Fillable DEFENDANT'S STATEMENT OF ASSETS CR-115 It is a (California)

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DEFENDANT'S STATEMENT OF ASSETS CR-115 It is a (California)

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CR-115
FOR COURT USE ONLY
NAME OF VICTIM ON WHOSE BEHALF RESTITUTION IS ORDERED:
NAME OF COURT:
PEOPLE OF THE STATE OF CALIFORNIA
vs.
DEFENDANT'S STATEMENT OF ASSETS
It is a misdemeanor to make any willful misstatement of material fact in completing this form. (Pen. Code, § 1202.4(f)(4).)
(Attach additional sheets if the space provided below for any item is not sufficient.)
PERSONAL INFORMATION
1. a. f.
b.
c.
g.
d.
e.
EMPLOYMENT
2.
4.
6.
8. Other sources of income (specify):
CASH, BANK DEPOSITS
9.
10. How much other money do you have in banks, savings and loans, credit unions, and other financial institutions either in your own
name or jointly (list):
Name and address of financial institution Individual or joint?Account number
Balance
a. $
b. $
c.
$
PROPERTY
11. List all automobiles, other vehicles, and boats owned in your name or jointly.
Legal owner if different
Value
Amount owed
Make and year
a.
b.
c.
(Continued on reverse)
DEFENDANT'S STATEMENT OF ASSETS
Adopted for Mandatory Use
Judicial Council of California
CR-115 [Rev. Jan. 1, 2020]
Penal Code, § 1202.4(f)
5.
h.
i.
$
$
$
$
$
$
DEFENDANT:
AKA:
What are your sources of income and occupation? (Provide job title and name of division or office in which you work.)
a. Name and address of your business or employer (include address of your payroll or human resources department, if different):
b. If not employed, names and addresses of all sources of income (specify):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Page 1 of 2
from registered owner
3.
Name:
Date of birth:
Social security number:
Marital status:
Driver license number:
State of issuance:
Home address (incl. city/zip):
Home telephone no.:
Employer's telephone no.:
What is your gross pay each pay period? $
What is your take-home pay each pay period? $
How often are you paid (for example, daily, weekly, biweekly, monthly)? (specify):
How much money do you have in cash? $
7.
CASE NUMBER:
If your spouse earns any income, give the name of your spouse, the name and address of the business or employer, job title, and
division or office (specify):
PEOPLE OF THE STATE OF CALIFORNIA vs.
12. List all real estate owned in your name or jointly:
Fair market value
Amount owed
a. $
$
b. $ $
OTHER PERSONAL PROPERTY (Do not list household furniture and furnishings, appliances, or clothing.)
13. List anything of value not listed above owned in your name or jointly
(continue on attached sheet if necessary)
Description Value Address where property is located
a.
b.
c.
ASSETS
14.
15. Is anyone holding assets for you? If yes, describe the assets and give the name and address of the
person or entity holding each asset (specify):
16. Except for attorney fees in this matter and ordinary and routine household expenses, have you disposed of or transferred any
assets since your arrest on this matter?
DEBTS
17.
18.
19.
20.
21.
(TYPE OR PRINT NAME)
(SIGNATURE)
DEFENDANT'S STATEMENT OF ASSETS
CR-115 [Rev. Jan. 1, 2020]
Page 2 of 2
$
$
$
Address of real estate
List all other assets, including stocks, bonds, mutual funds, and other securities (specify):
Support arrearages (attach copies of orders and statements):
If yes, give the name and address of each person or entity who received any asset and describe each asset (specify):
Loans (give details):
Taxes (give details):
Credit cards (give creditor's name and address and the account number):
Other debts (specify):
INTERPRETER'S STATEMENT
I, having been duly sworn or having a written oath on file, certify that I truly translated this form to the defendant in the language noted
below.
Language:
(INTERPRETER'S SIGNATURE)
DATE
(TYPE OR PRINT INTERPRETER'S NAME)
(CERTIFICATION NUMBER)
DEFENDANT:
Date:
Yes
No
Yes No
Spanish
Other (specify):
CASE NUMBER:
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DEFENDANT'S STATEMENT OF ASSETS CR-115 It is a (California)

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Completed 6 March 2022

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