(a) For Individuals
(CAPTION)
FACT INFORMATION SHEET — INDIVIDUAL
Full Legal Name: _________________________________________________
Nicknames or Aliases: ____________________________________________
Residence Address: _______________________________________________
Mailing Address (if different): __________________________________
Telephone Numbers: (Home)_________________ (Business)_____________
Name of Employer: ________________________________________________
Address of Employer: _____________________________________________
Position or Job Description: _____________________________________
Rate of Pay: $__________ per __________
Average Paycheck: $__________ per __________
Average Commissions or Bonuses: $__________ per __________
Commissions or bonuses are based on _____________________________
Other Personal Income: $__________ from __________________________
(Explain details on the back of this sheet or an additional sheet if necessary.)
Social Security Number:__________________ Birthdate:______________
Driver License Number:___________________ Issuing State:_________
Marital Status:___________________ Spouse’s Name:________________
Spouse’s Address (if different):__________________________________
Spouse’s Social Security Number:_________________ Birthdate:________
Spouse’s Employer:________________________________________________
Spouse’s Average Paycheck or Income: $__________ per __________
Other Family Income: $__________ per ____________________________
(Explain details on back of this sheet or an additional sheet if necessary.)
Names and Ages of All Your Children (and addresses if not living with you):
__________________________________________________________________
Child Support or Alimony Paid: $__________ per __________
Names of Others You Live With: ___________________________________
Who is Head of Your Household? __________ You __________ Spouse __________ Other Person
Checking Account at: ________________________ Account #___________
Savings Account at: _________________________ Account #___________
(Describe all other accounts or investments you may have, including stocks, mutual funds, savings bonds, or annuities, on the back of this sheet or an additional sheet if necessary.)
For Real Estate (land) You Own or Are Buying:
Address: __________________________________________________________
All Names on Title: ______________________________________________
Mortgage Owed to: _______________________ Balance Owed:___________
Monthly Payment: $__________
(Attach a copy of the deed or mortgage, or list the legal description of the property on the back of this sheet or an additional sheet if necessary. Also provide the same information on any other property you own or are buying.)
For All Motor Vehicles You Own or Are Buying:
Year/Make/Model:______________________ Color:____________________
Vehicle ID # (VIN):_____________________ Tag No:__________________
Mileage:______________________________
Names on Title:___________________________________________________
Present Value: $_______________ Loan Owed to:_____________________
Balance on Loan: $______________ Monthly Payment: $_______________
(List all other automobiles, as well as other vehicles, such as boats, motorcycles, bicycles, or aircraft, on the back of this sheet or an additional sheet if necessary.)
Have you given, sold, loaned, or transferred any real or personal property worth more than $100 to any person in the last year? If your answer is “yes,” describe the property and sale price, and give the name and address of the person who received the property.
__________________________________________________________________
Does anyone owe you money? Amount Owed: $__________
Name and Address of Person Owing Money: __________________________
Reason money is owed: ____________________________________________
Please attach copies of the following:
1. Your last pay stub.
2. Your last 3 statements for each bank, savings, credit union, or other financial account.
3. Your motor vehicle registrations and titles.
4. Any deeds or titles to any real or personal property you own or are buying, or leases to property you are renting.
5. Your last 2 income tax returns filed.
UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE.
_________________________
Judgment Debtor
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 an oath.
WITNESS my hand and official seal, on .....(date)......
_________________________
Notary Public
State of Florida
My Commission expires: ....................
SERVE THE COMPLETED FORM AND ATTACH ANY COPIES, PURSUANT TO FLORIDA RULE OF GENERAL PRACTICE AND JUDICIAL ADMINISTRATION 2.516, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.
(b) For Corporate Entities
(CAPTION)
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) [] Corporation [] Partnership [] Limited Partnership [] Sole Proprietorship [] Limited Liability Company (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 ID # (VIN):_______________________________________________
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
____ Mobile Home/RV
____ Stocks/Bonds
____ Other Real Property
____ Other Personal Property
____ Intangible Property
Please attach copies of the following:
1. All tax returns for the past 3 years...
2. All bank, savings and loan, and other account books or statements...
3. All canceled checks for the 12 months...
4. All deeds, leases, mortgages, or other written instruments...
5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any personal or real property...
6. Motor vehicle documents, including titles and registrations...
7. Financial statements and any other business records...
8. Copies of articles, by-laws, partnership agreement, operating agreement...
9. Resolutions of the shareholders, board of directors, or members...
10. A list or schedule of all inventory and equipment.
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 on .....(date)....., by __________________, as the defendant’s duly authorized representative, 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 .....(date)......
_________________________
Notary Public
State of Florida
My Commission expires:
SERVE THE COMPLETED FORM AND ATTACH ANY COPIES, PURSUANT TO FLORIDA RULE OF GENERAL PRACTICE AND JUDICIAL ADMINISTRATION 2.516, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.
This is the "Fact Information Sheet," a detailed financial questionnaire that a judge can order a judgment debtor (the person who lost the case) to complete. It is a powerful tool for a judgment creditor (the person who won) to discover the debtor's assets and income in order to collect the money they are owed. There are separate, detailed versions for individual debtors and business entities. A crucial instruction at the bottom of both forms specifies that the completed sheet should be sent to the creditor, **NOT** filed with the court.
