If you're a business owner, you know that keeping track of your finances is essential to making sure your company is successful. One way to do this is by using Form JGM301, which is a financial statement used to track income and expenses. This form can be helpful in determining your company's financial status and budgeting for the future. By understanding how to use Form JGM301, you can make informed decisions about your business's future.
| Question | Answer |
|---|---|
| Form Name | Form Jgm301 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | disclosure minnesota financial, jgm301 form, form jgm301, minnesota financial disclosure |
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, continue your answer on the back of the form or attach additional sheets if necessary. If you have questions about this form, you may contact your local court administrator, call the court self help center at 651
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.
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JUDGMENT DEBTOR Name |
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Individual |
Partnership |
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Corporation |
Other __________ |
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Street Address |
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4. City |
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State |
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Zip |
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7. |
Date of Birth |
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If Married, Spouse’s Full Name |
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9. |
Home Telephone Number |
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Employer or Business |
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11. Work Telephone Number |
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Street Address |
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13. City |
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State |
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Zip |
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What are your total wages, salary, or commissions per |
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17. How often are you paid? |
Daily |
Weekly |
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pay period? $____________________________________ |
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Twice a Month |
Monthly |
Other ________ |
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Do you have income from any other source? |
Yes |
No If yes, give the source and amount of the income: |
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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
If the Judgment is for child support, I claim that the following percentage of my
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 _________________________________________________________________________
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My income is exempt because it is: |
Unemployment Comp. Worker’s Comp. |
V.A. Benefits |
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Social Security |
Accident or Disability Benefits |
Retirement Benefits Other (Specify)______________ |
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20. Do you have a checking or savings account? (This includes any account whether you have it by yourself or with someone |
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else, or whether it is in your name or any other name) |
Yes No For each, provide the following information: |
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Name and address of bank, Credit Union or Financial Institution |
Type of Account |
Account Number |
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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.
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Yes No |
If yes, itemize these and the location of each. |
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JGM301 State |
ENG |
Rev 7/12 |
www.mncourts.gov/forms |
Page 1 of 2 |
Yes No
Value of $390,000 or if used primarily for agricultural purposes, $975,000. Do you own any other houses, land, or real estate?
Yes |
No |
For each, give the following: |
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Location |
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Estimated Value |
Amount Owed (if any) |
To Whom |
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24. Do you own any motor vehicles, motorcycles, boats, snowmobiles, trailers, etc.? |
Yes No |
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For each, provide the following: |
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Make |
Model |
Year |
Lic. Plate No. |
Market Value |
Amount You Owe (if any) |
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One motor vehicle worth up to $4,600 (or $46,000 if the vehicle has been modified at a cost of at least $3,450 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? |
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Yes |
No |
Farm supplies, implements, livestock, grain |
Yes |
No |
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Cash or travelers checks |
worth more than $13,000 |
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Household goods, furnishings, and personal |
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effects that are worth more than $10,350 |
Yes |
No |
Business equipment, tools, machinery worth |
Yes |
No |
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total |
more than $11,500 total |
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Jewelry |
Yes |
No |
Inventory |
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Yes |
No |
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Coins or stamp collections |
Yes |
No |
Accounts receivable/claims |
Yes |
No |
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Yes |
No |
Are you the owner or partner in any business |
Yes |
No |
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Firearms/Guns |
not already listed |
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Life insurance policy with a cash |
Yes |
No |
Any other property (specify) |
Yes |
No |
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(surrender) value more than $9,200 |
___________________________________ |
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Any property that you are selling on a |
Yes |
No |
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contract for deed |
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If you answered yes to any item in question 25, provide the following information: |
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Description and location of property (if not at residence) |
Estimated Value |
Amount Owed (if any) To Whom |
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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.
JGM301 State |
ENG |
Rev 7/12 |
www.mncourts.gov/forms |
Page 2 of 2 |