Declaration Of Disclosure Fl-140 Page 4

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YOUR NAME
YOUR STREET ADDRESS
YOUR CITY, STATE AND ZIP CODE
TELEPHONE #
WRITE “IN PRO PER”
COUNTY NAME
COURT’S PHYSICAL ADDRESS
COURT’S CITY, STATE AND ZIP CODE
FILL THIS OUT EXACTLY AS THE INFORMATION
APPEARS ON YOUR OTHER DOCUMENTS
CHECK WHICH
PARTY YOU
ARE
CHECK THE BOXES
COURT CASE NUMBER
DESCRIBING WHO YOU ARE
AND WHAT YOU ARE SERVING
X
CHECK THE APPROPRIATE BOX
DATE SERVED
IF YOU ARE WAIVING THE FINAL DECLARATION OF DISCLOSURE, CHECK THESE BOXES AND COMPLETE FL-144.
X
X
X
X
X
X
DATE
PRINT YOUR NAME
SIGN YOUR NAME

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