes No not already listed Yes No Life insurance policy with a cash Health Saving Account not exceeding a (surrender) value more than $9,600 Yes No present value of $25,000 Yes No Any property that you are selling on a Medical Savings Account not exceeding a contract for deed Yes No present value of $25,000 Yes No Any other property (specify) __________________________________ Yes No If you answered yes to any item in question 25, provide the following information: Description and location of property (if not at residence) Estimated Value Amount Owed (if any) To Whom If you need additional space to answer the questions, continue your answers here. Indicate the question number you are answering. Attach additional sheets if necessary. The above information is true and correct to the best of my knowledge. Date: _________________________________ Signature: __________________________________________________ NOTICE: FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM TO THE JUDGMENT CREDITOR WITHIN 10 DAYS MAY RESULT IN A CITATION FOR CIVIL CONTEMPT OF COURT. MNCIS‐JGM‐113 STATE Financial Disclosure Form JGM301 ENG 4/21