FORM 7.343. FACT INFORMATION SHEET

FORM 7.343. FACT INFORMATION SHEET

(a) For Individuals

(CAPTION)

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 License Number:

Issuing State:

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: $

per

Names of Others You Live With:

Who is Head of Your Household?

You Spouse

Other Person Checking Account at:

Account #

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 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 # (VIN):

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 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:

1. Your last pay stub.

2. Your last 3 statements for each bank, savings, credit union, or other financial account.

3. Your motor vehicle registrations and titles.

4. Any deeds or titles to any real or personal property you own or are buying, or leases to property you are renting.

5. Your last 2 income tax returns filed.

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 on .....(date)....., by ...................., who is personally known to me or has produced .................... as identification and who .....did/did not..... take an oath.

WITNESS my hand and official seal, on .....(date)......

Notary Public State of Florida

My Commission expires: ....................

SERVE THE COMPLETED FORM AND ATTACH ANY COPIES, PURSUANT TO FLORIDA RULE OF GENERAL PRACTICE AND JUDICIAL ADMINISTRATION 2.516, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.

(b) For Corporate Entities

(CAPTION)

FACT INFORMATION SHEET — BUSINESS ENTITY

Name/Title of person filling out this form:

Address:

Telephone Number: Home:

Business:

Address of Business Entity:

Type of Entity: (Check One)  Corporation  Partnership  Limited Partnership  Sole Proprietorship  Limited Liability Company (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):

Average No. of Employees/Month:

Names of Officers and Directors:

Checking Account at:

Account No:

Savings Account At:

Account No:

Does the Business Entity own any vehicles:

Years/Makes/Models:

Vehicle ID # (VIN):

Tag Nos.:

Loans Outstanding:

Does the Business Entity own any real property: YES

NO

If Yes: Address:

Please check if the business entity owns the following:

Boat

Mobile Home/RV

Stocks/Bonds

Other Real Property

Other Personal Property

Intangible Property

Please attach copies of the following: 1. All tax returns for the past 3 years, including but not limited to state and federal income tax returns and tangible personal property tax returns.

2. 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.

3. All canceled checks for the 12 months immediately preceding the date of this judgment for accounts in which the defendant held any legal or equitable interest.

4. 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.

5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any personal 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.

6. Motor vehicle documents, including titles and registrations relating to any motor vehicles owned by the defendant alone or with others.

7. Financial statements and any other business records, including but not limited to accounts payable and accounts receivable ledgers, as to the defendant’s assets and liabilities prepared within the 12 months immediately preceding the date of this judgment.

8. Copies of articles, by-laws, partnership agreement, operating agreement, and any other governing documents, and minutes of all meetings of the defendant’s shareholders, board of directors, or members held within 2 years of the date of this judgment.

9. Resolutions of the shareholders, board of directors, or members passed within 2 years of the date of this judgment.

10. A list or schedule of all inventory and equipment.

UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM 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 .....(date)....., by

, as the defendant’s duly authorized representative, who is personally known to me or has produced

as identification and who did/did not take an oath.

WITNESS my hand and official seal, on .....(date)......

Notary Public State of Florida

My Commission expires:

SERVE THE COMPLETED FORM AND ATTACH ANY COPIES, PURSUANT TO FLORIDA RULE OF GENERAL PRACTICE AND JUDICIAL ADMINISTRATION 2.516, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.