CL-0814-1809
IN THE COUNTY COURT OF THE SEVENTH JUDICIAL CIRCUIT
IN AND FOR VOLUSIA COUNTY, FLORIDA
Case No.
Division
Plaintiff(s)
vs
Defendant(s)
FACT INFORMATION SHEET BUSINESS ENTITY
Name of entity:
Name/Title of person filling out this form:
Telephone number: Home: Business:
Address of Business Entity:
Type of Entity: (Check One) Corporation Partnership Limited Partnership
Sole Proprietorship 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):
Average No. of Employees/Month:
Name of Officers and Directors:
Checking account at: Account No:
Savings account at: Account No:
CL-0814-1809
Does the Business Entity own any vehicles: Yes No
Years/Makes/Models:
Vehicle I.D. Nos.:
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 Camper
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 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 defendants assets and liabilities prepared
within the 12 months immediately preceding the date of this judgment.
CL-0814-1809
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
Printed Name:
Title:
STATE OF FLORIDA
COUNTY OF _______________________
The foregoing instrument was acknowledged before me on ,
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
Notary Public
State of Florida
My Commission expires:
MAIL OR DELIVER THE COMPLETED TO THE JUDGMENT CREDITOR OR THE
JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.