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I understand that this application neither obligates me to Judgment Support Services nor does it obligate Judgment Support Services to accept my case. Fields designated by an asterisk are required!

Judgment Information:
Case number (if known):
*Amount of judgment:
*Amount collected to date:
*Date judgment was issued:
*State in which judgment was issued:
Were you represented by an attorney?		Please select: Yes No
Was your judgment awarded by default (defendant not present)?		Please select: Yes No
Does judgment debtor (defendant) now reside in another state?		Please select: Yes No Unsure
Name of judgment debtor:
Last known street address of judgment debtor:
Last known city, state & zip of judgment debtor:
Personal Information:
*Full name:
*Street address:
*City, state & zip:
*Telephone number:
*Email address:
Description of my case (please be brief but thorough):
Word Verification:

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