JUDGMENT LIEN CORRECTION STATEMENT THE FOLLOWING IS SUBMITTED IN ACCORDANCE WITH s. 55.207, FLORIDA STATUTES, AS INFORMATION ONLY. THE CORRECTION STATEMENT DOES NOT AFFECT THE EFFECTIVENESS OF THE JUDGMENT LIEN NOR WILL IT CHANGE THE INFORMATION SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE. JUDGMENT DEBTOR(S) 1. JUDGMENT DEBTOR (DEFENDANT) NAME AS SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE: _____________________________________________________________________________________________________________________ INDIVIDUAL OR BUSINESS ENTITY NAME ______________________________________________________________________________________________________________________ MAILING ADDRESS ___________________________________________________________________________ CITY ADDITIONAL JUDGMENT DEBTOR, IF APPLICABLE: _______________ ST ________________________ ZIP DO NOT PHOTOCOPY THIS FORM PRIOR TO USE. BAR CODE MUST BE LEGIBLE. 2. _____________________________________________________________________________________________________________________ INDIVIDUAL OR BUSINESS ENTITY NAME _____________________________________________________________________________________________________________________ MAILING ADDRESS ___________________________________________________________________________ CITY _______________ ST _______________________ ZIP JUDGMENT CREDITOR(S) 3. JUDGMENT CREDITOR (PLAINTIFF) NAME AS SHOWN ON THE RECORDS OF THE DEPARTMENT OF STATE: _____________________________________________________________________________________________________________________ CREDITOR NAME(S) _____________________________________________________________________________________________________________________ MAILING ADDRESS ____________________________________________________________________________ CITY ________________ ST _____________________ ZIP THIS SPACE FOR USE BY FILING OFFICER 4. ___________________________________________________________________ ENTER FILE NUMBER ASSIGNED TO ORIGINAL JUDGMENT LIEN BY DEPARTMENT OF STATE 5. ____________________________________________ DATE JUDGMENT LIEN FILED WITH DEPARTMENT OF STATE 6. THE JUDGMENT BEARING THE FILE NUMBER REFERENCED ABOVE, TO MY BELIEF, WAS WRONGFULLY FILED OR THE RECORD IS INACCURATE. THE MANNER IN WHICH THE RECORD SHOULD BE CORRECTED TO CURE THE INACCURACY IS STATED BELOW: 7. UNDER PENALTY OF PERJURY, I hereby certify that: (1) All of the information set forth above is true, correct, current and complete; and (2) I have complied with all applicable laws in submitting this Judgment Lien Correction Statement for filing. 8. ______________________________________________________ Authorized Signature NAME AND ADDRESS TO WHOM ACKNOWLEDGMENT/CERTIFICATION IS TO BE MAILED: __________________________________________________________________________________________________________________ NAME ______________________________________________________ Printed Name NON-REFUNDABLE PROCESSING FEE: JUDGMENT LIEN CORRECTION STATEMENT __________________________________________________________________________________________________________________ MAILING ADDRESS _______________________________________________________________ CITY ______________________ ST _________________________ ZIP $20.00 EACH ATTACHED PAGE, IF NECESSARY $ 5.00 CERTIFIED COPY REQUESTED $10.00 Division of Corporations x P.O. Box 6250 x Tallahassee, Fl 32314 x 850-656-7463 CR2E093 (03/08) American LegalNet, Inc. www.FormsWorkflow.com