Fact Information Sheet - Individual Small Claims Rules Form 7.343 - County Court, Eighteenth Judicial Circuit, Brevard County

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IN THE COUNTY COURT, EIGHTEENTH JUDICIAL CIRCUIT, BREVARD COUNTY, FLORIDA
DIVISION: CIVIL
CASE NUMBER
05
-
-
-
-
XXXX-XX
PLAINTIFF
CLOCK IN
DEFENDANT
FACT INFORMATION SHEET - INDIVIDUAL
SMALL CLAIMS RULES FORM 7.343
FULL LEGAL NAME
NICK NAME OR ALIAS
RESIDENCE ADDRESS
MAILING ADDRESS
HOME TELEPHONE NUMBER
BUSINESS NUMBER
NAME OF EMPLOYER
ADDRESS OF EMPLOYER
POSITION OR JOB DESCRIPTION
RATE OF PAY:
$
PER
. AVERAGE PAYCHECK: $
PER
AVERAGE COMMISSIONS OR BONUS:
$
PER
. COMMISSIONS OR BONUS' ARE
BASED ON
OTHER PERSONAL INCOME
$
FROM
. Explain details on the back of this
sheet or an additional sheet if necessary.)
SOCIAL SECURITY NO .
BIRTHDATE
DRIVER' S LICENSE NO.
MARTIAL STATUS
SPOUSE' S NAME
SPOUSE' S ADDRESS (if different)
SPOUSE' S S.S.N.
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 w ith 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 #
LAW 390
BAR CODE LABEL
Rev. 10-2012

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