Application For Local Business Tax Receipt {401-279A}

EXHIBIT A IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA Case Number CACE _________________ (11) Plaintiff, v. Defendant(s). ________________________________________________/ AFFIDAVIT OF COMPLIANCE WITH ADMINISTRATIVE ORDER AS TO SUMMARY JUDGMENT HEARINGS On this date personally appeared before me, this undersigned authority, duly authorized to administer oaths and take acknowledgments, _______________________________________ Esq., who after being first duly sworn, upon his or her oath, deposes and states: 1. Original filing fee has been properly adjusted up or down to reflect the actual value of the claim in the Final Judgment: [ ] No additional fee required; or [ ] Additional filing fee enclosed; or [ ] Plaintiff to get a refund from the Clerk of Court. 2. [ ] Elements and Certification were filed with the Complaint for cases filed on or after July 1, 2013, pursuant to Section 702.015, Fla. Stat.; or [ ] Elements and Certification not applicable as case filed before July 1, 2013. 3. Service of Process is completed on all parties and any and all proof has been filed in this action. Defendant (s) Date Served Date of Default Date of Answer Affirmative Def. [ [ [ [ [ ]Yes/[ ]Yes/[ ]Yes/[ ]Yes/[ ]Yes/[ ] No ] No ] No ] No ] No Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Documents: 1. Current Notice of Hearing sent to all parties. [ ]Yes/[ ] No 2. Affidavit of Non-Military Service [ ] was or [ ] was not filed for defendants who have not answered. 3. Defendant filed bankruptcy [ ]Yes/[ ] No Date stay was lifted _________________ 4. Original promissory was filed [ ]Yes/[ ] No or an Affidavit of Lost Promissory Note was filed on ________________________________ and adequate protection is provided by: [ ] Written indemnification [ ] Surety bond [ ] Letter of credit [ ] Deposit of cash collateral [ ] Other Security approved by the court 5. Motion for Final Judgment was completed and filed: [ ] Summary Final Judgment Date Filed _______________ [ ] Order to Show Cause Date Filed _______________ [ ] Other Order ___________________________________ Date Filed _______________ 6. Motion to Dismiss [ ]Yes/[ ] No 7. Affidavit of Guardian Ad Litem filed [ ]Yes/[ ] No Date Filed _______________ $__________ 8. Affidavit of Indebtedness. Date Filed _______________ $_______________ 9. Affidavit of Costs. Date Filed _______________ $_______________ 10. Affidavit of Attorney's Fees Date Filed _______________ $_______________ 11. There are no pending motions [ ]Yes/[ ] No The information requested above is located in the court file. information in the court file. The dates reflect the FURTHER AFFIANT SAYETH NAUGHT. Attorney's Signature: ___________________________________ Attorney's Name: ___________________________________ Attorney's Bar#: ___________________________________ Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Sworn to and subscribed before me this ________ day of _________________________, 20_________. The undersigned notary public specifies that Affiant's signature is the signature being notarized and that Affiant personally appeared before the notary public at the time of notarization. Affiant is [ ] personally known or [ ] produced identification. Type of identification produced ___________________________________________ ________________________________ Notary Public - State of Florida My Commission Expires: Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com