Fact Information Sheet Business Entity

IN THE COUNTY COURT OF THE SEVENTH JUDICIAL CIRCUIT IN AND FOR VOLUSIA COUNTY, FLORIDA Case No. Judge Plaintiff(s) Division vs Defendant(s) 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) 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: 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 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 UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. Defendant222s Designated Representative Title: American LegalNet, Inc. www.FormsWorkFlow.com CL-0814-0512 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 oath. WITNESS my hand and official seal, on . (date) Notary Public State of Florida My Commission expires: MAIL OR DELIVER THIS FORM TO THE CLERK OF THE COURT, AND MAIL OR DELIVER A COPY OF THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE CREDITOR222S ATTORNEY. American LegalNet, Inc. www.FormsWorkFlow.com