FACT INFORMATION SHEET – INDIVIDUAL

IN THE SMALL CLAIMS COURT IN THE

SEVENTEENTH JUDICIAL CIRCUIT IN AND

FOR BROWARD COUNTY, FLORIDA

 

                                                                                     CASE NO.:  07-003253 COSO 60

 

Gerard J. Dour

                        Plaintiff

v.

Francine Vandal,         

                        Defendant

_________________________/

 

 

FACT INFORMATION SHEET

FOR JUDGMENT DEBTOR

(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’s License Number:                                                                                                                    

 

Marital Status: Spouse’s Name:                                                                                                           

 

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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.

 

 

 

 

 

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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                                                

 

The foregoing instrument was acknowledged before me this______ day of _______________, 20__, 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, this ______ day of ________________, 20___. 

 

 

 

                                                                       

Notary Public, State of Florida

Printed Name:

My Commission expires: ………………..

 

THE JUDGMENT DEBTOR SHALL FILE WITH THE CLERK OF THE COURT A NOTICE OF COMPLIANCE AFTER THE ORIGINAL FACT INFORMATION SHEET, TOGETHER WITH ALL ATTACHMENTS, HAS BEEN DELIVERED TO THE JUDGMENT CREDITOR’S ATTORNEY, OR TO THE JUDGMENT CREDITOR IF THE JUDGMENT CREDITOR IS NOT REPRESENTED BY AN ATTORNEY.

 

 

Voluntary Dismissal Without Prejudice

IN THE SMALL CLAIMS COURT IN THE

SEVENTEENTH JUDICIAL CIRCUIT IN AND

FOR BROWARD COUNTY, FLORIDA

 

                                                            CASE NO.:  07-003253 COSO 60

 

Gerard J. Dour

                        Plaintiff

v.

Francine Vandal,      

                        Defendant

and

 

Montreal Inn

                        Defendant

_________________________/

 

NOTICE OF VOLUNTARY DISMISSAL

WITHOUT PREJUDICE OF DEFENDANT MONTREAL INN

            In accordance with Rule 7.110 Small Claims Rules and Rule 1.250(b) Rules of Civil Procedure, Plaintiff, by and through its undersigned counsel, hereby voluntarily dismisses, without prejudice, Defendant MONTREAL INN.

            Plaintiff continues its action against Defendant Francine Vandal.

 

I hereby certify that a true copy of the foregoing was mailed on this ___________ day of June, 2007, to all parties listed below.

 

                                                                        Respectfully submitted,

                                                                        Attorney for Plaintiff

                                                                        335 S. Biscayne Blvd. PH #UPH00

                                                                        Miami, Florida 33131

                                                                        P:  305-394-8546

                                                                        F:  866-380-8986

                                                                        ___________________________

                                                                        Michael D. Stewart

                                                                        Florida Bar No.:  0012457

 

 

 

 

Copy to:          Clerk of Court

                        South Regional Courthouse

 

                        Judge Sharon Zeller

                        Chamber S214

                        South Regional Courthouse

                        3550 Hollywood Blvd.

                        Hollywood, FL 33021

 

                        Ms. Francine Vandal

                        316 Walnut Street

                        Hollywood, FL 33019

                                                

                        Montreal Inn

                        324 Balboa St.

                        Hollywood, FL 33019

 

                        H&N Friendly Estate, LC d/b/a Montreal Inn

                        780 Northwest Le Jeune Rd., Suite 516

                        Miami, Florida 33126

 

                        Michael D. Stewart, Esq.

                        335 S. Biscayne Blvd., PH #UPH00

                        Miami, Florida 33131

 

 

 

 

Default Final Judgment

IN THE SMALL CLAIMS COURT IN THE

SEVENTEENTH JUDICIAL CIRCUIT IN AND

FOR BROWARD COUNTY, FLORIDA

 

                                                                        CASE NO.:  07-003254 COSO 60

 

Gerard J. Dour

                        Plaintiff

v.

Helene Jean

                        Defendant

 

DEFAULT FINAL JUDGMENT

 

            It is ordered and adjudged:

 

Gerard Dour recovers $4,300 from Defendant Helene Jean, for which sum let execution issue forthwith.  This consists of $4,000 principal, $255 court filing fee; and $45 service of process fee.  Interest will accrue at the statutory rate.

 

            IT IS FURTHER ORDERED AND ADJUDGED that the judgment debtor(s) shall complete under oath Florida Small Claims Rules Form 7.343 (Fact Information Sheet (Fact Information Sheet), for an individual; including all required attachments, and serve it on the judgment creditor’s attorney, or the judgment creditor if the judgment creditor is not represented by an attorney, within 45 days from the date of this final judgment, unless the final judgment date is satisfied or post-judgment discovery is stayed.

 

Jurisdiction of this case is retained to enter further orders that are proper to compel the judgment debtor(s) to complete form 7.343, including all required attachments, and serve it on the judgment creditor’s attorney, or the judgment creditor if the judgment creditor is not represented by an attorney.

 

            ORDERED AND ADJUDGED at Broward County, Florida on _____________, 2007.

                                                                                    _____________________________

                                                                                    JUDGE SHARON L. ZELLER

                                                                                   

Copy to:           Ms. Helene Jean

                        318 Walnut Street

                        Hollywood, Florida 33019

 

                        Michael D. Stewart, Esq.

                        335 S. Biscayne Blvd., PH #UPH00

                        Miami, Florida 33131