Fact Information Sheet - Business Entity {7.343(b)}

IN THE CIRCUIT COURT OF THE IN AND FOR [DIVISION] ) ) ) ) ) ) ) ) ) ) JUDICIAL CIRCUIT COUNTY, FLORIDA , Plaintiff, -vs- No. , Defendant. FACT INFORMATION SHEET - BUSINESS ENTITY Name and title of person filling out this form: Address: Telephone Number: Home: Business: Address of Business Entity: Type of Ent ity: (Check One) Corporation Partnership Limited Partnership Limited Liability Corporation (LLC) Professional Association (PA) Other: (Please Explain) Does Business Entity own/have interest in any other business entity? If so please explain. Gross/taxable income reported for Federal Income Tax purposes last three years: $ $ Taxpayer identification number: List Partners (General or Limited and Designate Percentage of Ownership): $ Sole Proprietorship Average No. of Employees/Month: Names of Officers and Directors: Checking account at: Savings account at: Does Business Entity own any vehicles? Years/Makes/Models: Tag Nos.: Loans Outstanding; Does the entity own any real property: If Yes: Address: Fact Information Sheet - Business Entity {7.343(b)} Revised 12/19/11 Account # Account # YES NO Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Please check if the entity owns the following: Boat Stocks/bonds Other personal property Please attach copies of the following: 1. 2. 3. 4. 5. Camper Other real property All tax returns for th e past 3 years, in cluding but not limited to state an d federal income tax returns and tangible personal property tax returns. All bank, savings and loan, and other account books or statements for accounts in institutions in which the defendant had any legal or equitable interest for the past 3 years. All canceled checks for the 12 m onths immediately preceding the date of this judgm ent for accounts in which the defendant held any legal or equitable interest. All deeds, leases, mortgages, or other written instruments evidencing any interest in or ownership of real property at any time within the 12 months immediately preceding the date of this judgment. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any p ersonal or real property to or from the defendant within the 12 months immediately preceding the date of filing this lawsuit. Any transfer of property within the last year other than ordinary course of business transactions. Motor vehicle documents, including titles and registrations relating to any motor vehicles owned by the defendant alone or with others. Financial statements and any other business records, including but not limited to accounts payable and accounts receivable ledgers, as to the defend ant's assets and liabilities prepared within the 12 months immediately preceding the date of this judgment. Copies of articles, by-laws, partnership agreement, operating agreement, and any other governing documents, and minutes of a ll meetings of the defendant's shareholders, board of directors, or members held within 2 years of the date of this judgment. Resolutions of the shareholders, board of directors, or members passed within 2 years of the date of this judgment. A list or schedule of all inventory and equipment. 6. 7. 8. 9. 10. UNDER PENALTY OF PERJU RY, I SWEAR OR A FFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. Defendant's Designated Representative Title STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me on who is personally known to me or has produced did did not take an oath. WITNESS my hand and official seal, on Notary Public State of Florida , by , as identification and who My Commission expires: MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT. Fact Information Sheet - Business Entity {7.343(b)} Revised 12/19/11 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com