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Here is the text we could read:

NAME OF VICTIM ON WHOSE BEHALF RESTITUTION IS ORDERED:

CR-115

FOR COURT USE ONLY

PEOPLE OF THE STATE OF CALIFORNIA
vs.

DEFENDANT'S STATEMENT OF ASSETS

CASE NUMBER:

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.)

f. 

Driver license number:
State of issuance:

g. 

h. 
i. 

Home address (incl. city/zip):
Home telephone no.:
Employer's telephone no.:

What are your sources of income and occupation? (Provide job title and name of division or office in which you work.)

3.

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):

How often are you paid (for example, daily, weekly, biweekly, monthly)? (specify):

What is your gross pay each pay period?   $

What is your take-home pay each pay period?   $
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): 

8.   Other sources of income (specify):

How much money do you have in cash?   $

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 

Account number

Individual or joint?

Balance

$

$

$

$$ $

PROPERTY
11. List all automobiles, other vehicles, and boats owned in your name or jointly.

Make and year

Value

Legal owner if different 
from registered owner

  Amount owed

$$ $

Adopted for Mandatory Use 
Judicial Council of California 
CR-115 [Rev. Jan. 1, 2020]

(Continued on reverse)

DEFENDANT'S STATEMENT OF ASSETS

Page 1 of 2

Penal Code, § 1202.4(f)

4.   

5.  

6.  

7.  

a.

b.

c.

a.
b.
c.

NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

DEFENDANT:

PERSONAL INFORMATION
1.   a. 
b. 
c. 
d. 
e. 

Name:
AKA:
Date of birth:
Social security number:

Marital status:

EMPLOYMENT
2.   

PEOPLE OF THE STATE OF CALIFORNIA vs. 

CASE NUMBER:

DEFENDANT:

12. List all real estate owned in your name or jointly: 

Address of real estate

Fair market value

Amount owed

$

$

$

$

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.

a.

b.
c.

ASSETS
14. 

List all other assets, including stocks, bonds, mutual funds, and other securities (specify):

15. Is anyone holding assets for you?

Yes

No

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?

Yes

No

If yes, give the name and address of each person or entity who received any asset and describe each asset (specify):

DEBTS
17.

Loans (give details):

18.

Taxes (give details):

21. 

Other debts (specify):

Date:

19. 

Support arrearages (attach copies of orders and statements):

20. 

Credit cards (give creditor's name and address and the account number):

(TYPE OR PRINT NAME)

(SIGNATURE)

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:

Other (specify):

Spanish

(INTERPRETER'S SIGNATURE)

DATE

(TYPE OR PRINT INTERPRETER'S NAME)

(CERTIFICATION NUMBER)

CR-115 [Rev. Jan. 1, 2020]

Page 2 of 2

DEFENDANT'S STATEMENT OF ASSETS

Defendant's Statement of Assets

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 88
Average fields per page: 44
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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c_r_page__2 was CR-115[0].Page1[0].T27[0] (0.32 conf)
c_r_page_tex__1 was CR-115[0].Page1[0].TEXT\.1\.6[0] (0.38 conf)
c_r_page_tex__2 was CR-115[0].Page1[0].TEXT\.1\.9[0] (0.38 conf)
c_r_page_tex__3 was CR-115[0].Page1[0].TEXT\.1\.18\.1\.0[0] (0.38 conf)
c_r_page_tex__4 was CR-115[0].Page1[0].TEXT\.1\.18\.1\.0[1] (0.38 conf)
c_r_page_tex__5 was CR-115[0].Page1[0].TEXT\.1\.18\.0[0] (0.38 conf)
c_r_page_tex__6 was CR-115[0].Page1[0].TEXT\.1\.21[0] (0.38 conf)
c_r_page_tex__7 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.0[0] (0.38 conf)
c_r_page_tex__8 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.3\.0\.0[0] (0.38 conf)
c_r_page_tex__9 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.3\.0\.0[1] (0.38 conf)
c_r_page_tex__10 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.3\.0\.0[2] (0.38 conf)
c_r_page_tex__11 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.4\.0[0] (0.38 conf)
c_r_page_tex__12 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.4\.1[0] (0.38 conf)
c_r_page_tex__13 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.4\.2[0] (0.38 conf)
c_r_page_tex__14 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.5\.0[0] (0.38 conf)
c_r_page_tex__15 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.5\.1[0] (0.38 conf)
c_r_page_tex__16 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.5\.2[0] (0.38 conf)
c_r_page_tex__17 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.0\.0[0] (0.38 conf)
c_r_page_tex__18 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.0\.1[0] (0.38 conf)
c_r_page_tex__19 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.0\.2[0] (0.38 conf)
c_r_page_tex__20 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.1\.0[0] (0.38 conf)
c_r_page_tex__21 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.1\.0[1] (0.38 conf)
c_r_page_tex__22 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.1\.0[2] (0.38 conf)
c_r_page_tex__23 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.2\.0[0] (0.38 conf)
c_r_page_tex__24 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.2\.0[1] (0.38 conf)
c_r_page_tex__25 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.2\.0[2] (0.38 conf)
c_r_page_tex__26 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.3\.0[0] (0.38 conf)
c_r_page_tex__27 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.3\.0[1] (0.38 conf)
c_r_page_tex__28 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.3\.0[2] (0.38 conf)
c_r_page_tex__29 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.4\.0[0] (0.38 conf)
c_r_page_tex__30 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.4\.1[0] (0.38 conf)
c_r_page_tex__31 was CR-115[0].Page1[0].TEXT\.1\.23\.7\.6\.4\.2[0] (0.38 conf)
c_r_page_tex__32 was CR-115[0].Page1[0].TEXT\.1\.9[1] (0.38 conf)
c_r_page_tex__33 was CR-115[0].Page1[0].TEXT\.1\.9[2] (0.38 conf)
c_r_page_tex__34 was CR-115[0].Page1[0].TEXT\.1\.9[3] (0.38 conf)
c_r_page_tex__35 was CR-115[0].Page1[0].TEXT\.1\.9[4] (0.38 conf)
c_r_page_tex__36 was CR-115[0].Page1[0].TEXT\.1\.9[5] (0.38 conf)
c_r_page_tex__37 was CR-115[0].Page1[0].TEXT\.1\.9[6] (0.38 conf)
c_r_page_tex__38 was CR-115[0].Page1[0].TEXT\.1\.9[7] (0.38 conf)
c_r_page_tex__39 was CR-115[0].Page1[0].TEXT\.1\.9[8] (0.38 conf)
c_r_page_tex__40 was CR-115[0].Page1[0].TEXT\.1\.9[9] (0.38 conf)
c_r_page_tex__41 was CR-115[0].Page1[0].TEXT\.1\.9[10] (0.38 conf)
c_r_page_tex__42 was CR-115[0].Page1[0].TEXT\.1\.9[11] (0.38 conf)
c_r_page_tex__43 was CR-115[0].Page1[0].TEXT\.1\.9[12] (0.38 conf)
c_r_page_tex__44 was CR-115[0].Page1[0].TEXT\.1\.9[13] (0.38 conf)
c_r_page__3 was CR-115[0].Page1[0].T27[1] (0.32 conf)
c_r_page__4 was CR-115[0].Page1[0].T27[2] (0.32 conf)
c_r_page__5 was CR-115[0].Page1[0].T27[3] (0.32 conf)
c_r_page__6 was CR-115[0].Page1[0].T27[4] (0.32 conf)
c_r_page_case_number_ft__1 was CR-115[0].Page1[0].CaseNumber_ft[0] (0.38 conf)
c_r_page_tex__45 was CR-115[0].Page2[0].TEXT\.2\.0\.0[0] (0.38 conf)
c_r_page_tex__46 was CR-115[0].Page2[0].TEXT\.2\.0\.1[0] (0.38 conf)
c_r_page_tex__47 was CR-115[0].Page2[0].TEXT\.2\.2\.0[0] (0.38 conf)
c_r_page_tex__48 was CR-115[0].Page2[0].TEXT\.2\.2\.1[0] (0.38 conf)
c_r_page_tex__49 was CR-115[0].Page2[0].TEXT\.2\.3\.0[0] (0.38 conf)
c_r_page_tex__50 was CR-115[0].Page2[0].TEXT\.2\.3\.1[0] (0.38 conf)
c_r_page_tex__51 was CR-115[0].Page2[0].TEXT\.2\.4\.0[0] (0.38 conf)
c_r_page_tex__52 was CR-115[0].Page2[0].TEXT\.2\.4\.1[0] (0.38 conf)
c_r_page_tex__53 was CR-115[0].Page2[0].TEXT\.2\.4\.2[0] (0.38 conf)
c_r_page_tex__54 was CR-115[0].Page2[0].TEXT\.2\.5\.0[0] (0.38 conf)
c_r_page_tex__55 was CR-115[0].Page2[0].TEXT\.2\.5\.0[1] (0.38 conf)
c_r_page_tex__56 was CR-115[0].Page2[0].TEXT\.2\.5\.0[2] (0.38 conf)
c_r_page_tex__57 was CR-115[0].Page2[0].TEXT\.2\.6\.0[0] (0.38 conf)
c_r_page_tex__58 was CR-115[0].Page2[0].TEXT\.2\.6\.1[0] (0.38 conf)
c_r_page_tex__59 was CR-115[0].Page2[0].TEXT\.2\.6\.0[1] (0.38 conf)
c_r_page_tex__60 was CR-115[0].Page2[0].TEXT\.2\.7[0] (0.38 conf)
c_r_page_tex__61 was CR-115[0].Page2[0].TEXT\.2\.17[0] (0.38 conf)
c_r_page_tex__62 was CR-115[0].Page2[0].TEXT\.2\.22\.2[0] (0.38 conf)
c_r_page_tex__63 was CR-115[0].Page2[0].TEXT\.2\.7[1] (0.38 conf)
c_r_page_tex__64 was CR-115[0].Page2[0].TEXT\.2\.7[2] (0.38 conf)
c_r_page_tex__65 was CR-115[0].Page2[0].TEXT\.2\.7[3] (0.38 conf)
c_r_page_tex__66 was CR-115[0].Page2[0].TEXT\.2\.7[4] (0.38 conf)
c_r_page_tex__67 was CR-115[0].Page2[0].TEXT\.2\.7[5] (0.38 conf)
c_r_page_tex__68 was CR-115[0].Page2[0].TEXT\.2\.7[6] (0.38 conf)
c_r_page_txt_atty_statement_date__1 was CR-115[0].Page2[0].txt\.atty\.statement\.date[0] (0.28 conf)
c_r_page_txt_atty_statement_date__2 was CR-115[0].Page2[0].txt\.atty\.statement\.date[1] (0.28 conf)
c_r_page_statement_def_sig was CR-115[0].Page2[0].txt\.statement\.def\.sig[1] (0.28 conf)
c_r_page_text_field__1 was CR-115[0].Page2[0].TextField[0] (0.38 conf)
c_r_page_date_field was CR-115[0].Page2[0].DateField1[0] (0.35 conf)
c_r_page_check_box_caption__1 was CR-115[0].Page2[0].CheckBoxCaption[0] (0.34 conf)
c_r_page_check_box_caption__2 was CR-115[0].Page2[0].CheckBoxCaption[1] (0.34 conf)
c_r_page_check_box_captions__1 was CR-115[0].Page2[0].CheckBoxCaptions[0] (0.34 conf)
c_r_page_check_box_captions__2 was CR-115[0].Page2[0].CheckBoxCaptions[1] (0.34 conf)
c_r_page__7 was CR-115[0].Page2[0].we[0] (0.28 conf)
c_r_page_sc was CR-115[0].Page2[0].sc[0] (0.28 conf)
c_r_page_text_field__2 was CR-115[0].Page2[0].TextField6[0] (0.38 conf)
c_r_page_case_number_ft__2 was CR-115[0].Page2[0].CaseNumber_ft[0] (0.38 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Defendant's Statement of Assets

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02