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