Page _____ of _____
PLAINTIFF
CASE NUMBER
DEFENDANT
05
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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 your ow n or are buying.
FOR ALL MOTOR VEHICLES YOU OWN OR ARE BUYING:
YEAR
MAKE
MODEL
COLOR
VEHICLE ID#
TAG NO
MILEAGE
NAMES ON TITLE:
PRESENT VALUE
LOAN OWED TO:
BALANCE ON LOAN: $
MONTHLY PAYMENT: $
(List all other automobiles, as w ell 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 w orth more than $100 to any person in the last year?
If you answ er " yes" , describe the property and sale price, and give the name of the address of the person w ho received the
property.
DOES ANYONE OWE YOU MONEY?
AMOUNT OWED: $
NAME AND ADDRESS OF PERSON OWING MONEY:
REASON MONEY OWED:
Please attach copies of the follow ing:
a.
Your last pay stub.
b.
Your last 3 statements for each bank, savings, credit union, or other financial account.
c.
Your motor vehicle registrations and titles
d.
Any deeds or titles to any real or personal property you ow n or are buying, or leases to property
you are renting.
Under penalty of perjury, I sw ear or affirm that the foregoing answ ers are true and correct.
Judgment Debtor
STATE OF FLORIDA
COUNTY OF BREVARD
The foregoing instrument w as acknow ledged before me this _______ day of ____________________, 20___,
by ______________________________________________________________ , w ho is personally know n to me or has produced
____________________________________________ as identification and w ho
did
did not take an oath.
Witness my hand and official seal, this ______ day of __________________, 20____ .
NOTARY PUBLIC
STATE OF FLORIDA
My Commission Expires:
LAW 390
Rev. 12-14-2012
Print Form
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