Fact Information Sheet (Corporation-Business Entity) {1.977(b)}

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)} January1, 2014 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.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. 2. 3. 4. 5. 6. 7. 8. 9. Copies of state and federal income tax returns for the past 3 years. 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. All canceled checks for the 12 m onths immediately preceding the service date of this Fact Inform ation Sheet for accounts in which the entity held any legal or equitable interest. All deeds, leases, mortgages or other written instru ments evidencing any interest in or ownership of real property at any time within the 12 months immediately preceding the date this lawsuit was filed. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any real or personal property to or from the entity within the 12 months immediately preceding the date this lawsuit was filed. Motor vehicle or vessel documents, including titles and registrations relating to any motor vehicles or vessels owned by the entity alone or with others. Financial statemen ts as to th e en tity's assets, liabilities, and owner's equ ity prepared within the 12 months immediately preceding the service date of this Fact Information Sheet. 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. 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. Judgment Debtor's Designated Representative/Title Fact Information Sheet (Corporation-Business Entity) {1.977(b)} January1, 2014 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF FLORIDA COUNTY OF day of , 20 , by . Notary Public, State of Florida My Commission expires: Personally known or produced identification Type of identification produced __________________ YOU MUST MAIL OR DELIVER THIS COMPLETED FORM, WITH ALL ATTACHMENTS, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR'S ATTORNEY, BUT DO NOT FILE THIS TFORM WITH THE CLERK OF COURT. . Fact Information Sheet (Corporation-Business Entity) {1.977(b)} January 1, 2014 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com