Williams v. Packaging Corporation of America

Filing 74

ORDER granting 64 Motion for Attorney Fees. Ordered by Judge Hugh Lawson on 3/20/2009. (Attachments: # 1 Affidavit Financial). (nbp)

FINANCIAL AFFIDAVIT Case Name: _____________________________ Docket Number: _____________________________ EMPLOYMENT Are you now employed? ___ Yes ___ No ___ Self Employed Name & Address of Employer: ___________________________________________________ If YES, how much do you earn per month? $__________________ If NO, give month & year of last employment _________________ How much did you earn per month? _________________________ If married, is your spouse employed? ___ Yes ___ No If YES, how much does your spouse earn per month? $___________________ If a minor under age 21, what is your parents' or guardian's approximate monthly income? $___________________________ OTHER INCOME Have you received in the past 12 months any income from a business, profession, or other form of self-employment, or in the form of rent, payments, interest, dividends, retirement or annuity payments, or other sources? ___ Yes ___ No If YES, give the amount received and identify sources: Received ____________________ ____________________ ____________________ ____________________ CASH Have you any cash on hand or money in savings, a prisoner trust fund account or checking account? ___ Yes ___ No If YES, state total amount $___________ PROPERTY Do you own any real estate, stock, bonds, notes, automobiles or other valuable property ___ Yes___ No (excluding ordinary household furnishings and clothing?) Sources: ________________________________________ ________________________________________ ________________________________________ ________________________________________

If YES, give value and describe it: Value _____________________________ _____________________________ _____________________________ _____________________________ Description _________________________________________ _________________________________________ _________________________________________ _________________________________________

DEPENDENTS Marital status: ___Single ___Married ___Widowed ___Separated or Divorced List persons you actually support & your relationship _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ DEBTS & MONTHLY BILLS List all creditors, including banks, loan companies, charge accounts, etc. Creditors: __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ Total Debt: $__________ $__________ $__________ $__________ $__________ $__________ Monthly Payment: $__________ $__________ $__________ $__________ $__________ $__________ Total No. of Dependents: ________________

State of Georgia County of _______________ ______________________ personally appeared before me and took an oath that the foregoing is true and correct __________________________ (Signature of Affiant) Sworn to (or affirmed) and subscribed before me this ____day of , _____, ________ by__________________________________.
(name of person making statement)

____ Personally Known ____ Produced Identification Type and # of ID_________________________ _____________________ (Signature of Notary) (Seal) ________________________________
(Name of Notary Typed, Stamped, or Printed)

Notary Public, State of Georgia