Florida > Local County > St Lucie > Small Claims
Fact Information Sheet - Individual - Florida
| Fact Information Sheet - Individual Form. This is a Florida form and can be used in Small Claims St Lucie Local County . |
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St. Lucie County, Florida County Civil division In the County Court, Nineteenth Judicial Circuit, in and for County of St. Lucie, State of Florida Civil Division Case No. PLAINTIFF, VS DEFENDANT. _______________________________________/ FACT INFORMATION SHEET INDIVIDUAL FULL LEGAL NAME: ____________________________________________________________ NICKNAMES OR ALIASES: ______________________________________________________ RESIDENCE ADDRESS: ________________________________________________________ MAILING ADDRESS (IF DIFFERENT): ______________________________________________ TELEPHONE NUMBERS: (HOME): _______________________ (BUSINESS): _____________ NAME OF EMPLOYER: _________________________________________________________ ADDRESS OF EMPLOYER: ______________________________________________________ POSITION OR JOB DESCRIPTION: ________________________________________________ RATE OF PAY: $_________ PER ____________. AVERAGE PAYCHECK $_______ PER ____ AVERAGE COMMISSIONS OR BONUSES: $_________ PER ________. COMMISSIONS OR BONUSES ARE BASED ON ______________________________________________________ OTHER PERSONAL INCOME: $_______________ FROM ______________________________ (EXPLAIN DETAILS ON THE BACK OF THIS SHEET OR ADDITIONAL SHEET IF NECESSARY) SOCIAL SECURITY NUMBER: ________________________ BIRTHDATE: ________________ DRIVER'S LICENSE NUMBER: ___________________________________________________ MARITAL STATUS: _________________________ SPOUSE'S NAME: ____________________ SPOUSE'S ADDRESS (IF DIFFERENT): ____________________________________________ SPOUSE'S SOCIAL SECURITY NUMBER: _______________BIRTHDATE: ________________ SPOUSE'S EMPLOYER: _________________________________________________________ SPOUSE'S AVERAGE PAYCHECK OR INCOME: $_______________ PER ________________ OTHER FAMILY INCOME: $______________ PER _____________________ (EXPLAIN DETAILS ON BACK OF THIS SHEET OR AN ADDITIONAL SHEET IF NECESSARY) NAMES AND AGES OF ALL YOUR CHILDREN (AND ADDRESSES IF NOT LIVING WITH YOU): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ CHILD SUPPORT OR ALIMONY PAID $____________ PER ____________________________ NAMES OF OTHERS YOU LIVE WITH: _____________________________________________ _____________________________________________________________________________ WHO IS HEAD OF YOUR HOUSEHOLD? ___ YOU ______ SPOUSE ______ OTHER PERSON American LegalNet, Inc. www.FormsWorkFlow.com CHECKING ACCOUNT AT: _____________________________ ACCOUNT #______________ SAVINGS ACCOUNT AT: _______________________________ACCOUNT #_______________ (DESCRIBED ALL OTHER ACCOUNTS OR INVESTMENTS YOU MAY HAVE, INCLUDING STOCKS, MUTUAL FUNDS, SAVINGS BONDS OR ANNUITIES, ON THE BACK OF THIS SHEET OR AN ADDITIONAL SHEET IF NECESSARY) FOR REAL ESTATE (LAND) YOU OWN OR ARE BUYING: ADDRESS: ___________________________________________________________________ ALL NAMES ON TITLE: _________________________________________________________ MORTGAGE OWED TO: _________________________________________________________ BALANCE OWED: ______________________________________________________________ MONTHLY PAYMENT: $_________________________________________________________ (ATTACH A COPY OF THE DEED OR MORTGAGE, OR LIST THE LEGAL DESCRIPTION OF THE PROPERTY ON THE BACK OF THIS SHEET OR AN ADDITIONAL SHEET IF NECESSARY. ALSO PROVIDE THE SAME INFORMATION ON ANY OTHER PROPERTY YOU OWN OR ARE BUYING) FOR ALL MOTOR VEHICLES YOU OWN OR ARE BUYING: YEAR/MAKE/MODEL: ______________________________________ COLOR: _____________ VEHICLE ID #: _______________________ TAG NO: ______________ MILEAGE: __________ NAMES ON TITLE: ____________________________________ PRESENT VALUE: _________ LOAN OWED TO: ______________________________________________________________ BALANCE ON LOAN: $__________________________________________________________ MONTHLY PAYMENT: $________________ LIST ALL OTHER AUTOMOBILES, AS WELL AS OTHER VEHICLES, SUCH AS BOATS, MOTORCYCLES, BICYCLES OR AIRCRAFT, ON THE BACK OF THIS SHEET OR AN ADDITIONAL SHEET IF NECESSARY.) __________________ _____________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________ HAVE YOU GIVEN, SOLD, LOANED OR TRANSFERRED AN REAL OR PERSONAL PROPERTY WORTH MORE THAN $100 TO ANY PERSON IN THE LAST YEAR? IF YOU ANSWER IS "YES", DESCRIBE THE PROPERTY AND SALE PRICE, AND GIVE THE NAME AND ADDRESS OF THE PERSON WHO RECEIVED THE PROPERTY: __________________________________________________________________________________ ________________________________________________________________________ DOES ANYONE OWE YOU MONEY? AMOUNT OWED: $______________________________ NAME AND ADDRESS OF PERSON OWING MONEY:_________________________________ _____________________________________________________________________________ REASON MONEY IS OWED: _____________________________________________________ PLEASE ATTACH COPIES OF THE FOLLOWING: A. YOUR LAST PAY STUB B. YOUR LAST 3 STATEMENTS FOR EACH BANK, SAVINGS, CREDIT UNION OR OTHER FINANCIAL ACCOUNT. C. YOUR MOTOR VEHICLE REGISTRATIONS AND TITLES D. ANY DEEDS OR TITLES TO ANY REAL OR PERSONAL PROPERTY YOU OWN OR ARE BUYING OR LEASES TO PROPERTY YOU ARE RENTING. American LegalNet, Inc. www.FormsWorkFlow.com UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWER ARE TRUE AND COMPLETE. ____________________________________ JUDGMENT DEBTOR STATE OF FLORIDA COUNTY OF ST. LUCIE THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME ON _____________________________________, BY ____________________________________ WHO IS PERSONALLY KNOWN TO ME OR HAS PRODUCED ________________________ AS IDENTIFICATION AND WHO _____ DID/DID NOT _____ TAKE AN OATH. WITNESS MY HAND AND OFFICIAL SEAL ON ________________________________ ___________________________________________ NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXPIRES: _____________________ MAIL OR DELIVER THIS FORM TO THE CLERK OF THE COURT AND MAIL OR DELIVER A COPY OF THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE CREDITOR'S ATTORNEY. Revised 2/5/10 American LegalNet, Inc. www.FormsWorkFlow.com
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