Fl. R. Civ. P. form 1.977

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As amended through November 4, 2024

Form 1.977 - FACT INFORMATION SHEET

(a) For Individuals.

(CAPTION)

FACT INFORMATION SHEET

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's License Number: ____________________________________

Marital Status:___ Spouse's Name:_________________

********

Spouse Related Portion

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.)

Describe all other accounts or investments you may have, including stocks, mutual funds, savings bonds, or annuities, on the back of this sheet or on 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 #_____________

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 #:_____________ 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, market value, 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:

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 own or are buying, or leases to property you are renting.

e. Your financial statements, loan applications, or lists of assets and liabilities submitted to any person or entity within the last 3 years.

f. 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 ..........

Sworn to (or affirmed) and subscribed before me this ________day of ______ (year) by (name of person making statement)

Notary Public of Florida My Commission expires: ..........

Personally known ________OR Produced Identification _______

Type of identification produced ___________________________

YOU MUST MAIL OR DELIVER THIS COMPLETED FORM, WITH ALL ATTACHMENTS, TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR'S ATTORNEY, BUT DO NOT FILE THIS FORM WITH THE CLERK OF COURT.

(b) For Corporations and Other Business Entities.

(CAPTION)

FACT INFORMATION SHEET

Name of entity:____________________________________________

Name and title of person filling out this form:________________________

Telephone number:__________________________________________

Place of business:___________________________________________

Mailing address (if different): ____________________________________________

Gross/taxable income reported for federal income tax purposes last three years:

$___________ /$___________ $___________ /$___________ $___________ /$

Taxpayer identification number:____________________________

Is this entity an S corporation for federal income tax purposes?________ Yes__________ No

Average number of employees per month__________________________

Name of each shareholder, member, or partner owning 5% or more of the entity's common stock, preferred stock, or other equity interest:

_________________________________________________________

Names of officers, directors, members, or partners: _________________________________________________

Checking account at:__________________ Account #_______________

Savings account at:__________________ Account #_______________

Does the entity own any vehicles?__________ Yes___________ No___________

For each vehicle please state: ______________________________________________

Year/Make/Model:_______________ Color:______________

Vehicle ID No:___________________ Tag No:______ Mileage:________

Names on Title:___________________ Present Value: $_____________

Loan Owed to:______________________________

Balance on Loan: $______________________________

Monthly Payment: $______________________________

Does the entity own any real property? ____________ Yes ___________No

If yes, please state the address(es):______________________________

Please check if the entity owns the following

______Boat

______Camper

______Stocks/bonds

______Other real property

______Other personal property

Please attach copies of the following:

1. Copies of state and federal income tax returns for the past 3 years.

2. All bank, savings and loan, and other account books and statements for accounts in institutions in which the entity had any legal or equitable interest for the past 3 years.

3. All canceled checks for the 12 months immediately preceding the service date of this Fact Information Sheet for accounts in which the entity held any legal or equitable interest.

4. All deeds, leases, mortgages, or other written instruments evidencing any interest in or ownership of real property at any time within the 12 months immediately preceding the date this lawsuit was filed.

5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any personal or real property to or from the entity within the 12 months immediately preceding the date this lawsuit was filed.

6. Motor vehicle or vessel documents, including titles and registrations relating to any motor vehicles or vessels owned by the entity alone or with others.

7. Financial statements as to the entity's assets, liabilities, and owner's equity prepared within the 12 months immediately preceding the service date of this Fact Information Sheet.

8. Minutes of all meetings of the entity's members, partners, shareholders, or board of directors held within 2 years of the service date of this Fact Information Sheet.

9. Resolutions of the entity's members, partners, shareholders, or board of directors passed within 2 years of the service date of this Fact Information Sheet.

UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE.

________________________

Judgment Debtor's Designated

Representative/Title

STATE OF FLORIDA

COUNTY OF ..........

Sworn to (or affirmed) and subscribed before me this _____day of ____________ (year) by (name of person making statement).

Personally known ____OR Produced identification __________

Type of identification produced __________________________

YOU MUST MAIL OR DELIVER THIS COMPLETED FORM, WITH ALL ATTACHMENTS, TO THE PLAINTIFF'S JUDGMENT CREDITOR OR THE PLAINTIFF'S JUDGMENT CREDITOR'S ATTORNEY, BUT DO NOT FILE THIS FORM WITH THE CLERK OF THE COURT.

Fl. R. Civ. P. form 1.977

Amended by 131 So.3d 643, effective 1/1/2014; amended by 858 So.2d 1013, effective 1/1/2004; added by 773 So.2d 1098, effective 1/1/2001; added by 211 So.2d 174, effective 10/1/1968.

Committee Notes

2000 Adoption. This form is added to comply with amendments to rule 1.560.

2013 Amendment. This amendment clarifies that the judgment debtor should mail or deliver the Fact Information Sheet only to the judgment creditor or the judgment creditor's attorney, and should not file the Fact Information Sheet with the clerk of the court.