Fact Information Sheet - Individual {7.343(a)}

IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA [DIVISION] ) ) ) ) ) ) ) ) ) ) Plaintiff, -vs- , No. 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 an 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: $ Names of Others You Live With: Who is Head of Your Household? Checking Account at: per You Spouse Account # Other Person Fact Information Sheet - Individual {7.343(a)} Revised 12/19/11 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Savings Account at: Account # Describe all other accounts or investments you may have, including stocks, mutual funds, savings bonds, or annuities, on the back of this sheet or on 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 any real or personal property worth more than $100 to any person in the last year? If your answer is "yes," describe the property, market value, 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, saving, credit union, or other financial account. c. Your motor vehicle registrations and titles. d. Any deeds or titles to any real o r personal property you own or are bu ying, or leases to property you are renting. UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. Judgment Debtor STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this by day of , 20 , , who is personally known to me or has produced as Fact Information Sheet - Individual {7.343(a)} Revised 12/19/11 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com identification and who did did not take an oath. . Notary Public State of Florida WITNESS my hand and official seal, on My Commission expires: MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR TO THE JUDGMENT CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT. Fact Information Sheet - Individual {7.343(a)} Revised 12/19/11 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com