IN THE COUNTY COURT IN AND FOR OKALOOSA COUNTY, FLORIDA SMALL CLAIMS DIVISION _________________________________ Plaintiff(s) vs. Case No._____________________________ _________________________________ Defendant(s) FACT INFORMATION SHEET --- BUSINESS ENTITY Name/Title of person filing 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 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: __________________________________ 1 Form 7.343 Business Entity 10/11 American LegalNet, Inc. www.FormsWorkFlow.com Years/Makes/Models: ____________________________________________________ Vehicle I.D. Numbers: ____________________________________________________ Tag Numbers:__________________________________________________________ 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 ________ Stocks/Bonds ________ Camper ________ 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 held any legal or equitable interest. 3. All cancelled 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. Bill 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 this judgment. 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. Resolution 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. 2 Form 7.343 Business Entity 10/11 American LegalNet, Inc. www.FormsWorkFlow.com UNER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE ____________________________________ Defendant's Designation Representative Title:________________________________ STATE OF FLORIDA COUNTY OF ___________________________ The foregoing instrument was acknowledged before me on _________, 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, on __________________, 20_____. ________________________________ Notary Public State of Florida My commission expires: MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR'S ATTORNEY. 3 Form 7.343 Business Entity 10/11 American LegalNet, Inc. www.FormsWorkFlow.com