Fact Information Sheet {1.977(a)}

OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA ______________________ DIVISION ) ) ) ) ) ) ) ) ) ) Plaintiff, -vs- , No. Defendant. , FACT INFORMATION SHEET Full Legal Name: Nicknames or Aliases: Residence Address: Mailing Address (if different): Telephone Numbers: (Home) Name of Employer: Address of Employer: Position or Job Description: Rate of Pay: $ per (Business) . 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 Related Portion 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.) 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. Fact Information Sheet {1.977(a)} Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com January 1, 2014 . ******************************************************************************************** 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: Savings Account at: For Real Estate (land) You Own or Are Buying: Address: All Names on Title: Mortgage Owed to: You per Spouse Account # Other Person Account # Balance Owed: Monthly Payment: $ (Attach a c opy of t he 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 p erson 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: Fact Information Sheet {1.977(a)} Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com January 1, 2014 . 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 or personal property you own or are buying, or leases to property you are renting. e. Your financial statements, loan applications, or lists of assets and liabilities submitted to any person or entity within the last 3 years. f. Your last 2 income tax returns filed. UNDER PENALTY OF PERJURY, I S WEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TR UE AND COMPLETE. Judgment Debtor 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 {1.977(a)} January 1, 2014 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com