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Fact Information Sheet (Corporation-Business Entity) 1.977(b) - Florida

Fact Information Sheet (Corporation-Business Entity) Form. This is a Florida form and can be used in Civil Statewide .
 Fillable pdf Last Modified 6/14/2006
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IN THE COUNTY COURT IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA ______________________ DIVISION ) ) ,) ) ) ) ) ) ,) ) Plaintiff, -vs- No. Defendant. FACT INFORMATION SHEET Name of entity: Name and title of person filling out this form: Telephone Number: Place of business: Mailing address (if different): Gross/taxable income reported for federal income tax purposes last three years: $_________/$_________$_________/$_________$_________/$_________ Taxpayer identification number: ___________________________________________________________________ Is this entity an S corporation for federal income tax purposes? ________Yes ________No Average number of employees per month: ___________________________________________________________ Name of each shareholder, member, or partner owning 5% or more of the entity's common stock, preferred stock, or other equity interest: Names of officers, directors, members, or partners :____________________________________________________ Checking account at: __________________________________ Account # ________________________________ Savings account at: __________________________________ Account # __________________________________ Does this entity own any vehicles? ________Yes ________No Fact Information Sheet (Corporation-Business Entity) {1.977(b)} Page 1 of 3 American LegalNet, Inc. www.USCourtForms.com For each vehicle, please state: 1 Year/Make/Model: _________________ Color: _________________ 2 _________________ _________________ 3 _________________ _________________ 4 _________________ _________________ Vehicle ID No.: _________________ _________________ _________________ _________________ Tag No.: _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ Mileage: Names on Title: _________________ _________________ _________________ _________________ Present Value: $_________________ $_________________ $_________________ $_________________ Loan Owed to: _________________ _________________ _________________ _________________ Balance on Loan: $_________________ $_________________ $_________________ $_________________ Monthly Payment: $_________________ $_________________ $_________________ $_________________ Does the entity own any real property? ________Yes ________No If yes, please state the address(es): _______________________________________________________________ Please check if the entity owns the following: _____Boat _____Camper _____Stocks/bonds _____Other real property _____Other personal property Please attach copies of the following: 1. Copies of state and federal income tax returns for the past 3 years. 2. All bank, savings and loan and other account books and statements for accounts in institutions in which the entity had any legal or equitable interest for the past 3 years. 3. All canceled checks for the 12 months immediately preceding the service date of this Fact Information Sheet for accounts in which the entity held any legal or equitable interest. 4. All deeds, leases, mortgages or other written instruments evidencing any interest in or ownership of real at any time within the 12 months immediately preceding the date this lawsuit was filed. 5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any personal or real property to or from the entity within the 12 months immediately preceding the date this lawsuit was filed. 6. Motor vehicle or vessel documents, including titles and registrations relating to any motor vehicles or vessels owned by the entity alone or with others. 7. Financial statements as to the entity's assets, liabilities, and owner's equity prepared within the 12 months immediately preceding the service date of this Fact Information Sheet. 8. Minutes of all meetings of the entity's members, partners, shareholders, or board of directors held within 2 years of the service date of this Fact Information Sheet. 9. Resolutions of the entity's members, partners, shareholders, or board of directors passed within 2 years of the service date of this Fact Information Sheet. UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. Fact Information Sheet (Corporation-Business Entity) {1.977(b)} Page 2 of 3 American LegalNet, Inc. www.USCourtForms.com Judgment Debtor's Designated Representative/Title STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of , 20 , 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, this day of , 20 . Notary Public State of Florida My Commission expires: THE JUDGMENT DEBTOR SHALL FILE WITH THE CLERK OF THE COURT A NOTICE OF COMPLIANCE AFTER THE ORIGINAL FACT INFORMATION SHEET, TOGETHER WITH ALL ATTACHMENTS, HAS BEEN DELIVERED TO THE JUDGMENT CREDITOR'S ATTORNEY, OR TO THE JUDGMENT CREDITOR IF THE JUDGMENT CREDITOR IS NOT REPRESENTED BY AN ATTORNEY. Fact Information Sheet (Corporation-Business Entity) {1.977(b)} Page 3 of 3 American LegalNet, Inc. www.USCourtForms.com
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