FACT INFORMATION SHEET-BUSINESS ENTITY Name/Title of person filling out this form: ________________________________________ Address: ____________________________________________________________________________ Street City State Zip Code Telephone Numbers: (Home) ______________________ (Business) __________________________ Address of Business Entity: ____________________________________________________________ Street City State Zip Code 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 purpose last three years: $ __________________________ $_____________________ $ ________________________ Taxpayer Identification Number: _______________________ List Partners (General or Limited and designate Percentage of Ownership): Average Number of Employees/month: __________________________ Names of Officers and Directors: ____________________________________________________________________________________ ____________________________________________________________________________________ Checking Account at:: _________________________________ Account Number : _________________ Savings Account at: ___________________________________ Account Number: _________________ Does the Business Entity own any vehicles: ________________________________________________ Years/Makes/Models: __________________________________________________________________ Vehicle I. D. Numbers : ________________________________________________________________ Tag Numbers: _______________________________________________________________________ Loans Outstanding: ___________________________________________________________________ Does the Business Entity own any real property: YES ___________ NO ________________________ If Yes: Address: ______________________________________________________________________ 12/30/05/Updated 04/13/2012 C:COUNTY/FORMS/JUDGMENTS/Fact Information Sheet/12/2002/updated 11/20/2015 American LegalNet, Inc. www.FormsWorkFlow.com Please check if the business entity owns the following: _______ Boat _______ Stocks/Bonds _______ Other Personal Property __________Camper __________ Other Real Property ___________Intangible Property 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 this _______ day of _____________________, 20___, 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, this ___________ day of ______________________, 20___. ______________________________________ Notary Public State of Florida My Commission Expires; __________________ MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE CREDITOR'S ATTORNEY. THIS FORM IS NOT TO BE FILED WITH THE CLERK OF THE COURT. wanda/finfact 11/20/2015 C:COUNTY/FORMS/JUDGMENTS/Fact Information Sheet/12/2002/updated 12/30/05/Updated 04/13/2012 American LegalNet, Inc. www.FormsWorkFlow.com