Amendments to the Florida Family Law Rules

713 So.2d 1 (1998) AMENDMENTS TO THE FLORIDA FAMILY LAW RULES. No. 89955. Supreme Court of Florida. February 26, 1998. John F. Harkness, Jr., Executive Director, The Florida Bar, Tallahassee, Linda Vitale, Outgoing Chair, Florida Family Law Rules Committee, Fort Lauderdale, Burton Young, Chair, Florida Family Law Rules Committee, Young, Berman & Karpf, P.A., North Miami Beach, Durand Adams, Chair, Family Court Steering Committee, Bradenton, Debra Behnke, Co-Chair, Access to the Courts Workgroup, Family Courts Steering Committee, Tampa, and George S. Reynolds, III, Co-Chair, Access to the Courts Workgroup, Family Courts Steering Committee, Tallahassee, for Petitioner. Amy Karan, Administrative Judge, Richard Yale Feder, Administrative Judge, Judith Kreeger, Associate Administrative Judge, Lester Langer, Circuit Judge, Michael B. Chavies, Circuit Judge, Eugene Fierro, Circuit Judge, Carol R. Gersten, Circuit Judge, Maynard Gross, Circuit Judge, Gerald D. Hubbart, Circuit Judge, Arthur Taylor, Circuit Judge, Cecilia Altonaga, County Judge, Deborah White Labora, County Judge, Mark King Leban, County Judge and Bertha Soto, County Judge, Eleventh Judicial Circuit, Miami, Robert L. Doyel, Circuit Judge, Tenth Judicial Circuit, Bartow, J.K. "Buddy" Irby, Clerk of the Circuit Court for Alachua County, Gainesville, Katherine Fernandez Rundle, State Attorney, Eleventh Judicial Circuit, Miami, Gerald S. Deutsch, Fort Lauderdale, Robert E. Schroeder, Director, Department of Human Services, on behalf of Metro-Dade Advocates for Victims Program, Miami, B. Niklas Brihammar of Sheri Smallwood, Chartered, Key West, Patricia Grogan, Chair, Governor's Task Force on Domestic and Sexual Violence, Florida Department of Community Affairs, Tallahassee, Caroline C. Emery, Jacksonville, Kathryn Gutstein, Chairperson, Dade County Alliance Against Domestic Violence, Miami, Ivon Mesa, on behalf of the Commission on the Status of Women, Miami, Rana Holz of Rubinstein & Holz, P.A., Fort Myers, Virginia Daire, General Counsel, Florida Coalition Against Domestic Violence, Tallahassee, A. Quinn Jones, III, City Attorney and Ana Maria Pando, Assistant City Attorney, on behalf of the City of Miami Police Department, Miami, Marilyn R. McLean, Staff Attorney, Family Court Division, Eighth Judicial Circuit, Gainesville, Robert J. Jones, Administrative General Master, Eleventh Judicial Circuit, Miami, David B. Higginbottom, Frostproof, George F. Hachigian, Staff Representative, on behalf of the Fraternal Order of Police, Florida Labor Council, Inc., Fort Lauderdale, Linda J. Blue, Major, Metro-Dade Police Department, Domestic Crimes Bureau, Miami, Rachel Kronick, on behalf of Dade County Bar Association Legal Aid Society Domestic Violence Project, Miami, Geraldine E. Bishop, Judicial Staff Attorney, Fifth Judicial Circuit, Brooksville, Robert L. Vogel, Jr., Sheriff and Lt. Craig Broughton, Volusia County Sheriff's Department, Daytona Beach, comments regarding Family Law Rules. OVERTON, Justice. In 1990, the legislature established the Commission on Family Courts for the purpose of making recommendations regarding the implementation of the family law divisions. Ch. 90-273, Laws of Fla. After this Court received the commission's report recommending the implementation of such divisions, this Court established a new process for family law cases by directing that family court divisions be instituted. See In re Report of Com'n on Family Cts., 588 So.2d 586 (Fla.1991). Subsequently, we adopted new rules of procedure for these family law divisions, which were intended to address the unique problems of family law cases. In re Family Law Rules of Procedure, 663 So.2d 1047 (Fla.1995) (Family Law I), and In re Family Law Rules of Procedure, 663 So.2d 1049 (Fla.1995) (Family Law II). In doing so, we included a significant number of forms and instructions. Because these rules were new, and in some instances appeared to be complicated, we recognized that the rules and forms would need additional prompt refinement. To address *2 this problem, in Family Law II we directed the Family Law Rules Committee, the Family Courts Steering Committee, and the Supreme Court Mediation and Arbitration Rules Committee to review the rules and forms following their implementation and to make recommendations for changes to the rules and forms. In issuing that directive, we stressed that the committees should place particular emphasis on making revisions to further simplify the family law process, particularly because of the many litigants in family law cases who represent themselves. The development of common sense rules and forms in family law cases, understandable by both lawyers and pro se litigants alike, is essential. Reports submitted to the Office of State Courts Administrator by the circuits of this state reflect that, on average, sixtyfive percent of all family law cases have at least one unrepresented party. Consequently, the rules governing family law cases should be crafted to establish an easy-tounderstand process. Unfortunately, in adopting separate family law rules and forms, it appears that we may have complicated rather than simplified the process. One lawyer commenting on the rules stated that they are now so complicated that he has had to substantially increase his fees for dissolution proceedings. Our goal must be to simplify the process. Otherwise, we deny many citizens meaningful and affordable access to the courts, particularly when so many of them are self-represented. Moreover, every litigant in family law cases, whether represented by an attorney or not, is entitled to have contested matters heard by an article V judicial officer. Where custody, property, or liberty is involved, citizens in this state are entitled to a judicial resolution of a dispute, absent a mediated settlement. In 1997, the rules and steering committees finalized their second review and submitted to us recommended rule and form modifications. The mediation committee found no need to recommend changes to the rules regarding family law mediation at this time. Additionally, in an effort to fulfill the spirit of this Court's directives to simplify the process of litigation in family law matters, the steering committee completely revised the forms, incorporating instructions for litigants throughout the forms, rather than keeping those instructions in attached appendices. The committee also added a number of new forms to the rules. The proposed amendments and modifications to the rules and forms are extensive; the rules and forms now constitute more than 500 pages. The proposed rule changes were published for comment in The Florida Bar News, and many comments were received by this Court. We have now reviewed the proposed changes and the comments. The majority of the proposed changes fall into the following categories: technical revisions to improve or correct the forms and related instructions, domestic and repeat violence, mandatory disclosure, court appointed experts, evaluations of minor children, hearing officers and paternity determinations, motions for new trial and rehearing, civil contempt, and case management and pretrial conferences for adoptions. We adopt, without comment, the majority of technical changes made to the forms and related instructions. Additionally, after having reviewed the forms and related instructions, this Court has made numerous additional technical changes on its own. We address the numerous other issues raised by the proposed changes to the rules and the forms below. DOMESTIC AND REPEAT VIOLENCE Both the steering and rules committees have made suggested changes to Florida Family Law Rule of Procedure 12.610, which governs domestic and repeat violence, and the forms related to that rule. Some of the recommended changes were necessitated by recent changes to the statutes governing these issues. Petition Forms This Court received comments regarding the inclusion of the "Disclosure of Assistance by a Nonlawyer" on the domestic and repeat violence petition forms as well as on all other forms. Concern was raised as to the safety of the person assisting a victim of domestic violence in filling out the forms. Further, many comments asserted that there was no rule requiring this information and that it *3 should thus be deleted from all forms. That argument is erroneous. The disclosure is directed by Rule Regulating the Florida Bar 10-2.1(a). That rule provides in pertinent part as follows: (a) Unlicensed Practice of Law. The unlicensed practice of law shall mean the practice of law, as prohibited by statute, court rule, and case law of the State of Florida. For purposes of this chapter, it shall not constitute the unlicensed practice of law for a nonlawyer to engage in limited oral communications to assist a person in the completion of blanks on a legal form approved by the Supreme Court of Florida. Oral communications by nonlawyers are restricted to those communications reasonably necessary to elicit factual information to complete the blanks on the form and inform the person how to file the form. The following language shall appear on any form completed pursuant to this rule and any individuals assisting in the completion of the form shall provide their name, business name, address, and telephone number on the form: This form was completed with the assistance of: Name of Individual Name of Business Address Telephone Number Before a nonlawyer assists a person in the completion of a form in the manner set forth in this rule, the nonlawyer shall provide the person with a copy of a disclosure. A copy of the disclosure, signed by both the nonlawyer and the person, shall be given to the person to retain and the nonlawyer shall keep a copy in the person's file. The disclosure does not act as or constitute a waiver, disclaimer, or limitation of liability. (Emphasis added.) The Florida Family Law Forms were originally drafted by the standing committee on the unlicensed practice of law and were approved by this Court as simplified forms for pro se litigants. The intent in approving the numerous forms available in family law is still to assist pro se litigants, and the disclosure information is still required by that rule. We conclude that the disclosure information should continue to be required on the Florida Family Law Forms generally. We agree, however, that the safety of the victim as well as that of the form preparer is potentially at risk by the disclosure of this information on domestic and repeat violence petition forms. Further, most petition forms in domestic and repeat violence cases are completed at the office of the clerk of court, thus reducing the risk of unlicensed practice of law by form preparers. As such, we conclude that there should be a narrow exception to the disclosure requirement when domestic or repeat violence is at issue. Accordingly, we find that rule 10-2.1(a) should be modified to eliminate the requirement that the name, address, and telephone number of the preparer be placed on domestic and repeat violence forms, and we have eliminated the nonlawyer disclosure block from forms implementing rule 12.610. Injunction Forms We have been asked to require all Florida judges to use standardized forms for issuing injunctions in domestic and repeat violence cases. Currently, most counties use different injunction forms, which often results in enforcement problems across county lines for law enforcement officers. According to the steering committee and the Governor's Task Force on Domestic Violence, standardized forms would assist law enforcement officers in the enforcement of injunctions because, at a glance, they would be able to easily determine the terms of an injunction no matter which court generated the injunction. Most comments received by this Court favored this proposal in concept. Significant concern, however, was raised regarding the forms as proposed. Specifically, concerns were raised as to vague language regarding prohibited contact, language permitting contact generally and visitation with children in the temporary domestic violence injunction forms, the full faith and credit language, language regarding firearms, the length of the forms, and prohibitions against leaving the state with a minor child. We agree with the concept of standardized forms and have modified rule 12.610 to require *4 all judges to use the standardized injunction forms contained in Appendix B of this opinion. To accommodate the concerns addressed in the preceding paragraph, we have reviewed each of the suggestions in detail and have modified the injunction forms accordingly. For instance, where the forms prohibited a respondent from going "near" a petitioner's residence or place of employment, we have modified the forms to prohibit a respondent from going within 500 feet of petitioner's residence or place of employment unless otherwise provided by the trial judge issuing the injunction. Numerous other similar changes were made in response to specific comments received. Additionally, some comments noted the significant length of some forms due to the inclusion of standardized provisions regarding support and visitation issues that were not applicable to all cases. To accommodate those concerns, we have structured the injunction forms so that pages addressing support and visitation issues are separate and can be included or deleted as necessary. Judges are provided with a provision at the end of each applicable injunction form to indicate whether pages regarding support and visitation issues are included and to thus alert law enforcement officers as to the inclusion or exclusion of those pages. We have also eliminated the options for allowing contact between the petitioner and respondent and visitation with minor children in the temporary injunction form. The "additional provisions" space on the form will still allow judges to include provisions for contact or visitation; however, comments received expressed concern that a form which included a standard provision allowing for contact and/or visitation would encourage contact during the brief but volatile period of time between the issuance of the temporary and permanent injunctions. Some modifications in this regard have also been made to the permanent injunction form. The full faith and credit language that was included on the domestic violence injunctions has been modified to eliminate the language that the form "shall be afforded full faith and credit." The federal statute, 18 U.S.C. § 2265 (1994), does mandate that protection orders be afforded full faith and credit if certain conditions are met. However, comments received pointed out that such a determination must be made on a case by case basis by the judge issuing the order and a judge in the state in which enforcement is sought. The language has been modified to indicate that the "[i]t is intended" that the injunction be afforded full faith and credit. We were also asked by the Governor's Task Force on Domestic Violence to eliminate the provision in the forms precluding a victim from leaving the state with the parties' minor child. The concern was that a victim could not leave the state if necessary for safety purposes. Having considered this proposal, we conclude that a victim should be permitted to leave the state with the parties' minor child only if permitted through court order. While we recognize the concern for the victim's safety, this concern can be easily remedied by simply asking for permission to leave the state when filing the petition. We were also requested to make mandatory the current "optional" prohibition against possession of firearms or ammunition as well as to require that all firearms be surrendered to law enforcement. Currently, it is a violation of federal law to possess certain firearms while under an injunction for protection. 18 U.S.C. § 922(g)(8)(1994). However, there is apparently no similar provision in Florida law, and the federal prohibition covers only firearms used "in commerce." Under these circumstances, we are without authority to require Florida judges to automatically preclude possession of firearms. That would require a substantive legislative act. While we believe that judges would be well advised to make such a preclusion, we have left the provision optional. We have, however, included additional space on the form for judges to include instructions regarding the surrender of firearms and any related procedure for doing so should they conclude that surrender is appropriate. Both the committees and this Court also recognize that individual counties and circuits may have local provisions that need to be incorporated into the forms. The rule thus provides a procedure to be used to incorporate local provisions into the forms. *5 We have also been asked to make changes to rule 12.610 and related injunctions forms regarding the following two issues: (1) whether service of the permanent injunction may be mailed when the temporary injunction has been personally served on a respondent; and (2) whether the permanent injunction is to be issued for an indefinite or fixed period of time. Currently, rule 12.610 provides that both temporary and permanent injunctions in domestic violence cases must be served by personal service. The only exception to this provision is when a party is present at the hearing on a permanent injunction and that party fails or refuses to acknowledge receipt of a certified copy of the injunction from the clerk. Under those circumstances, the clerk may mail a certified copy of the injunction to that party's last known address and service is then complete upon mailing. We have been asked to amend rule 12.610 to allow service of the permanent injunction by mail when the respondent has been personally served with the temporary injunction. According to the rules committee, personal service of the temporary injunction, which (as proposed) includes directives that the permanent injunction will be served by mail, should be sufficient. The justification for the amendment is the difficulty in finding a respondent after the respondent is removed from the parties' joint residence. The domestic violence statute, section 741.30, Florida Statutes (1997), appears to have conflicting provisions regarding this issue. However, at least one provision in this statute specifically requires personal service of the permanent injunction. See § 741.30(7)(c)1. ("Within 24 hours after the court issues an injunction for protection against domestic violence ... the clerk of the court must forward a certified copy of the injunction for service to the sheriff with jurisdiction over the residence of the petitioner. The injunction must be served in accordance with the subsection.") (emphasis added). We received many comments from both judges and prosecutors opposing any change that would allow service by mail due to concerns about enforcement of the injunction and prosecution of injunction violations. We agree with those concerns. We conclude that the rule should not be amended to allow service by mail. Section 741.30 has also been revised to provide that the terms of an injunction are to remain in effect until modified or dissolved. See § 741.30(6)(b). Recommended changes to the rules and forms conform to that requirement. Some comments opposed this change because of problems that arise when awards of support and custody are made in a domestic violence injunction but no dissolution action is ever filed. In effect, by eliminating time limitations on permanent injunctions, the legislature has directed the courts to make permanent decisions regarding support and custody in domestic violence proceedings. While we recognize that an injunction should perhaps be issued for an indefinite period of time for purposes of protecting victims from violence, we agree with the concerns raised about this change. Further, we do not believe that the legislature can restrict a trial court's discretion to place time limitations on injunctions it issues. We have thus made modifications to allow judges to choose whether the injunction is to be indefinite or is to expire on a date certain. MANDATORY DISCLOSURE Both the steering and rules committees have requested changes to rule 12.285, which governs mandatory disclosure. First, we have been asked to modify the rule to reduce the scope and amount of items to be disclosed. Currently, any party whose income exceeds $50,000 per annum must file a number of items covering a period of three years preceding the filing of a petition and must automatically file answers to standard interrogatories. Under the proposed changes, the time period covered for most items to be produced has been reduced to one year or three months and would apply to all parties regardless of income; interrogatories would be supplemental to the financial affidavits and would not be automatic. Additionally, the committees recommend shortening the financial affidavits and requiring that any party making over $30,000 per annum file the *6 long-form affidavit.[1] We agree with all of the recommendations except the last. We conclude that the rule should continue to require any party making over $50,000 per annum to file the long-form affidavit, but note that the affidavit is shorter than the one currently contained in the rules. We reject the request that those with income between $30,000 and $50,000 also be required to file this long-form affidavit. Second, we have been asked to allow parties to be exempted from the mandatory filing of financial affidavits. Currently, all parties must file financial affidavits with the court. Presumably, to avoid public disclosure, the rules committee seeks to amend rule 12.285 to allow a court to exempt individuals from this requirement when they certify that they are serving the financial affidavits on each other. Only one comment was filed regarding this issue, cautioning that judges must have the financial affidavits to make financial determinations. We decline to adopt this recommendation at this time because we are concerned about the problems this change could cause. For instance, in any case where a court is charged with dividing the assets and liabilities of parties, financial affidavits are necessary to assist in such a decision. Moreover, even where no dispute exists as to the division of assets, financial affidavits must be available to the court should subsequent litigation in the case ensue, such as modification requests or subsequent allegations of fraud. If financial affidavits are not filed with the court, the court might be significantly hindered in rendering future decisions regarding a case. Further, as we noted in Family Law I, under certain limited conditions, financial affidavits could be sealed if necessary. See Barron v. Florida Freedom Newspapers, Inc., 531 So.2d 113 (Fla.1988). See also Fla. R. Jud. Admin. 2.051. A third proposal concerning mandatory disclosure is the steering committee's request to create new rule 12.287. The new rule would allow parties to serve requests for financial affidavits in enforcement or contempt proceedings because, under the current mandatory disclosure rule, an interrogatory process is the only means available to obtain such an affidavit. We approve the rule as proposed by the committee. EVALUATION OF MINOR CHILDREN The rules committee seeks adoption of a new rule, 12.363, concerning interviews, testing, and evaluations of minor children to discourage multiple evaluations and evaluations conducted by one party without the knowledge of the other. Such a rule was proposed but rejected by this Court when the family law rules were first adopted after numerous comments were received objecting to particular provisions of the rule. See Family Law I. The committee has altered the proposal to eliminate many of the concerns raised when it was previously proposed. We received only one comment to this proposal, which expressed support for the new rule. We approve the rule as proposed. COURT-APPOINTED EXPERTS The rules committee also seeks adoption of new rule 12.365 concerning the appointment of experts by the court. Among other things, the proposed rule provides for the method and order of appointment; restricts communication of the experts with the court except with notice and an opportunity to be present and heard during such communication; and provides that the report shall be served on the parties prior to trial. It does not apply to the appointment of experts under proposed new rule 12.363. As with rule 12.363, a similar rule was proposed and rejected when the family law rules were proposed in Family Law I. We note that the committee has made a number of changes to the rule as proposed here, but we still are concerned about the increase in costs the adoption of this rule may cause the parties. We decline to approve the proposed rule at this time. *7 HEARING OFFICERS Currently, rule 12.491 prohibits hearing officers from hearing contested paternity cases. Under the proposed amendment to that rule, hearing officers are prohibited only from presiding over jury trials in paternity cases but they may evaluate evidence and make findings and recommendations regarding paternity in cases where a jury trial will not be conducted. The steering committee requests this change to comply with federal requirements regarding an expedited paternity determination in certain cases. We decline to adopt this change at this time. The fact that an expedited paternity determination is required in certain cases does not eliminate the right of litigants to have substantive due process decisions be determined by article V judicial officers. Federal regulations cannot change or eliminate that right. Clearly, judges can provide expedited paternity determinations when necessary. Given the nature of paternity proceedings, we decline to approve this proposed change. MOTIONS FOR NEW TRIAL AND REHEARING The steering committee seeks to expand rule 12.530, which governs motions for new trial and rehearing and amendments of judgments, to address the need to require parties to bring an omission of factual findings required under chapter 61 to the trial court's attention. The committee suggests that this change will eliminate unnecessary appeals. The committee does raise the concern as to what would happen when one party invokes the rule, which would delay the time for filing an appeal, but another party wants to appeal other issues. This proposed rule change is opposed by the rules committee and several comments were received raising concerns about the change and its interaction with the appellate rules. We decline to adopt this rule at this time given the concerns raised by the committees and comments. The purpose of the proposed rule does seem to have merit; however, the steering and rules committees need to discuss this proposal with the appellate rules committee, and appropriate rule changes to both the family law and appellate rules need to be crafted that ensure the appellate rights of litigants are not compromised. CIVIL CONTEMPT The rules committee seeks adoption of a new rule to govern the procedures for noticing a hearing on contempt, for establishing purge conditions, and for providing a contemnor's right of review. The committee asserts that this rule is necessary to avoid the current confusion that exists in handling civil contempt proceedings, particularly when those proceedings are before a hearing officer or general master. We have a number of serious concerns regarding this rule as proposed. Any rule concerning contempt, particularly one dealing with incarceration, must comply with United States and Florida Supreme Court decisions in this area. International Union, United Mine Workers v. Bagwell, 512 U.S. 821, 114 S.Ct. 2552, 129 L.Ed.2d 642 (1994); Bowen v. Bowen, 471 So.2d 1274 (Fla.1985); Pugliese v. Pugliese, 347 So.2d 422 (Fla. 1977). Portions of the rule as proposed appear to require a prospective finding of contempt before the contemnor has had an opportunity to be heard. This would violate the due process rights of contemnors and be specifically prohibited by the above decisions. Further, certain language in the rule imposes a rebuttable presumption that the contemnor has the present ability to comply with a prior order. The language apparently is derived from section 61.14(5)(a), Florida Statutes (1997), which addresses support enforcement. Unlike the statutory provision, however, the rule as written covers "any civil contempt proceeding"—it is not limited to support. We are concerned that this is a substantive change not intended by the statute. While we are not necessarily opposed to the adoption of a rule regarding contempt proceedings, we find the new rule, as proposed, to be unacceptable. Because we reject the adoption of this rule, we have, of necessity, eliminated proposed forms that would implement portions of this rule. *8 CASE MANAGEMENT AND PRETRIAL CONFERENCES FOR ADOPTIONS The rules committee seeks to amend rule 12.200, governing case management conferences, to require case management conferences in adoption proceedings. Under the proposed amendment, the court will determine notice, intermediary, and cost issues early in the litigation to avoid protracted adoption litigation. We approve the proposed amendments to this rule. INCOME DEDUCTION FORMS We have eliminated the income deduction forms currently contained in the judgments and orders portion of the forms. First, those forms are no longer orders given changes in the statute and should be placed elsewhere in the forms. Second, several of the forms must be rewritten because portions are incorrect. Third, we have serious due process concerns regarding the ability of a party to require income to be deducted from another party's paycheck without the necessity of a court order. While the statute governing this issue allows this to be done, the process for doing so is not definitive and has caused significant confusion. For instance, the forms as drafted provide that the clerk of court is to sign the forms to verify payments to be made. Comments received regarding this issue ask that the clerk's verification be deleted from these forms due to the burden this verification places on the clerks. Additionally, we understand that proposed legislation is currently being drafted to amend the process and to address these issues. We suggest that the committees evaluate these concerns and any new legislation that passes regarding income deduction and then draft new proposed forms accordingly. MISCELLANEOUS SUGGESTIONS The committees and interested individuals and groups who commented on the rules made numerous other suggestions, most of which are technical and most of which we have implemented. Some, however, have not been implemented at this time. For instance, in the response of the rules committee to the forms submitted by the steering committee, the rules committee suggests that the words "custody" and "visitation" be eliminated in the forms and instructions given that other terms such as "shared parental responsibility" and "primary residency" are now to be used in place of the terms "custody" and "visitation." Likewise, the committee suggests that rule 12.440 be clarified to provide when uncontested final hearings are to be set by court order or notice of hearing and that the forms be amended accordingly. The committee submitted no proposed rules or forms to implement those changes. While we agree that these changes may need to be implemented, given the massive nature of the amendment of the 550-plus pages of the rules and forms in this case, we decline to adopt these recommendations until the rules or steering committee submits proposed rules and forms that specifically incorporate these suggestions. The rules committee has also asked that we adopt a new form for notice of lis pendens. Before adopting this form, we ask the rules committee to prepare an appropriate instruction sheet to advise litigants why and when that form is to be used. POLICY RECOMMENDATIONS In addition to recommended changes to the rules and forms, the steering committee, in its annual report, made recommendations regarding the future direction of the Family Court Initiative. In its report, the committee makes certain conclusions and recommendations concerning its responsibilities. First, it concludes that the original notion of the "one family—one judge" concept, that is, that all court matters involving members of the same family be handled by the same judge, is "unrealistic and unworkable." Instead, the committee recommends that our judicial system have "an integrated and coordinated approach that insures that any judge handling any matter involving a member of a family will be well informed as to any other pending matters involving another member of that same family." Second, it recommends that a comprehensive array of services and referrals be implemented to assist self-represented litigants. According to the committee, while we have made significant strides in this area by implementing *9 the family law forms and related instructions, we must continue to work towards developing personnel and automation prototypes to enable circuits to provide an integrated approach to family cases and must pursue funding to accomplish this objective. Third, the committee asks that this Court clarify the committee's responsibilities for monitoring and ensuring compliance by the circuits with the mandates of this Court and of the Family Court Initiative. Fourth, the committee asks that it be allowed to make revisions to the forms on an annual basis given the large volume of forms and of the need to change those forms whenever statutes affecting the forms are revised. Finally, the committee asks for this Court's support in obtaining increased state funding of court support services to meet these goals. Before addressing the committee's concerns, we believe that evaluation, review, and perhaps reorganization of both the rules and steering committees may be warranted. At this time, significant overlap exists as to the duties of the two committees. Both committees have provided extremely valuable services in implementing rules and policies regarding the ever- increasing involvement of courts in family matters. The efforts of both committees are to be highly commended. The steering committee has been very instrumental in providing direction for improving assistance and access to the courts for family law litigants. However, a review of the recommendations submitted for rule and form revisions reflects that a significant amount of duplication has occurred in the efforts of the committees. To continue in dual roles appears to be unproductive and costly. To avoid further duplication, we believe that it may be in the best interests of all concerned for the two committees either to have more specifically defined areas of responsibility or to be combined to create one comprehensive body for proceeding with the design and implementation of plans for future development in the area of family law and changes to the rules and forms. As previously mentioned, we also have concerns that we may have further complicated rather than simplified the family law process through the creation of family law divisions and the adoption of the rules and forms. The very fact that the package of forms and rules consists of over 550 pages is evidence of that complication. In reviewing the rules and forms, we believe several changes might simplify the process to enhance access. First, we believe that the judgments should be deleted from the forms and be placed in a "bench book" for distribution to judges. Pro se litigants should not be required to provide judges with blank judgment forms. It may be that the Conference of Circuit Judges should appoint a select committee to develop appropriate forms for judicial orders and decrees in family law matters. Second, perhaps the forms and accompanying instructions should be deleted entirely from the rule-making process and be grouped instead into packets for distribution according to the type of proceeding. The forms could then be evaluated and changed on an "as needed" basis and be approved by this Court as simplified forms through opinion rather than being confined by the rule-making process. The Court recognizes that the manner in which family law cases are processed is an access issue which necessitates significant attention because it can have a greater effect on individual litigants than any other area of the law. To that end, we request the committees to make recommendations by September 1, 1998, regarding how best to accomplish the objectives outlined in this section of this opinion. CONCLUSION We commend the work of both committees in their efforts to further simplify the rules and forms. We recognize that the work regarding simplification will be a continuing process. Further, as noted above, we believe that many of the proposed changes that we have declined to approve in this opinion may have merit. As such, we will allow revisions to the proposed changes and/or additional comments to the matters discussed in this opinion to be submitted to this Court no later than May 1, 1998. This Court may set any of those issues on which comment is received *10 for oral argument during the Court's June 1998 oral argument calendar. Accordingly, we adopt the amendments to the Florida Family Law Rules of Procedure as set forth in Appendix A and the revised forms and related instructions as set forth in Appendix B effective midnight, March 1, 1998. It is so ordered. KOGAN, C.J., and SHAW, HARDING, WELLS, ANSTEAD and PARIENTE, JJ., concur. NO MOTION FOR REHEARING WILL BE ENTERTAINED BY THE COURT GIVEN THAT WE WILL BE ACCEPTING COMMENTS UNTIL MAY 1, 1998, TO BE CONSIDERED IN JUNE 1998. APPENDIX A RULE 12.070. PROCESS (a) Family Law Actions Generally. Service of process uUpon the commencement of all family law actions, including proceedings to modify a final judgment, except domestic and repeat violenceservice of process shall be as set forth in Florida Rule of Civil Procedure 1.070,. except thatThe summons, cross-claim summons, and third-party summons in family law matters shall be patterned after Florida Family Law Form 12.910(a) and shall specifically contain the following language: WARNING: Rule 12.285, Florida Family Law Rules of Procedure, requires certain automatic disclosure of documents and information. Failure to comply can result in sanctions, including dismissal or striking of pleadings. This rule does not govern service of process in domestic and repeat violence proceedings. (b)Domestic and Repeat Violence Injunctions. Service of process regarding domestic and repeat violence actions shall be governed by Florida Family Law Rule of Procedure 12.610. RULE 12.080. SERVICE OF PLEAINGS AND PAPERS (a) Service. (1) Family Law Actions Generally. Service of pleadings and papers after commencement of all family law actions except domestic and repeat violence shall be as set forth in Florida Rule of Civil Procedure 1.080, except that rule 1.080 shall be expanded as set forth in subdivisions (b) and (c) to include additional requirements for service of recommended orders and for service on defaulted parties. (2) Domestic and Repeat Violence Actions. Service of pleadings and papers regarding domestic and repeat violence actions shall be governed by Florida Family Law Rule of Procedure 12.610. (b) Service and Preparation of Orders and Judgments. (1) Family Law Actions Generally. A copy of all orders or judgments involving family law matters except domestic and repeat violence shall be transmitted by the court or under its direction to all parties at the time of entry of the order or judgment. The court may require that recommended orders, orders, or judgments be prepared by a party. If the court requires that a party prepare the recommended order, order, or judgment, the party shall furnish the court with stamped, addressed envelopes to all parties for service of the recommended order, order, or judgment. The court also may require that any proposed recommended order, order, or judgment that is prepared by a party be furnished to all parties no less than 24 hours before submission to the court of the recommended order, order, or judgment. (2) Domestic and Repeat Violence Actions. Service and preparation of orders and judgments involving domestic and repeat violence shall be governed by Florida Family Law Rule of Procedure 12.610. (c) Defaulted Parties. No service need be made on parties against whom a default has been entered, except that: (1) Pleadings asserting new or additional claims against defaulted parties shall be served in the manner provided for service of summons contained in Florida Rule of Civil Procedure 1.070. (2) Notice of final hearings or trials and court orders shall be served on defaulted *11 parties in the manner provided for service of pleadings and papers contained in Florida Rule of Civil Procedure 1.080. (3) Final judgments shall be served on defaulted parties as set forth in Florida Rule of Civil Procedure 1.080(h)(2). Commentary 1995 Adoption. This rule provides that the procedure for service shall be as set forth in Florida Rule of Civil Procedure 1.080 with the following exceptions or additions to that rule. First, subdivision (b) corresponds to and replaces subdivision (h)(1) of rule 1.080 and expands the rule to include recommended orders. Second, this rule expands items that must be served on defaulted parties to ensure that defaulted parties are at least minimally advised of the progress of the proceedings. This rule is not intended to require the furnishing of a proposed recommended order, proposed order, or proposed final judgment to a defaulted party. RULE 12.200. CASE MANAGEMENT AND PRETRIAL CONFERENCES (a) Case Management Conference. (1) Family Law Proceedings, Generaly. A case management conference may be ordered by the court at any time on the court's initiative. A party may request a case management conference 30 days after service of a petition or complaint. At such a conference the court may: (1A) schedule or reschedule the service of motions, pleadings, and other papers; (2B) set or reset the time of trials, subject to rule 12.440; (3C) coordinate the progress of the action if complex litigation factors are present; (4D) limit, schedule, order, or expedite discovery; (5E) schedule disclosure of expert witnesses and the discovery of facts known and opinions held by such experts; (6F) schedule or hear motions related to admission or exclusion of evidence; (7G) pursue the possibilities of settlement; (8H) require filing of preliminary stipulations if issues can be narrowed; (9I) refer issues to a master for findings of fact, if consent is obtained as provided in rules 12.490 and 12.492 and if no significant history of domestic or repeat violence that would compromise the process is involved in the case; (10J) refer the parties to mediation if no significant history of domestic or repeat violence that would compromise the mediation process is involved in the case and consider allocation of expenses related to the referral; or refer the parties to counseling if no significant history of domestic or repeat violence that would compromise the process is involved in the case and consider allocation of expenses related to the referral; (11K) coordinate voluntary binding arbitration consistent with Florida law if no significant history of domestic or repeat violence that would compromise the process is involved in the case; (12L) appoint court experts and allocate the expenses for the appointments; (13M) refer the cause for a home study or psychological evaluation and allocate the initial expense for that study; (14N) appoint an attorney or guardian ad litem for a minor child or children if required and allocate the expense of the appointment; and (15O) schedule other conferences or determine other matters that may aid in the disposition of the action. (2) Adoption Proceedings. A case management conference shall be ordered by the court within 60 days of the filing of a petition when (A) there is a request for a waiver of consent to an adoption by those persons required to consent by section 63.062, Florida Statutes; (B) notice of the hearing on the petition to adopt is not afforded a person whose consent is required but who has not consented; (C) an intermediary, attorney, or agency is seeking fees or costs in excess of those provided under sections 63.097 or 63.212(4), Florida Statutes; *12 (D) an affidavit of diligent search and inquiry is filed in lieu of personal service; or (E) the court is otherwise aware that any person having standing objects to the adoption. (b) Pretrial Conference. After the action is at issue the court itself may or shall on the timely motion of any party require the parties to appear for a conference to consider and determine: (1) proposed stipulations and the simplification of the issues; (2) the necessity or desirability of amendments to the pleadings; (3) the possibility of obtaining admissions of fact and of documents that will avoid unnecessary proof; (4) the limitation of the number of expert witnesses; and (5) any matters permitted under subdivision (a) of this rule. (c) Notice. Reasonable notice shall be given for a case management conference, and 20 days' notice shall be given for a pretrial conference. On failure of a party to attend a conference, the court may dismiss the action, strike the pleadings, limit proof or witnesses, or take any other appropriate action. Any documents that the court requires for any conference shall be specified in the order. Orders setting pretrial conferences shall be uniform throughout the territorial jurisdiction of the court. (d) Case Management and Pretrial Order. The court shall make an order reciting the action taken at a conference and any stipulations made. The order shall control the subsequent course of the action unless modified to prevent injustice. Commentary 1995 Adoption. This rule addresses issues raised by decisions such as Dralus v. Dralus, 627 So.2d 505 (Fla. 2d DCA 1993); Wrona v. Wrona, 592 So.2d 694 (Fla. 2d DCA 1991); and Katz v. Katz, 505 So.2d 25 (Fla. 4th DCA 1987), regarding the cost of marital litigation. This rule provides an orderly method for the just, speedy, and inexpensive determination of issues and promotes amicable resolution of disputes. This rule replaces and substantially expands Florida Rule of Civil Procedure 1.200 as it pertained to family law matters. Under this rule, a court may convene a case management conference at any time and a party may request a case management conference 30 days after service of a petition or complaint. The court may consider the following additional items at the conference: motions related to admission or exclusion of evidence, referral of issues to a master if consent is obtained pursuant to the rules, referral of the parties to mediation, referral of the parties to counseling, coordination of voluntary binding arbitration, appointment of court experts, referral of the cause for a home study psychological evaluation, and appointment of an attorney or guardian ad litem for a minor child. Committee Note 1997 Amendment. In In re Adoption of Baby E.A.W., 658 So.2d 961 (Fla.1995), and other cases involving protracted adoption litigation, it becomes clear that the earlier the issue of notice is decided by the court, the earlier the balance of the issues can be litigated. Because both parents' constitutional standing and guarantees of due process require notice and an opportunity to be heard, this rule amendment will help solve the problems of adoption litigation lasting until a child's third, fourth, or even fifth birthday. Furthermore, this rule will encourage both parents to be more candid with intermediaries and attorneys involved in the adoption process. In E.A.W., 658 So.2d at 979, Justice Kogan, concurring in part and dissenting in part, stated: "I personally urge the Family Law Rules Committee . . . to study possible methods of expediting review of disputes between biological and adoptive parents." This rule expedites resolution of preliminary matters concerning due process in difficult adoption disputes. This rule also mandates early consideration of the child's rights to due process at early stages of adoption litigation. Noncompliance with subdivision (a)(2) of this rule shall not invalidate an otherwise valid adoption. *13 RULE 12.285. MANDATORY DISCLSURE (a) Application. (1) Scope. This rule shall apply to all proceedings within the scope of these rules except proceedings involving adoption, simplified dissolution, enforcement, contempt, and injunctions for domestic or repeat violence, and uncontested dissolutions when the respondent is served by publication and does not file an answer. Additionally, no financial affidavit or other documents shall be required under this rule from a party seeking attorneys' fees, suit money, or costs, if the basis for the request is solely under section 57.105, Florida Statutes, or any successor statute. Except for the provisions as to financial affidavits, any portion of this rule may be modified by order of the court or agreement of the parties. (2) Original and Duplicate Copies. Unless otherwise agreed by the parties or ordered by the court, copies of documents required under this rule may be produced in lieu of originals. Originals, when available, shall be produced for inspection upon request. Parties shall not be required to serve duplicates of documents previously served. (b) Time for Production of Documents. (1) Temporary Financial Hearings. Any document required under this rule in any temporary financial relief proceeding shall be served on the other party for inspection and copying as follows. (A) The party seeking relief shall serve the required documents on the other party with the notice of temporary financial hearing, unless the documents have been served under subdivision (b)(2) of this rule. (B) The responding party shall serve the required documents on the party seeking relief on or before 5:00 p.m., 2 business days before the day of the temporary financial hearing if served by delivery or 7 days before the day of the temporary financial hearing if served by mail, unless the documents have been received previously by the party seeking relief under subdivision (b)(2) of this rule. A responding party shall be given no less than 12 days to serve the documents required under this rule, unless otherwise ordered by the court. If the 45-day period for exchange of documents provided for in subdivision (b)(2) of this rule will occur before the expiration of the 12 days, the provisions of subdivision (b)(2) control. (2) Initial and Supplemental Proceedings. Any document required under this rule for any initial or supplemental proceeding shall be served on the other party for inspection and copying within 45 days of service of the initial pleading on the respondent. (c) Disclosure Requirements for Temporary Financial Relief. In any proceeding for temporary financial relief heard within 45 days of the service of the initial pleading or within any extension of the time for complying with mandatory disclosure granted by the court or agreed to by the parties, the following documents shall be served on the other party: (1) A financial affidavit in substantial conformity with Family Law Form 12.901(d) if the party's gross annual income is less than $50,000, or Family Law Form 12.901(e), if the party's gross annual income is equal to or more than $50,000. This requirement cannot be waived by the parties. The affidavit must also must be filed with the court. (2) A Child Support Guidelines Worksheet in substantial conformity with Family Law Form 12.901(g), if the case involves child support. (3) All federal and state income tax returns, gift tax returns, and intangible personal property tax returns filed by the party or on the party's behalf for the past year. A party may file a transcript of the tax return as provided by Internal Revenue Service Form 4506 in lieu of his or her individual federal income tax return for purposes of a temporary hearing. (4) IRS forms W-2, 1099, and K-1 for the past year, if the income tax return for that year has not been prepared. (5) Pay stubs or other evidence of earned income for the 3 months prior to service of the financial affidavit. *14 (cd) Parties'Whose Annual Income and Expenses Are Less Than $50,000,Disclosure Requirements for Initial or Supplement Proceedings. Any party whese gross annual income from all sources is less than $50,000 and whose total annual expenses are less then $50,000 shall be required to serve the following documents in any proceeding for an initial or supplemental request for temperary or permanent financial relief, including, but not limited to, a request for child support, alimony, equitable distribution of assets or debts, or attorneys' fees, suit money, or costs: (1) A financial affidavit in substantial conformity with Family Law Form 12.901(d) if the party's gross annual income is less than $50,000, or Family Law Form 12.901(e) if the party's gross annual income is equal to or more than $50,000, which requirement cannot be waived by the parties, and which. The financial affidavits also must be filed with the court. A party may request, by using the Standard Family Law Interrogatories, or the court on its own motion may order, a party whose gross annual income is less than $50,000 to complete Family Law Form 12.901(e). (2) A Child Support Guidelines Worksheet in substantial conformity with Family Law Form 12.901(g), if the case involves child support. (23) All federal and state income tax returns, gift tax returns, and intangible personal property tax returns filed by the party or on the party's behalf for the past three 3 years. (34) IRS forms W-2, 1099, and K-1 for the past year, if the income tax return for that year has not been prepared. (45) Pay stubs or other evidence of earned income for the 3 months prior to service of the financial affidavit. (56) A statement by the producing party identifying the amount and source of all income received from any source during the 3 months preceding the service of the financial affidavit required by this rule if not reflected on the pay stubs produced. (67) All loan applications and financial statements prepared or used within the 3 years12 months preceding service of that party's financial affidavit required by this rule, whether for the purpose of obtaining or attempting to obtain credit or for any other purpose. (d) Parties Whose Annual Income or Expenses Are Equal To or Exceed $50,000. Any party whose gross annual income from all sources is equal to or exceeds $50,000 or whose total annual expenses are equal to or exceed $50,000 shall be required to serve the documents on the other party as follows. (1) Temporary Financial Relief. In any proceeding for temporary financial relief, the following documents shall be served on the other party: (A) A financial affidavit in cubctantial conformity with Family Law Form 12.901(e), which requirement cannot be waived by the parties, and which also must be filed with the court. (B) All federal and state income tax returns, gift tax returns, and intangible personal property tax returns filed by the party or on the party's behalf for the part 3 years. (C) IRS forms W-2, 1099, and K-1 for the past year, if the income tax return for that year has not been prepared. (D) Pay stubs or other evidence of earned income for the 3 months prior to service of the financial affidavit. (E) A statement by the producing party identifying the amount and source of all income received from any source during the 3 months preceding the serviee of the financial affidavit required by this rule if not reflected on the pay stubs produced. (F) All loan applications and financial statements prepared or used within the 3 years preceding service of that party's financial affidavit required by this rule, whether for the purpose of obtaining or attempting to obtain credit or for any other purpose. (G) Corporate, partnership, and trust tax returns for the last tax year, if the producing party has an interest in a corporation, partnership, or trast greater than or equal to 30%. *15 (2) Initial Proceedings. In any intial proceeding for permanent financial relief, including, but not limited to, a request for child support, alimony, equitable distribution of assets or debts, or attorneys' fees, suit money, or costs, the following documents shall be served on the other party: (A) All documents listed in subdivision (d)(1), including the financial affidavit which also must be filed with the court. (B) The answers to interrogatories found in Family Law Form 12.930(b). (C) All documents showing reimbursed expenses and in kind payments that reduce the party's personal living expenses that were received by or made available to the party for the last 3 years. (D8) All deeds within the last 3 years, all promissory notes within the last 12 months, and all present leases, mortgages, promissory notes, and closing statements pertaining to real estate in which the party owns or owned an interest within the last 3 years, whether held in the party's name individually, in the party's name jointly with any other person or entity, in the party's name as trustee or guardian for any other person, or in someone else's name on the party's behalf. (E9) All periodic statements and pass books from the last 3 years months for all checking accounts, and from the last 12 months for all other accounts (for example, savings accounts, money market funds, certificates of deposit, etc.), and credit union accounts (regardless of whether or not the account has been closed), including those held in the party's name individually, in the party's name jointly with any other person or entity, in the party's name as trustee or guardian for any other person, or in someone else's name on the party's behalf. (F10) All brokerage account statements in which either party to this action held within the last 3 years12 months or holds an interest including those held in the party's name individually, in the party's name jointly with any person or entity, in the party's name as trustee or guardian for any other person, or in someone else's name on the party's behalf. (G) All title certificates, lease agreements, and registration certificates for all motor vehicles, boats, airplanes, and any other vehicle requiring registration that the party regularly uses, owns, or owned in the last 3 years. (H11) The most recent statement for any profit sharing, retirement, deferred compensation, or pension plan (for example, IRA, 401(k), 403(b), SEP, KEOGH, or other similar account) in which the party is a participant or alternate payee and the summary plan description for any retirement, profit sharing, or pension plan in which the party is a participant or an alternate payee. (The summary plan description must be furnished to the party on request by the plan administrator as required by 29 U.S.C. § 1024(b)(4).) (I) All documents pertaining to any money owed to the party or spouse. (J12) The declarations page, the last periodic statement, and the certificate for any group insurance for a All life insurance policies insuring the party's life or the life of the party's spouse., and all current health and dental insurance cards covering either of the parties and/or their dependent children. (K13) Corporate, partnership, and trust tax returns for the last 3 tax years if the party has an ownership or interest in a corporation, partnership, or trust greater than or equal to 30%. (L14) PeriodicAll promissory notes for the last 12 months, all credit card and charge account statements and amortization sehedules, or other records showing the party's indebtedness as of the date of the filing of this action and for the last 3 years months., and all present lease agreements, whether owed in the party's name individually, in the party's name jointly with any other person or entity, in the party's name as trustee or guardian for any other person, or in someone else's name on the party's behalf. (M15) All written premarital or marital agreements entered into at any time between the parties to this marriage, whether before or during the marriage. Additionally, in any modification proceeding, each party shall serve on the opposing party all written agreements entered into between them at *16 any time since the order to be modified was entered. (N16) All documents and tangible evidence supporting the producing party's claim of special equity or nonmarital status of an asset or debt for the time period from the date of acquisition of the asset or debt to the date of production or from the date of marriage, if based on premarital acquisition. (O17) Any court orders directing a party to pay or receive spousal or child support. (3) Supplemental Proceedings. In any temporary or permanent supplemental procedding regarding financial relief, documents shall be produced as set forth in subdivisions (d)(1) and (d)(2), respectively and shall be served as set forth in subdivision (b). Additionally, in any modification proceeding, each party shall serve on the oppesing party all written agreements entered into between them at any time since the order to be modified was entered. (e) Duty to Supplement Disclosure; Amended Financial Affidavit. (1) Parties have a continuing duty to supplement documents described in this rule, including financial affidavits, whenever a material change in their financial status occurs. (2) If an amended financial affidavit or an amendment to a financial affidavit is filed, the amending party also shall serve any subsequently discovered or acquired documents supporting the amendments to the financial affidavit if the party falls within the provisions of subdivision (d). (f) Sanctions. Any document to be produced under this rule that is served on the opposing party fewer than 24 hours before a nonfinal hearing or in violation of the court's pretrial order shall not be admissible in evidence at that hearing unless the court finds good cause for the delay. In addition, the court may impose other sanctions authorized by rule 12.380 as may be equitable under the circumstances. The court may also impose sanctions upon the offending lawyer in lieu of imposing sanctions on a party. (g) Extensions of Time for Complying with Mandatory Disclosure. By agreement of the parties, the time for complying with mandatory disclosure may be extended. Either party also may file, at least 5 days before the due date, a motion to enlarge the time for complying with mandatory disclosure. The court shall grant the request for good cause shown. (gh) Objections to Mandatory Automatic Disclosure. Objections to the mandatory automatic disclosure required by this rule shall be served in writing at least 5 days prior to the due date for the disclosure or the objections shall be deemed waived. The filing of a timely objection, with a notice of hearing on the objection, automatically stays mandatory disclosure for those matters within the scope of the objection. For good cause shown, the court may extend the time for the filing of an objection or permit the filing of an otherwise untimely objection. The court shall impose sanctions for the filing of meritless or frivolous objections. (hi) Certificate of Compliance. All parties subject to automatic mandatory disclosure shall file with the court a certificate of compliance, Florida Family Law Form 12.932, identifying with particularity the documents which have been delivered and certifying the date of service of the financial affidavit and documents by that party. (ij) Place of Production. (1) Unless otherwise agreed by the parties or ordered by the court, all production required by this rule shall take place in the county where the action is pending and in the office of the attorney for the party receiving production. Unless otherwise agreed by the parties or ordered by the court, if a party does not have an attorney or if the attorney does not have an office in the county where the action is pending, production shall take place in the county where the action is pending at a place designated in writing by the party receiving production, served at least 5 days before the due date for production. (2) If venue is contested, on motion by a party the court shall designate the place where production will occur pending determination of the venue issue. (k) Failure of Defaulted Party to Comply. Nothing in this rule shall be deemed to preclude the entry of a final judgment when *17 a party in default has failed to comply with this rule. Commentary 1995 Adoption. This rule creates a procedure for automatic financial disclosure in family law cases. By requiring production at an early stage in the proceedings, it is hoped that the expense of litigation will be minimized. See Dralus v. Dralus, 627 So.2d 505 (Fla. 2d DCA 1993); Wrona v. Wrona, 592 So.2d 694 (Fla. 2d DCA 1991); and Katz v. Katz, 505 So.2d 25 (Fla. 4th DCA 1987). A limited number of requirements have been placed upon parties making and spending less than $50,000 annually unless otherwise ordered by the court. In cases where the income or expenses of a party are equal to or exceed $50,000 annually, the requirements are much greater. Except for the provisions as to financial affidavits, other than as set forth in subdivision (k), any portion of this rule may be modified by agreement of the parties or by order of the court. For instance, upon the request of any party or on the court's own motion, the court may order that the parties to the proceeding comply with some or all of the automatic mandatory disclosure provisions of this rule even though the parties do not meet the income requirements set forth in subdivision (de). Additionally, the court may, on the motion of a party or on its own motion, limit the disclosure requirements in this rule should it find good cause for doing so. Committee Note 1997 Amendment. Except for the form of financial affidavit used, mandatory disclosure is made the same for all parties subject to the rule, regardless of income. The amount of information required to be disclosed is increased for parties in the under $50,000 category and decreased for parties in the $50,000-or-over category. The standard family law interrogatories are no longer mandatory, and their answers are designed to be supplemental and not duplicative of information contained in the financial affidavits. RULE 12.287. FINANCIAL AFFIDAVITS IN ENFORCEMENT AND CONTEMPT PROCEEDINGS Any party in an enforcement or contempt proceeding may serve upon any other party a written request to file and serve a financial affidavit if the other party's financial circumstances are relevant in the proceeding. The party to whom the request is made shall file and serve the requested financial affidavit within 10 days after the service of the written request. The court may allow a shorter or longer time. The financial affidavit shall be in substantial conformity with Florida Family Law Form 12.901(d) (Short Form), all sections of which shall be completed. RULE 12.340. INTERROGATORIES TO PARTIES Interrogatories to parties shall be governed generally by Florida Rule of Civil Procedure 1.340, with the following exceptions. (a) Service of Interrogatories. (1) Initial Interrogatories. Initial interrogatories to parties in original and enforcement actions shall be those set forth in Family Law Form 12.930(b). Parties governed by the mandatory disclosure requirements of rule 12.285(d) (income or expenses of $50,000 or more) shall automatically submit the answers to those interrogatories as provided in that rule. Parties governed by the mandatory disclosure requirements of rule 12.285(c) (income and expenses under $50,000), may serve the interrogatories set forth in Family Law Form 12.930(b) as set forth in rule 1.340. (2) Modification Interrogatories. Interrogatories to parties in cases involving modification of a final judgment shall be those set forth in Family Law Form 12.930(c). Parties governed by the mandatory disclosure requirements of rule 12.285 may serve the interrogatories set forth in Family Law Form 12.930(c) as set forth in rule 1.340. (b) Additional Interrogatories. Ten interrogatories, including subparts, may be sent to a party, in addition to the standard interrogatories contained in Family Law Form 12.930(b) or Family Law Form 12.930(c). A party must obtain permission of the court to send more than ten additional interrogatories. *18 Commentary 1995 Adoption. For parties governed under the disclosure requirements of rule 12.285(d) (income or expenses of $50,000 or more), the answers to the interrogatories contained in Form 12.930(b) must be automatically served on the other party. For parties governed under the disclosure requirements of rule 12.285(c) (income and expenses under $50,000), the service of the interrogatories contained in Form 12.930(b) is optional as provided in Florida Rule of Civil Procedure 1.340. Additionally, under this rule, 10 additional interrogatories, including subparts, may be submitted beyond those contained in Family Law Form 12.930(b). Leave of court is required to exceed 10 additional interrogatories. The provisions of Florida Rule of Civil Procedure 1.340 are to govern the procedures and scope of the additional interrogatories. Committee Note 1997 Amendment. The rule was amended to conform to the changes made to rule 12.285, Mandatory Disclosure. RULE 12.363. EVALUATION OF MINOR CHILD (a) Appointment of Mental Health Professional or Other Expert. (1) When the issue of visitation, parental responsibility, or residential placement of a child is in controversy, the court, on motion of any party or the court's own motion, may appoint a licensed mental health professional or other expert for an examination, evaluation, testing, or interview of any minor child or to conduct a social or home study investigation. The parties may agree on the particular expert to be appointed, subject to approval by the court. If the parties have agreed, they shall submit an order including the name, address, telephone number, area of expertise, and professional qualifications of the expert. If the parties have agreed on the need for an expert and cannot agree on the selection, the court shall appoint an expert. (2) After the examination, evaluation, or investigation, any party may file a motion for an additional expert examination, evaluation, interview, testing, or investigation by a licensed mental health professional or other expert. The court upon hearing may permit the additional examination, evaluation, testing, or interview based on good cause shown that further examinations, testing, interviews, or evaluations would be in the best interests of the minor child. (3) Any order entered under this rule shall specify the issues to be addressed by the expert. (4) Any order entered under this rule may require that all interviews of the child be recorded and the tapes be maintained as part of the expert's file. (5) The order appointing the expert shall include an initial allocation of responsibility for payment. (6) A copy of the order of appointment shall be provided immediately to the expert by the court unless otherwise directed by the court. The order shall direct the parties to contact the expert or investigator appointed by the court to establish an appointment schedule to facilitate timely completion of the evaluation. (b) Providing of Reports. (1) Unless otherwise ordered, the expert shall prepare and provide a written report to the attorney for each party or the party, if unrepresented, and the guardian ad litem, if appointed, a reasonable time before any evidentiary hearing on the matter at issue. The expert also shall send written notice to the court that the report has been completed and that a copy of the written report has been provided to the attorney for each party or the party, if unrepresented, and the guardian ad litem, if appointed. In any event, the written report shall be prepared and provided no later than 30 days before trial or 75 days from the order of appointment, unless the time is extended by order of the court. (2) On motion of any party, the court may order the expert to produce the expert's complete file to another qualified licensed mental health professional, at the initial cost of the requesting party, for review by such qualified licensed mental health expert, who may testify. *19 (c) Testimony of Other Professionals. Any other expert who has treated, tested, interviewed, examined, or evaluated a child may testify only if the court determines that good cause exists to permit the testimony. The fact that no notice of such treatment, testing, interview, examination, or evaluation of a child was given to both parents shall be considered by the court as a basis for preventing such testimony. (d) Communications with Court by Expert. No expert may communicate with the court without prior notice to the parties and their attorneys, who shall be afforded the opportunity to be present and heard during any such communication between the expert and the court. A request for communication with the court may be informally conveyed by letter or telephone. Further communication with the court, which may be conducted informally, shall be done only with notice to the parties. (e) Use of Evidence. An expert appointed by the court shall be subject to the same examination as a privately retained expert and the court shall not entertain any presumption in favor of the appointed expert's findings. Any finding or report by an expert appointed by the court may be entered into evidence on the court's own motion or the motion of any party in a manner consistent with the rules of evidence, subject to crossexamination by the parties. The report shall not be considered by the court before it is properly admitted into evidence. Committee Note 1997 Adoption. This rule should be interpreted to discourage subjecting children to multiple interviews, testing, and evaluations, without good cause shown. The court should consider the best interests of the child in permitting evaluations, testing, or interviews of the child. The parties should cooperate in choosing a mental health professional or individual to perform this function to lessen the need for multiple evaluations. This rule is not intended to prevent additional mental health professionals who have not treated, interviewed, or evaluated the child from testifying concerning review of the data produced pursuant to this rule. This rule is not intended to prevent a mental health professional who has engaged in long-term treatment of the child from testifying about the minor child. RULE 12.491. CHILD SUPPORT ENFORCEMENT (a) Limited Application. This rule shall be effective only when specifically invoked by administrative order of the chief justice for use in a particular county or circuit. (b) Scope. This rule shall apply to proceedings for the establishment, enforcement, or modification of child support wherein the party seeking support is receiving services pursuant to Title IV-D of the Social Security Act (42 U.S.C. §§ 651 et seq.) and to non-Title IV-D proceedings upon administrative order of the chief justice. (c) Support Enforcement Hearing Officers. The chief judge of each judicial circuit shall appoint such number of support enforcement hearing officers for the circuit or any county within the circuit as are necessary to expeditiously perform the duties prescribed by this rule. A hearing officer shall be a member of The Florida Bar unless waived by the chief justice and shall serve at the pleasure of the chief judge and a majority of the circuit judges in the circuit. (d) Referral. Upon the filing of a cause of action or other proceeding for the establishment, enforcement, or modification of support to which this rule applies, the court or clerk of the circuit court shall refer such proceedings to a support enforcement hearing officer, pursuant to procedures to be established by administrative order of the chief judge. (e) General Powers and Duties. The support enforcement hearing officer shall be empowered to issue process, administer oaths, require the production of documents, and conduct hearings for the purpose of taking evidence. A support enforcement hearing officer does not have the authority to hear contested paternity cases. Upon the receipt of a support proceeding, the support enforcement hearing officer shall: (1) assign a time and place for an appropriate hearing and give notice to each of the parties as may be required by law; *20 (2) take testimony and establish a record, which record may be by electronic means as provided by Florida Rule of Judicial Administration 2.070(d); (3) accept voluntary acknowledgment of paternity and support liability and stipulated agreements setting the amount of support to be paid; and (4) evaluate the evidence and promptly make a recommended order to the court. Such order shall set forth findings of fact. (f) Entry of Order and Relief from Order. Upon receipt of a recommended order, the court shall review the recommended order and shall enter an order promptly unless good cause appears to amend the order, conduct further proceedings, or refer the matter back to the hearing officer to conduct further proceedings. Any party affected by the order may move to vacate the order by filing a motion to vacate within 10 days from the date of entry. Any party may file a cross-motion to vacate within 10 days from the date of rendition; an additional 5 days shall be allowed if the order was served by mail. Any party may file a cross-motion to vacate within 5 days of service of a motion to vacate, provided, however, that the filing of a cross-motion to vacate shall not delay the hearing on the motion to vacate unless good cause is shown. A motion to vacate the order shall be heard within 10 days after the movant applies for hearing on the motion. (g) Modification of Order. Any party affected by the order may move to modify the order at any time. (h) Record. For the purpose of hearing on a motion to vacate, a record, substantially in conformity with this rule, shall be provided to the court by the party seeking review. (1) The record shall consist of the court file, including the transcript of the proceedings before the hearing officer, if filed, and all depositions and evidence presented to the hearing officer. (2) The transcript of all relevant proceedings shall be delivered to the judge and provided to opposing counsel not less than 48 hours before the hearing on the motion to vacate. If less than a full transcript of the proceedings taken before the hearing officer is ordered prepared by the moving party, that party shall promptly file a notice setting forth the portions of the transcript that have been ordered. The responding party shall be permitted to designate any additional portions of the transcript necessary to the adjudication of the issues raised in the motion to vacate or cross-motion to vacate. (3) The cost of the original and all copies of the transcript of the proceedings shall be borne initially by the party seeking review, subject to appropriate assessment of suit monies. Should any portion of the transcript be required as a result of a designation filed by the responding party, the party making the designation shall bear the initial cost of the additional transcript. Commentary 1995 Adoption. Previously, this rule was contained in Florida Rule of Civil Procedure 1.491. The new rule is substantially the same as previous rule 1.491, with the following additions. It is intended that any administrative order issued by the chief justice of the Florida Supreme Court under rule 1.491(a) shall remain in full force and effect as though such order was rendered under this rule until changed by order of that same court. Subdivision (e) now makes clear that contested paternity cases are not to be heard by support enforcement hearing officers. Subdivision (h) has been added to provide requirements for a record. The following notes and commentary have been carried forward from rule 1.491. 1988 Adoption. Title: The terminology "hearing officer" is used rather than "master" to avoid confusion or conflict with rule 1.490. Subdivision (a): The rule is intended as a fall back mechanism to be used by the chief justice as the need may arise. Subdivision (b): The expedited process provisions of the applicable federal regulations apply only to matters which fall within the purview of Title IV-D. The committee recognizes, however, that the use of hearing officers could provide a useful case flow management *21 tool in non-Title IV-D support proceedings. It is contemplated that a circuit could make application to the chief justice for expansion of the scope of the rule upon a showing of necessity and good cause. It is the position of the representative of the Family Law Section of The Florida Bar that reference of non-Title IV-D proceedings should require the consent of the parties as is required by rule 1.490(c). Subdivision (c): It is the position of the committee that hearing officers should be members of the Bar in that jurisdictional and other legal issues are likely to arise in proceedings of this nature. The waiver provision is directed to small counties in which it may be difficult or impossible to find a lawyer willing to serve and to such other special circumstances as may be determined by the chief justice. Subdivision (d): This paragraph recognizes that the mechanics of reference and operation of a program are best determined at the local level. Subdivision (e): This paragraph is intended to empower the hearing officer to fully carry out his or her responsibilities without becoming overly complicated. The authority to enter defaults which is referred to in the federal regulations is omitted, the committee feeling that the subject matter is fully and adequately covered by rule 1.500. The authority to accept voluntary acknowledgments of paternity is included at the request of the Department of Health and Rehabilitative Services. Findings of fact are included in the recommended order to provide the judge to whom the order is referred basic information relating to the subject matter. Subdivision (f): Expedited process is intended to eliminate or minimize delays which are perceived to exist in the normal processing of cases. This paragraph is intended to require the prompt entry of an order and to guarantee due process to the obligee. General Note: This proposed rule, in substantially the same form, was circulated to each of the chief judges for comment. Five responses were received. Two responding endorsed the procedure, and 3 responding felt that any rule of this kind would be inappropriate. The committee did not address the question of funding, which included not only salaries of hearing officers and support personnel, but also capital outlay for furniture, fixtures, equipment and space, and normal operating costs. The committee recognizes that the operational costs of such programs may be substantial and recommends that this matter be addressed by an appropriate body. RULE 12.610. INJUNCTIONS FOR DMESTIC AND REPEAT VIOLENCE (a) Application. This rule shall apply only to temporary and permanent injunctions for protection against domestic violence and temporary and permanent injunctions for protection against repeat violence. All other injunctive relief sought in cases to which the Family Law Rules apply shall be governed by Florida Rule of Civil Procedure 1.610. (b) Petitions. (1) Requirements for Use. (A) Domestic Violence. Any person may file a petition for an injunction for protection against domestic violence if they certify under oath that (i) the party filing the injunction and the party against whom the injunction is sought are spouses, former spouses, persons related by blood or marriage, persons who are presently residing together as if a family or who have resided together in the past as if a family, or persons who have a child in common regardless of whether they have been married or have resided together at any time; (ii) the party filing the petition was the victim of, or has reasonable cause to believe he or she may becomeis in imminent danger of becoming the victim of an assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death perpetrated by the party against whom the injunction is sought; and *22 (iii) the specific facts and circumstances upon the basis of which relief is sought are true. (B) Repeat Violence. Any person may file a petition for an injunction for protection against repeat violence if they certify under oath that (i) two incidents of violence, defined as any assault, battery, sexual battery or stalking, one of which must have occurred within 6 months of the filing of the petition, have been committed by the person against whom the injunction is sought against the petitioner or the petitioner's immediate family member; and (ii) the specific facts and circumstances upon the basis of which relief is sought are true. (2) Service of Petitions. (A) Domestic Violence. Personal service by a law enforcement agency is required. The clerk of the court shall furnish a copy of the petition for an injunction for protection against domestic violence, financial affidavit (if support is sought), Uniform Child Custody Jurisdiction Act affidavit (if custody is sought), temporary injunction (if one has been entered), and notice of hearing to the appropriate sheriff or law enforcement agency of the county where the respondent resides or can be found for expeditious service of process. (B) Repeat Violence. Personal service by a law enforcement agency is required. The clerk of the court shall furnish a copy of the petition for an injunction for protection against repeat violence, temporary injunction (if one has been entered), and notice of hearing to the appropriate sheriff or law enforcement agency of the county where the respondent resides or can be found for expeditious service of process. (C) Additional Documents. Service of pleadings in cases of domestic or repeat violence other than the petition and orders granting injunctions shall be governed by rules 12.070 and 12.080. (3) Consideration by Court. Upon the filing of a petition, the court shall set a hearing to be held at the earliest possible time. A denial of a petition for an ex parte injunction shall be by written order noting the legal grounds for denial. When the only ground for denial is no appearance of an immediate and present danger of domestic violence, the court shall set a full hearing on the petition for injunction with notice at the earliest possible time. Nothing herein affects a petitioner's right to promptly amend any petition, or otherwise be heard in person on any petition consistent with these rules. (4) Forms. (A) Provision of Forms. The clerk of the court or family or domestic/repeat violence intake personnel shall provide simplified forms, including instructions for completion, for any person whose circumstances meet the requirements of this rule and shall assist the petitioner in obtaining an injunction for protection against domestic or repeat violence as provided by law. (B) Confidential Filing of Address. A petitioner's address may be furnished to the court in a confidential filing separate from a petition or other form if, for safety reasons, a petitioner believes that the address should be concealed. The ultimate determination of a need for confidentiality must be made by the court as provided in Florida Rule of Judicial Administration 2.051. (c) Orders of Injunction. (1) Consideration by Court. (A) Temporary Injunction. For the injunction for protection to be issued ex parte, it must appear to the court that an immediate and present danger of domestic or repeat violence exists. In an ex parte hearing for the purpose of obtaining an ex parte temporary injunction, the court may limit the evidence to the verified pleadings or affidavits or may receive additional testimony under oath if necessary for a determination of whether an immediate and present danger of domestic or repeat violence exists. If the respondent appears at the hearing or has received reasonable notice of the hearing, the court may hold a hearing on the petition. (B) Permanent Injunction. A full evidentiary hearing shall be conducted. (2) Issuing of Injunction. *23 (A) Standarized Forms. The temporary and permanent injunction forms in these rules for repeat and domestic violence injunctions shall be the forms used in the issuance of injunctions under chapters 741 and 784, Florida Statutes. Additional provisions, not inconsistent with the standarized portions of those forms, may be added to the special provisions section of the temporary and permanent injunction forms on the written approval of the chief judge of the circuit. Copies of such additional provisions shall be sent to the Chief Justice, the chair of the Family Law Rules Committee of The Florida Bar, the chair of the Family Courts Steering Committee, and the chair of The Governor's Task Force on Domestic and Sexual Violence. (B) Bond. No bond shall be required by the court for the entry of an injunction for protection against domestic or repeat violence. The clerk of the court shall provide the parties with sufficient certified copies of the order of injunction for service. (3) Service of Injunctions. (A) Temporary Injunction. A temporary injunction for protection against domestic or repeat violence must be personally served. When the respondent has been served previously with the temporary injunction and has failed to appear at the initial hearing on the temporary injunction, any subsequent pleadings seeking an extension of time may be served on the respondent by the clerk of the court by certified mail in lieu of personal service by a law enforcement officer. If the temporary injunction was issued after a hearing because the respondent was present at the hearing or had reasonable notice of the hearing, the injunction may be served in the manner provided for a permanent injunction. (B) Permanent Injunction. (i) Party Present at Hearing. The parties may acknowledge receipt of the permanent injunction for protection against domestic or repeat violence in writing on the face of the original order. If a party is present at the hearing and that party fails or refuses to acknowledge the receipt of a certified copy of the injuction, the clerk shall cause the order to be served by mailing certified copies of the injunction to the parties who were present at hearing at the last known address of each party. Service by mail is complete upon mailing. When an order is served pursuant to this subdivision, the clerk shall prepare a written certification to be placed in the court file specifying the time, date, and method of service and within 24 hours shall forward a copy of the injunction and the clerk's affidavit of service to the sheriff with jurisdiction over the residence of the petitioner. This procedure applies to service of orders to modify or vacate injunctions for protection against domestic or repeat violence. (ii) Party not Present at Hearing. Within 24 hours after the court issues, continues, modifies, or vacates an injunction for protection against domestic or repeat violence, the clerk shall forward a copy of the injunction to the sheriff with jurisdiction over the residence of the petitioner for service. (4) Duration. (A) Temporary Injunction. Any temporary injunction shall be effective for a fixed period not to exceed 15 days. A full hearing shall be set for a date no later than the date when the temporary injunction ceases to be effective. The court may grant a continuance of the temporary injunction and of the full hearing for good cause shown by any party, or upon its own motion for good cause, including failure to obtain service. (B) Permanent Injunction. Any relief granted by an injunction for protection against domestic or repeat violence shall be granted for a fixed period not to exceed 1 yearor until further order of court. Such relief may be granted in addition to other civil and criminal remedies. Upon petition of the victim, the court may extend the injunction for successive fixed periods not to exceed 1 year or until further order of court. Broad discretion resides with the court to grant an extension after considering the circumstances. No specific allegations are required. *24 (5) Enforcement. The court may enforce violations of an injunction for protection against domestic or repeat violence in civil contempt proceedings, which are governed by rule 12.570, or in criminal contempt proceedings, which are governed by Florida Rule of Criminal Procedure 3.840, or, if the violation meets the statutory criteria, it may be prosecuted as a crime under Florida Statutes. (6) Motion to Modify or Vacate Injunction. The petitioner or respondent may make a motion to the court to modify or vacate an injunction at any time. Motions to modify or vacate an injunction shall be governed by the Florida Rules of Civil Procedure. (7) Forms. The clerk of the court or family or domestic/repeat violence intake personnel shall provide simplified forms including instructions for completion, for the persons whose circumstances meet the requirements of this rule and shall assist in the preparation of the affidavit in support of the violation of an order of injunction for protection against domestic or repeat violence. Commentary 1995 Adoption. A cause of action for an injunction for protection against domestic violence and repeat violence has been created by section 741.30, Florida Statutes (Supp. 1994) (modified by chapter 95-195, Laws of Florida), and section 784.046, Florida Statutes (Supp.1994), respectively. This rule implements those provisions and is intended to be consistent with the procedures set out in those provisions except as indicated in this commentary. To the extent a domestic or repeat violence matter becomes criminal or is to be enforced by direct or indirect criminal contempt, the appropriate Florida Rules of Criminal Procedure will apply. The facts and circumstances to be alleged under subdivision 12.610(b)(1)(A) include those set forth in Florida Family Law Form 12.980(b). An injunction for protection against domestic or repeat violence may be sought whether or not any other cause of action is currently pending between the parties. However, the pendency of any such cause of action must be alleged in the petition. The relief the court may grant in a temporary or permanent injunction against domestic violence is set forth in section 741.30(6). The facts and circumstances to be alleged under subdivision (b)(1)(B) include those set forth in Florida Family Law Form 12.980(d). The relief the court may grant in a temporary or permanent injunction against repeat violence is set forth in section 784.046(7), Florida Statutes. Subdivision (b)(4) expands sections 741.30(2)(c)1 and (2)(c)2, Florida Statutes, to provide that the responsibility to assist the petitioner may be assigned not only to the clerk of court but also to the appropriate intake unit of the court. Family Law Form 12.980(b) provides the form for a petition for injunction against domestic violence. If the custody of a child is at issue, a Uniform Child Custody Jurisdiction Act affidavit must be provided and completed in conformity with Family Law Form 12.901(f). If alimony or child support is sought a Financial Affidavit must be provided and completed in conformity with Family Law Form 12.901(d) or 12.901(e). Subdivision (c)(1)(A) expands chapter 95-195, Laws of Florida, and section 784.046(6)(a), Florida Statutes, to make the limitation of evidence presented at an ex parte hearing permissive rather than mandatory given the due process concerns raised by the statutory restrictions on the taking of evidence. Unlike traditional injunctions, under subdivision (c)(2), no bond will be required for the issuance of injunctions for protection against domestic or repeat violence. This provision is consistent with the statutes except that, unlike the statutes, it does not set a precise number of copies to be provided for service. Subdivision (c)(3)(A) makes the procedure for service of a temporary order of injunction for protection against domestic violence and repeat violence consistent. This is intended to replace the differing requirements contained in sections 741.30(7)(b)3 and (7)(c)1 and 784.046(8)(a)1, Florida Statutes. Subdivision (c)(3)(B) makes the procedure for service of a permanent order of injunction *25 for protection against domestic violence and repeat violence consistent. This is intended to replace the differing requirements contained in sections 741.30(7)(a)3 and (7)(c)1 and 784.046(8)(c)1, Florida Statutes, and to specifically clarify that service of the permanent injunction by mail is only effective upon a party who is present at the hearing which resulted in the issuance of the injunction. Subdivision (c)(4)(A) restates sections 741.30(5)(c) and 784.046(6)(c), Florida Statutes, with some expansion. This subdivision allows the court upon its own motion to extend the protection of the temporary injunction for protection against domestic or repeat violence for good cause shown, which shall include, but not be limited to, failure to obtain service. This subdivision also makes the procedures in cases of domestic and repeat violence identical, resolving the inconsistencies in the statutes. Subdivision (c)(4)(B) makes the procedures in cases of domestic and repeat violence identical, resolving inconsistencies in the statutes. As stated in section 741.30(1)(c), Florida Statutes, in the event a subsequent cause of action is filed under chapter 61, Florida Statutes, any orders entered therein shall take precedence over any inconsistent provisions of an injunction for protection against domestic violence which addresses matters governed by chapter 61, Florida Statutes. Subdivision (c)(5) implements a number of statutes governing enforcement of injunctions against domestic or repeat violence. It is intended by these rules that procedures in cases of domestic and repeat violence be identical to resolve inconsistencies in the statutes. As such, the procedures set out in section 741.31(1), Florida Statutes, are to be followed for violations of injunctions for protection of both domestic and repeat violence. Pursuant to that statute, the petitioner may contact the clerk of the court of the circuit court of the county in which the violation is alleged to have occurred to obtain information regarding enforcement. Subdivision (c)(7) expands sections 741.30(2)(c)1 and (2)(c)2, Florida Statutes, to provide that the responsibility to assist a petitioner may not only be assigned to the clerk of court but also to the appropriate intake unit of the court. This subdivision makes the procedures in cases of domestic and cases of repeat violence identical to resolve inconsistencies in the statutes. Committee Note 1997 Amendment. This change mandates use of the injunction forms provided with these rules to give law enforcement a standardized form to assist in enforcement of injunctions. In order to address local concerns, circuits may add special provisions not inconsistent with the mandatory portions. APPENDIX B SECTION II FAMILY LAW FORMS, COMMETARY, AND INSTRUCTIONS, AND APPENDICES INTRODUCTION GENERAL INFORMATION FOR PRO SE LITIGANTS On the page before each form you will find explanations of how that form is used in the court case, help in filling out the form, and a list of other forms you may need to fill out. The instructions for each form also say if there are any laws or court rules that could help you understand the form and its use in your case. The instructions are not the only place that you can get information about how a court case works or how that form is used and you may want to look at other law books for more help. The Florida Statutes, Florida Family Law Rules of Procedure, Florida Rules of Civil Procedure and other legal information books may be found in a law library at your county courthouse or a law school in your area. There are five (5) appendices at the end of the forms. You should read the appendices that deal with the type of court case that you are a party to. There are also instructions with each form to help you fill out that form. Read each form carefully, it may tell you that there are other forms that need to be filled out and filed with the court. If you find out there is something you need to do in your case and you do not find the right form here, check the forme at the and of the Florida *26 Rules of Civil Procedure and you may find the form you need there. Appendix 1-Simplified Dissolution of Marriage Appendix 2-Regular Dissolution of Marriage Appendix 3-Child Support Appendix 4-Injunction for Protection Appendix 5-Stepparent Adoption You should read this General Information thoroughly before taking any other steps to file your case or represent yourself in court. Most of this information is not repeated in the attached forms. This information should provide you with an overview of the court system, its participants, and its processes. It should be useful whether you want to represent yourself in a pending matter or have a better understanding of the way family court works. This is not intended as a substitute for legal advice from an attorney. Each case has its own particular set of circumstances, and an attorney may advise you of what is best for you in your individual situation. These instructions are not the only place that you can get information about how a family case works. You may want to look at other books for more help. The Florida Statutes, Florida Family Law Rules of Procedure, Florida Rules of Civil Procedure, and other legal information or books may be found at the public library or in a law library at your county courthouse or a law school in your area. If you are filing a petition forName Change and/or Adoption, these instructions may not apply. If the word(s) is printed inbold, this means that the word is being emphasized. Throughout these instructions, you will also find words printed in bold and underlined. This means that the definitions of these words may be found in the glossary of common family law terms at the end of this general information section. Commentary 1995 Adoption. To help the many people in family law court cases who do not have attorneys to represent them (pro se litigants), the Florida Supreme Court added these simplified forms and directions to the Florida Family Law Rules of Procedure. The directions refer to the Florida Family Law Rules of Procedure or the Florida Rules of Civil Procedure. Many of the forms were adapted from the forms accompanying the Florida Rules of Civil Procedure. Practitioners should refer to the committee notes for those forms for rule history. The forms were adopted by the Court pursuant to Family Law Rules of Procedure, No. 84,337 (Fla. June 15, 1995)Family Law Rules of Procedure, 667 So.2d 202 (Fla.1995); In re Petition for Approval of Forms Pursuant to Rule 10-1.1(b) of the Rules Regulating the Florida Bar—Stepparent Adoption Forms, 613 So.2d 900 (Fla.1992); Rules Regulating the Florida Bar—Approval of Forms, 581 So.2d 902 (Fla.1991). Although the forms are part of these rules, they are not all inclusive and additional forms, as necessary, should be taken from the Florida Rules of Civil Procedure as provided in Florida Family Law Rules of Procedure. Also, the following notice has been included to strongly encourage individuals to seek the advice, when needed, of an attorney who is a member in good standing of the Florida Bar. 1997 Amendment. In 1997, the Florida Family Law Forms were completely revised to simplify and correct the forms. Additionally, the appendices were eliminated, the instructions contained in the appendices were incorporated into the forms, and the introduction following the Notice to Parties was created. Minor changes were also made to the Notice to Parties set forth below. NOTICE TO PARTIES WHO ARE NOT REPRESENTED BY AN ATTORNEY WHO IS A MEMBER IN GOOD STANDING OF THE FLORIDA BAR If you have questions or concerns about these forms, instructions, commentary, instructions, and appendices, the use of the forms, or your legal rights, it is strongly recommended that you talk to an attorney. If you do not know an attorney, you should call the lawyer referral service listed in the yellow pages of the telephone *27 book under "Attorney." If you do not have the money to hire an attorney, you should call the legal aid office in your area. Because the law does change, the forms and information about them may have become outdated. You should be aware that changes may have happenedtaken place in the law or court rules that would affect the accuracy of the forms, commentary, or instructions or appendices. In no event will the Florida Supreme Court, The Florida Bar, or anyone contributing to the production of these forms, commentary, or instructions, and appendices be liable for any direct, indirect, or consequential damages resulting from their use. [Note: From this point to the end of the forms all text has been completely changed and has been replaced with the following language and forms. Additionally, appendices have been deleted and the instructions contained therein have been incorporated into the instructions accompanying each form. Underlining of additions and strike-throughs of deletions have not been used to avoid confusion.] FAMILY LAW PROCEDURES Communication with the court... Ex parte communication is communication with the judge with only one party present. Judges are not allowed to engage in ex parte communication except in very limited circumstances, so, absent specific authorization to the contrary, you should not try to speak with or write to the judge in your case unless the other party is present or has been properly notified. If you have something you need to tell the judge, you must ask for a hearing and give notice to the other party or file a written statement in the court file and send a copy of the written statement to the other party. Filing a case ... A case begins with the filing of a petition. A petition is a written request to the court for some type of legal action. The person who originally asks for legal action is called the petitioner and remains the petitioner throughout the case. A petition is given to the clerk of the circuit court, whose office is usually located in the county courthouse or a branch of the county courthouse. A case number is assigned and an official court file is opened. Delivering the petition to the clerk's office is called filing a case. A filing fee is usually required. Once a case has been filed, a copy must be given to (served on) the respondent. The person against whom the original legal action is being requested is called the respondent, because he or she is expected to respond to the petition. The respondent remains the respondent throughout the case. Service... When one party files a petition, motion, or other pleading, the other party must be "served" with a copy of the document. This means that the other party is given proper notice of the pending action(s) and any scheduled hearings. Personal service of the petition and summons on the respondent by a deputy sheriff or private process server is required in all original petitions and supplemental petitions, unless constructive service is permitted by law. Personal service may also be required in other actions by some judges. After initial service of the original or supplemental petition and summons by a deputy sheriff or private process server, service of most motions and other documents or papers filed in the case generally may be made by regular U.S. mail or hand delivery. However, service by certified mail is required at other times so you have proof that the other party actually received the papers. The instructions with each form will advise you of the type of service required for that form. If the other party is represented by an attorney, you should serve the attorney and send a copy to the other party, except for original or supplemental petitions, which must be personally served on the respondent. Other than the initial original or supplemental petitions, anytime you file additional pleadings or motions in your case, you must provide a copy to the other party and include a certificate of service. Likewise, the other party must provide you with copies of everything *28 that he or she files. Service of additional documents is usually completed by U.S. mail. For more information, see the instructions for Certificate of Service (General), Florida Family Law Form 12.914. Forms for service of process are included in the Florida Family Law Forms, along with more detailed instructions and information regarding service. The instructions to those forms should be read carefully to ensure that you have the other party properly served. If proper service is not obtained, the court cannot hear your case. Note: If you absolutely do not know where the other party to your case lives or if the other party resides in another state, you may be able to use constructive service. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). Additionally, if the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. Default... After being served with a petition or counterpetition, the other party has 20 days to file a response. If a response to a petition is not filed, the petitioner may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk. This means that you may proceed with your case and set a final hearing, and a judge will make a decision, even if the other party will not cooperate. For more information, see rule 12.080(c), Florida Family Law Rules of Procedure. Answer and counterpetition... After being served, the respondent has 20 days to file an answer admitting or denying each of the allegations contained in the petition. In addition to an answer, the respondent may also file a counterpetition. In a counterpetition, the respondent may request the same or some other relief or action not requested by the petitioner. If the respondent files a counterpetition, the petitioner should then file an Answer to Counterpetition, Florida Family Law Form 12.902(d), and either admit or deny the allegations in the respondent's counterpetition. Mandatory disclosure... Rule 12.285, Florida Family Law Rules of Procedure, requires each party in a dissolution of marriage to exchange certain information and documents, and file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Failure to make this required disclosure within the time required by the Florida Family Law Rules of Procedure may allow the court to dismiss the case or to refuse to consider the pleadings of the party failing to comply. This requirement also must be met in other family law cases, except adoptions, simplified dissolutions of marriage, enforcement proceedings, contempt proceedings, and proceedings for injunctions for domestic or repeat violence. The Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932, lists the documents that must be given to the other party. For more information see rule 12.285, Florida Family Law Rules of Procedure, and the instructions to the Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. Setting a hearing or trial... Generally, the court will have hearings on motions, final hearings on uncontested or default cases, and trials on contested cases. Before setting your case for final hearing or trial, certain requirements such as completing mandatory disclosure and filing certain papers and having them served on the other party must be met. These requirements vary depending on the type of case and the procedures in your particular jurisdiction. For further information, you should refer to the instructions for the type of form you are filing. Next, you must obtain a hearing or trial date so that the court may consider your request. You should ask the clerk of court, or family law intake staff about the local procedure for setting a hearing or trial, which you should attend. These family law forms contain *29 orders and final judgments, which the judge may use. You should ask the clerk of court or family law intake staff if you need to bring one of these forms with you to the hearing or trial. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Below are explanations of symbols or parts of different family law forms ... {specify}, {date}, {name(s)}, {street}, {city}, {state}, {phone} Throughout these forms, you will find hints such as those above. These tell you what to put in the blank(s). [√ one only] [√ all that apply] These show how many choices you should check. Sometimes you may check only one, while other times you may check several choices. ( ) This also shows an area where you must make a choice. Check the ( ) in front of the choice that applies to you or your case. Florida Family Law Form The symbol above tells you about another family law form you may need. IN THE CIRCUIT COURT OF THE ______(1)______ JUDICIAL CIRCUIT, IN AND FOR ______(2)______ COUNTY, FLORIDA Case No.:__________(3)__________ Division:____________(4)________ _______________(5)_______________, Petitioner, and ________________(6)_______________, Respondent. Line 1 The clerk of court can tell you the number of your judicial circuit. Type or print it here. Line 2 Type or print your county name on line (2). Line 3 If you are filing an initial petition or pleading, the Clerk of the Court will assign a case number after the case is filed. You should type or print this case number on all papers you file in this case. Line 4 The clerk of the court can tell you the name of the division in which your case is being filed, and you should type or print it here. Divisions vary from court to court. For example, your case may be filed in the civil division, the family division, or the juvenile division. Line 5 Type or print the legal name of the person who originally filed the case on line 5. This person is the petitioner because he/she is the one who filed the original petition. Line 6 Type or print the other party's legal name on line 6. The other party is the respondent because he/she is responding to the petition. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: __________(1)_______________ _______________(2)_______________ Signature of Petitioner Printed Name: ____________(3)_______ Address: ________________(4)________ City, State, Zip: _______(5)________ Telephone Number:________(6)________ Fax Number:_______________(7)_______ *30 Some forms require that your signature be witnessed. You must sign the form in the presence of a notary public or deputy clerk (employee of the clerk of the court's office). When signing the form, you must have a valid photo identification unless the notary knows you personally. You should completely fill in all lines (1 & 3-7) except 2 with the requested information, if applicable. Line 2, the signature line, must be signed in the presence of the notary. STATE OF FLORIDA COUNTY OF___________ Sworn to or affirmed and signed before me on _________by_________________________ ___________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ____________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced____________ DO NOT SIGN OR FILL IN THIS PART OF ANY FORM. This section of the form is to be completed by the notary public who is witnessing your signature. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________(1)________, a nonlawyer, located at {street} ________(2)________, {City} ________(3)________, {state} ____(4)____, {phone} ______(5)______, helped {name} ________(6)________, who is the petitioner, fill out this form. This section should be completed by anyone who helps you fill out these forms but is not an attorney who is a member in good standing of The Florida Bar, which means that he or she is not licensed to practice law in Florida. Line 1 The nonlawyer who helps you should type or print his or her name on line 1. Lines 2-5 The nonlawyer's address and telephone number should be typed or printed on lines 2-5. Line 6 Your name should be typed or printed on line 6. In addition, a Disclosure from Nonlawyer, Florida Family Law Form 12.900, should be completed if a nonlawyer assists you. The disclosure is available as a family law form and should be completed before the nonlawyer helps you. This is to be sure that you understand the role and limitations of a nonlawyer. You and the nonlawyer should keep a copy of this disclosure for your records. FAMILY LAW GLOSSARY OF COMMON TERMS AND DEFINITIONS Note: The following definitions are intended to be helpful, BUT they are not intended to constitute legal advice or address every possible meaning of the term(s) contained in this glossary. Affidavit—a written statement in which the facts stated are sworn or affirmed to be true. Answer—written response by a respondent that states whether he or she admits (agrees with) or denies (disagrees with) the allegations in the petition. Any allegations not *31 specifically denied are considered to be admitted. Appeal—asking a district court of appeal to review the decision in your case. There are strict procedural and time requirements for filing an appeal. Asset—everything owned by you or your spouse, including property, cars, furniture, bank accounts, jewelry, life insurance policies, businesses, or retirement plans. An asset may be marital or nonmarital, but that distinction is for the court to determine if you and your spouse do not agree. Attorney—a person with special education and training in the field of law who is a member in good standing of The Florida Bar and licensed to practice law in Florida. An attorney is the only person who is allowed to give you legal advice. An attorney may file your case and represent you in court, or just advise you of your rights before you file your own case. In addition to advising you of your rights, an attorney may tell you what to expect and help prepare you for court. In family law matters, you are not entitled to a court-appointed lawyer, like a public defender in a criminal case. However, legal assistance is often available for those who are unable to hire a private attorney. You may consult the yellow pages of the telephone directory for a listing of legal aid or lawyer referral services in your area, or ask your local clerk of court or family law intake staff what services are available in your area. You may also obtain information from the Florida Supreme Court's Internet cite located at http://www.flcourts.org/courts/supct. Bond—money paid to the clerk of court by one party in a case, to be held and paid to an enjoined party in the event that the first party causes loss or damage of property as a result of wrongfully enjoining the other party. Central Governmental Depository—the office of the clerk of court that is responsible for collecting and disbursing court-ordered alimony and child support payments. The depository also keeps payment records and files judgments if support is not paid. Certificate of Service—a document that must be filed whenever a form you are using does not contain a statement for you to fill in showing to whom you are sending copies of the form. Florida Family Law Form 12.914 is the certificate of service form and contains additional instructions. Certified Copy—a copy of an order or final judgment, certified by the clerk of the circuit court to be an authentic copy. Certified Mail—mail which requires the receiving party to sign as proof that they received it. Child Support—money paid from one parent to the other for the benefit of their dependent or minor child(ren). Clerk of the Circuit Court—elected official in whose office papers are filed, a case number is assigned, and case files are maintained. The clerk's office usually is located in the county courthouse. Constructive Service—notification of the other party by newspaper publication or posting of notice at designated places when the other party cannot be located for personal service. You may also be able to use constructive service when the other party lives in another state. Constructive service is also called "service by publication." However, when constructive service is used, the relief the Court may grant is limited. For more information on service, see the instructions for Florida Family Law Forms 12.910(a) and 12.913(a) and (b). Contested Issues—any or all issues upon which the parties are unable to agree and which must be resolved by the judge at a hearing or trial. Contingent Asset—an asset that you may receive or get later, such as income, tax refund, accrued vacation or sick leave, a bonus, or an inheritance. Contingent Liability—a liability that you may owe later, such as payments for lawsuits, unpaid taxes, or debts that you have agreed or guaranteed to pay if someone else does not. Counterpetition—a written request to the court for legal action, which is filed by a respondent after being served with a petition. *32 Default—a failure of a party to respond to the pleading of another party. This failure to respond may allow the court to decide the case without input from the party who did not appear or respond. Delinquent - late. Dependent Child(ren)—child(ren) who depend on their parent(s) for support either because they are under the age of 18, they have a mental or physical disability that prevents them from supporting themselves, or they are in high school while between the ages of 18 and 19 and are performing in good faith with reasonable expectation of graduation before the age of 19. Deputy Clerk—an employee of the office of the clerk of court, which is usually located in the county courthouse or a branch of the county courthouse. Dissolution of Marriage—divorce; a court action to end a marriage. Enjoined—prohibited by the court from doing a specific act. Ex Parte—communication with the judge by only one party. In order for a judge to speak with either party, the other party must have been properly notified and have an opportunity to be heard. If you have something you wish to tell the judge, you should ask for a hearing or file information in the clerk of court's office, with certification that a copy was sent to the other party. Family Law Intake Staff—a court's employee(s) who is (are) available to assist you in filing a family law case. Family law intake staff are not attorneys and cannot give legal advice. They may only assist you with filling out the form(s). Your local clerk's office can tell you if your county has such assistance available. Filing—delivering a petition, response, motion, or other pleading in a court case to the clerk of court's office. Filing Fee—an amount of money, set by law, that the petitioner must pay when filing a case. If you cannot afford to pay the fee, you must file an Affidavit of Indigency, Florida Family Law Form 12.901(c), to ask the clerk to file your case without payment of the fee. Final Hearing—trial in your case. Financial Affidavit—a sworn statement that contains information regarding your income, expenses, assets, and liabilities. Final Judgment—a written document signed by a judge and recorded in the clerk of the circuit court's office that contains the judge's decision in your case. Guardian ad Litem—a neutral person who may be appointed by the court to evaluate or investigate your child's situation, and file a report with the court about what is in the best interests of your child(ren). Guardians do not "work for" either party. The guardian may interview the parties, visit their homes, visit the child(ren)'s school(s) and speak with teachers, or use other resources to make their recommendation. Hearing—a legal proceeding before a judge or designated officer (general master or hearing officer) on a motion. Judge—an elected official who is responsible for deciding matters on which you and the other parties in your case are unable to agree. A judge is a neutral person who is responsible for ensuring that your case is resolved in a manner which is fair, equitable, and legal. A judge is prohibited by law from giving you or the other party any legal advice, recommendations, or other assistance, and may not talk to either party unless both parties are present, represented, or at a properly scheduled hearing. Judicial Assistant—the judge's personal staff assistant. Liabilities—everything owed by you or your spouse, including mortgages, credit cards, or car loans. A liability may be marital or nonmarital, but that distinction is for the court to determine if you and your spouse do not agree. Lump Sum Alimony—money ordered to be paid by one spouse to another in a limited number of payments, often a single payment. Mandatory Disclosure—items that must be disclosed by both parties except those exempted from disclosure by Florida Family Law Rule 12.285. *33 Marital Asset—generally, anything that you and/or your spouse acquired or received (by gift or purchase) during the marriage. For example, something you owned before your marriage may be nonmarital. An asset may only be determined to be marital by agreement of the parties or determination of the judge. Marital Liability—generally, any debt that you and/or your spouse incurred during the marriage. A debt may only be determined to be nonmarital by agreement of the parties or determination of the judge. Mediator - a person who is trained and certified to assist parties in reaching an agreement before going to court. Mediators do not take either party's side and are not allowed to give legal advice. They are only responsible for helping the parties reach an agreement and putting that agreement into writing. In some areas, mediation of certain family law cases may be required before going to court. Modification—a change made by the court in an order or final judgment. Motion—a request made to the court, other than a petition. No Contact—a court order directing a party not speak to, call, send mail to, visit, or go near his or her spouse, ex-spouse, child(ren), or other family member. Nonlawyer—a person who is not a member in good standing of the Florida Bar. Nonmarital Asset—generally, anything owned separately by you or your spouse. An asset may only be determined to be nonmarital by either agreement of the parties or determination of the judge. Nonmarital Liability—generally, any debt that you or your spouse incurred before your marriage or since your separation. A debt may only be determined to be nonmarital by either agreement of the parties or determination of the judge. Nonparty—a person who is not the petitioner or respondent in a court case. Notary Public—a person authorized to witness signatures on court related forms. Obligee—a person to whom money, such as child support or alimony, is owed. Obligor—a person who is ordered by the court to pay money, such as child support or alimony. Order—a written decision signed by a judge and filed in the clerk of the circuit court's office, that contains the judge's decision on part of your case, usually on a motion. Original Petition—see Petition Parenting Course—a class that teaches parents how to help their child(ren) cope with divorce and other family issues. Party—a person involved in a court case, either as a petitioner or respondent. Paternity Action—A lawsuit used to determine whether a designated individual is the father of a specific child or children. Payor—an employer or other person who provides income to an obligor. Permanent Alimony—spousal support ordered to be paid at a specified, periodic rate until modified by a court order, the death of either party, or the remarriage of the Obligee, whichever occurs first. Personal Service—when a summons and a copy of a petition (or other pleading) that has been filed with the court are delivered by a deputy sheriff or private process server to the other party. Personal service is required for all petitions and supplemental petitions. Petition—a written request to the court for legal action, which begins a court case. Petitioner—the person who files a petition that begins a court case. Pleading—a formal written statement of exactly what a party wants the court to do in a lawsuit or court action. Primary Residence— the home in which the child(ren) spends most of his/her (their) time. Pro Se Litigant—a person who appears in court without the assistance of a lawyer. Pro Se Coordinator—see Family Law Intake Staff. Reasonable Visitation—visitation between the nonresidential parent and child(ren) that provides frequent and unhampered contact with the child(ren). Such visitation is designed *34 to encourage a close and continuing relationship with due regard for educational commitments of child(ren), any health or social factors of the child(ren), business and personal commitments of both parents, and home arrangements of both parents. Rehabilitative Alimony—spousal support ordered to be paid for a limited period of time to allow one of the parties an opportunity to complete a plan of education or training, according to a rehabilitative plan accepted by the court, so that he or she may better support himself or herself. Respondent—the person who is served with a petition requesting some legal action against him or her. Rotating Custody—physical custody of child(ren) after divorce, which is alternated between the mother and father at specified periods of time, as determined by the court. Rotating custody allows each parent equal time with the child(ren). Scientific Paternity Testing—a medical test to determine who is the father of a child. Secondary Residential Responsibility (Visitation)—the time that the parent with whom the child(ren) does (do) not have primary residence spends with the child(ren). Service—the delivery of legal documents to a party. This must be accomplished as directed by Florida Family Law Rule 12.070 and 12.080. Shared Parental Responsibility—an arrangement under which both parents have full parental rights and responsibilities for their child(ren), and the parents make major decisions affecting the welfare of the child(ren) jointly. Shared Parental Responsibility is presumptive in Florida. Sole Parental Responsibility—a parenting arrangement under which the responsibility for the minor child(ren) is given to one parent by the court, with or without rights of visitation to the other parent. Specified Visitation—a parenting arrangement under which a specific schedule is established for the visitation and exchange of the child(ren). Spouse—a husband or wife. Supervised Visitation—a parenting arrangement under which visitation between a parent and his or her child(ren) is supervised by either a friend, family member, or a supervised visitation center. Supplemental Petition—a petition that may be filed by either party after the judge has made a decision in a case and a final judgment or order has been entered. For example, a supplemental petition may be used to request that the court modify the previously entered final judgment or order. Trial—the final hearing in a contested case. Uncontested—any and all issues on which the parties are able to agree and which are part of a marital settlement agreement. INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.900, DISCLSURE FROM NONLAWYER When should this form be used? This form must be used when anyone who is not a lawyer in good standing with The Florida Bar helps you complete any Florida Family Law Form. Attorneys who are licensed to practice in other states but not Florida, or who have been disbarred or suspended from the practice of law in Florida, are nonlawyers for the purposes of the Florida Family Law Forms and instructions. The nonlawyer must complete this form and both of you are to sign it. In addition, on any other form with which a nonlawyer helps you, the nonlawyer shall complete the nonlawyer section located at the bottom of the form unless otherwise specified in the instructions to the form. This is to protect you and be sure that you are informed in advance of the nonlawyer's limitations. What should I do next? After this form has been completed, both you and the nonlawyer should keep a copy for your records. *35 Special notes... This disclosure form does NOT act as or constitute a waiver, disclaimer, or limitation of liability. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. DISCLOSURE FROM NONLAWYER I, {full legal name} ______________________certify that {nonlawyer's full legal and trade names} _____________________ explained to me that he or she is not an attorney who is a member in good standing of The Florida Bar and that he or she CANNOT: 1) give me legal advice; 2) tell me what my legal rights or remedies are; 3) represent me in court; or 4) tell me how to testify in court. This nonlawyer further explained to me that he or she CAN ONLY: 1) help me fill out forms that have been approved by the Supreme Court of Florida; 2) ask me questions to fill in the form(s); and 3) show or explain to me how to file the form(s). [√ one only] _____ I can read English. _____ I cannot read English, but this disclosure was read to me [ fill in both blanks] by {name}__________________ in {language}_________________________ Dated:________________________________ _______________________________________ Signature of Party ______________________________________ Signature of NONLAWYER Printed Name:_________________________ Address:______________________________ ______________________________________ Telephone Number:_____________________ *36 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(a), PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE When should this form be used? This form should be used when a husband and wife are filing for a simplified dissolution of marriage. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You may file a simplified dissolution of marriage in Florida if all of the following are true: • You and your spouse agree that the marriage cannot be saved. • You and your spouse have no minor or dependent child(ren) together and the wife is not now pregnant. • You and your spouse have worked out how the two of you will divide the things that you both own (your assets) and who will pay what part of the money you both owe (your liabilities), and you are both satisfied with this division. • You are not seeking support (alimony) from your spouse, and vice versa. • Neither you nor your spouse wish to have any financial information other than that provided in the financial affidavits. • You are willing to give up your right to trial and appeal. • You and your spouse are both willing to go into the clerk's office to sign the petition (not necessarily together). • You and your spouse are both willing to go to the final hearing (at the same time). If you do not meet the criteria above, you must file a regular petition for dissolution of marriage. This petition should be typed or printed in black ink. Each of you must sign the petition in the presence of a deputy clerk (in the clerk's office), although you do not have to go into the clerk's office at the same time. You will need to provide picture identification (valid driver's license or official identification card) for the clerk to witness your signatures. What should I do next? 1. After completing this form, you should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. In addition to this petition, you must file the forms listed below. • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (Each of you must complete a separate financial affidavit.) • Notice of Social Security Number, Florida Family Law Form 12.901(j). (Each of you must complete a separate notice.) • Marital Settlement Agreement, Florida Family Law Form 12.901(h)(3). (You will complete one agreement together.) 2. You must prove to the court that the husband and/or wife has (have) lived in Florida for more than 6 months before filing the petition for dissolution of marriage. Residence can be proved by: • a valid Florida driver's license, Florida identification card, or voter registration card issued to one of you at least 6 months prior to filing for dissolution of marriage; or • the testimony of another person who knows that either you or your spouse has resided in Florida for more than 6 months and is available to testify in court; or • an affidavit. To prove residence by affidavit, use an Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i). This form must be signed by a person who knows that either you or your spouse has lived in Florida for more than 6 months before the date that you filed the petition for dissolution of marriage. This affidavit may be signed in the presence of the clerk of the court or in the presence of a notary public, who must affix his or her seal at the proper place on the affidavit. *37 3. You must pay the appropriate filing fees to the clerk of the circuit court. If you and your spouse cannot afford to pay the filing fees, you may ask the court to waive the filing fees. If requesting a waiver, you will need to fill out an Affidavit of Indigency, Florida Family Law Form 12.901(c), and file it with your petition for dissolution of marriage. 4. Either you or the clerk of court will need to complete a civil cover sheet found in Form 1.997 of the Florida Rules of Civil Procedure. The clerk's office can provide this form. 5. You must obtain a date and time for a court appearance from the clerk of court. On that date, you and your spouse must appear together before a judge. You should complete a Final Judgment of Simplified Dissolution of Marriage, Florida Family Law Form 12.990(a), and bring it with you to the hearing. At that time, if all of the papers are in order, the judge may grant a final judgment dissolving your marriage under simplified dissolution of marriage procedures by signing the final judgment which you have provided. 6. If you fail to complete this procedure, the court may dismiss the case to clear its records. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes, and Rule 12.105, Florida Family Law Rules of Procedure. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________JUDICIAL CIRCUIT, IN AND FOR________COUNTY, FLORIDA Case No.:_________________________ Division:_________________________ ________________________________, Husband, and ________________________________, Wife. PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE We, {full legal name}, _____________________________________________ Husband, and {full legal name}, ___________________________________________, Wife, being sworn, certify that the following information is true: [ fill in all blanks] 1. We are both asking the Court for a dissolution of our marriage. 2. Husband lives in {name} ________ County, {state} ________, and has lived there since {date} ________. Wife lives in {name}__________ County, {state} ________, and has lived there since {date} _______ 3. We were married to each other on {date} ______ in the city of {city} ______ in state of {state} ________, or country of {country} ____________________ 4. Our marriage is irretrievably broken. *38 5. Together, we have no minor (under 18) or dependent children and the wife is not pregnant. 6. We have made a marital settlement agreement dividing our assets (what we own) and our liabilities (what we owe). We are satisfied with this agreement. Our marital settlement agreement, Florida Family Law Form 12.901(h)(3), is attached. This agreement was signed freely and voluntarily by each of us and we intend to be bound by it. 7. We have each completed and signed financial affidavits, Florida Family Law Forms 12.901(d) or (e), which are attached to this petition. 8. Completed Notice of Social Security Number forms, Florida Family Law Form 12.901(j), are filed with this petition. 9. [√ one only] ( ) yes ( ) no Wife wants to be known by her former name, which was {full legal name}_________________________________________________________ 10. We each certify that we have not been threatened or pressured into signing this petition. We each understand that the result of signing this petition may be a final judgment ending our marriage and allowing no further relief. 11. We each understand that we both must come to the hearing to testify about the things we are asking for in this petition. 12. We understand that we each may have legal rights as a result of our marriage and that by signing this petition we may be giving up those rights. 13. We ask the Court to end our marriage and approve our marital settlement agreement. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated:_______________________________ __________________________________ Signature of HUSBAND Printed Name:_____________________ Address:__________________________ City, State, Zip:_________________ Telephone Number:_________________ Fax Number:_______________________ Sworn to or affirmed and signed before me on ____________ by ___________ CLERK OF THE CIRCUIT COURT By: ____________________________ Deputy Clerk ____Personally known ____Produced identification Type of identification produced___________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ ___________________________________ Signature of WIFE *39 Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ Sworn to or affirmed and signed before me on ____________ by ___________, CLERK OF THE CIRCUIT COURT By: ______________________________ Deputy Clerk ____Personally known ____Produced identification Type of identification produced___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} ______________ {city} ______________, {state} __________, {phone} ________, helped {name} ___________, [√ one only] ( ) Husband ( ) Wife or ( ) both, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(b)(1), PETTION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form should be used when a husband or wife is filing for a dissolution of marriage and you and your spouse have a dependent or minor child(ren) together or the wife is pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You must file this form if the following is true: • You and your spouse have a dependent or minor child(ren) together or the wife is pregnant. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the respondent has 20 days to answer after being served *40 with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED... If your spouse files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED... If your spouse files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If your spouse files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if you are asking that child support be ordered in the final judgment. (If you do not know your spouse's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), if you and your spouse have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family *41 Law Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.) Child Custody... If you and your spouse are unable to agree about with whom the child(ren) will live most of the time, a judge will decide for you. The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you live. Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for the child(ren), you should request child support in your petition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Alimony... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony. Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, custody, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital labilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities. *42 Temporary Relief... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and visitation with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a). For more information, see the instructions for that form. Marital Settlement Agreement... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). Both of you must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form... These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ___________________________ Division: ___________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name}_________________________________________________, the [√ one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [√ one only] ( ) is ( ) is not a member of the military service. The wife [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year}____________________________________ Place of marriage: {city, state, country}_______________________________ *43 Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. DEPENDENT OR MINOR CHILD(REN) [√ all that apply] ____ a. The wife is pregnant. Baby is due on: {date} ___________ ____ b. The minor (under 18) child(ren) common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ____ c. The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ The birth father(s) of the above minor child(ren) is (are) {name and address} ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____ d. The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical disability are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ 5. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this petition. (You must complete and attach this form in a dissolution of marriage with minor child(ren)). 6. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this petition. 7. This petition for dissolution of marriage should be granted because: [√ one only] ____ a. The marriage is irretrievably broken. ____ b. One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to the filing of this petition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [√ one only] ____ 1. There are no marital assets or liabilities. ____ 2. There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Form 12.901(d) or (e), to be filed in this case. [√ all that apply] ____ a. All marital assets and liabilities have been divided by a written agreement between the parties, which is attached, to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1)). ____ b. The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. *44 ____ c. Petitioner should be awarded an interest in Respondent's property because: ___________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [√ one only] ____ 1. Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. ____ 2. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Respondent has the ability to pay that support. Spousal support (alimony) is requested in the amount of $_______ every ( ) week ( ) other week ( ) month, beginning {date} ___________ and continuing until {date or event} _________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): __________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ [√ if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION III. CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain} ___________________________________________________________________ _____________________________________________________________________________________ 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [√ one only] ____ a. shared by both Father and Mother. ____ b. awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: ____________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. Primary Residential Parent (Custody). It is in the best interests of the child(ren) that the primary residential parent be ( ) Father ( ) Mother ( ) undesignated ( ) rotating because: ___________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. Visitation or Time Sharing. Petitioner requests that the court order [√ all that apply] ____ a. no visitation. ____ b. limited visitation. ____ c. supervised visitation. ____ d. supervised or third-person exchange of child(ren). ____ e. visitation or time sharing as determined by the Court. ____ f. a visitation or time sharing schedule as follows: Explain the requested visitation or time sharing schedule: *45 _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Explain why this request is in the best interests of the child(ren): ________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Has the above visitation or time sharing schedule been agreed to by the parties? ( ) yes ( ) no SECTION IV. CHILD SUPPORT [√ all that apply] ____ 1. Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is, or will be filed. Such support should be ordered retroactive to: ____ a. the date of separation {date} _______ ____ b. the date of the filing of this petition. ____ c. other {date} ______ {explain} ________________________ ____ 2. Petitioner requests that the Court award child support to be paid beyond the age of 18 years because: ____ a. the following child(ren) {name(s)} _____________________________ is (are) dependent because of a mental or physical incapacity which began before the age of 18. {explain} ________________________________________________________ ___________________________________________________________________________ ____ b. the following child(ren) {name(s)} ____________________________ is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. ____ 3. Petitioner requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Petitioner understands that Motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943, must be filed before the court will consider this request. ____ 4. Petitioner requests that medical/dental insurance coverage for the minor child(ren) be provided by: [√ one only] ____ a. Father. ____ b. Mother. ____ 5. Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: [√ one only] ____ a. by Father. ____ b. by Mother. ____ c. by Father and Mother [each pay one-half]. ____ d. according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). ____ e. Other {explain}: ___________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ *46 ____ 6. Petitioner requests that life insurance to secure child support be provided by: ____ a. Father. ____ b. Mother. ____ c. Both. SECTION V. OTHER 1. [If Petitioner is also the Wife, [√ one only] ( ) yes ( ) no Petitioner/Wife wants to be known by her former name, which was {full legal name} _________________ 2. Other relief {specify}: _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ SECTION VI. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [√ all that apply] ____ 1. distributing marital assets and liabilities as requested in Section I of this petition; ____ 2. awarding spousal support (alimony) as requested in Section II of this petition; ____ 3. establishing the primary residential parent (custody), parental responsibility, and visitation for the dependent or minor child(ren) common to both parties, as requested in Section III of this petition; ____ 4. establishing child support for the dependent or minor child(ren) common to both parties, as requested in Section IV of this petition; ____ 5. restoring Wife's former name as requested in Section V of this petition; ____ 6. awarding other relief as requested in Section V of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF___________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ *47 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________, a nonlawyer, located at {street} __________________, {city} ___________, {state} ________, {phone} ____________, helped {name} _____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(b)(2), PETTION FOR DISSOLUTION OF MARIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have marital assets and/or marital liabilities but they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a simplified dissolution of marriage petition, Florida Family Law Form 12.901(a). However, you cannot file for a simplified dissolution of marriage if any of the following are true: • You disagree about property, debts, or other matters and wish to have a judge settle them for you. • Either you or your spouse is seeking support (alimony). • You would like to ask questions and get documents concerning your spouse's income, expenses, assets, debts, or other matters before having a trial or settlement. • You would like to reserve your rights to have any matters reconsidered or appeal the judge's decision. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you *48 may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). With this form, you must also file the following: • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2), if you and your spouse have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.) Alimony... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony. Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not *49 consider it when distributing marital assets and liabilities. Temporary Relief... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(a). For more information, see the instructions for that form. Marital Settlement Agreement... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). Both husband and wife must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR__________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ________________________________________________, the [√ one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [√ one only] ( ) is ( ) is not a member of the military service. The wife [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ___________________________________ Place of marriage: {city, state, country} ______________________________ *50 Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this petition. 6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: [√ one only] ____ a. The marriage is irretrievably broken. ____ b. One of the parties has been adjudged mentally incapacitated for a period of 3 years before the filing of this petition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [√ one only] ____ 1. There are no marital assets or liabilities. ____ 2. There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Form 12.901(d) or (e), to be filed in this case. [√ all that apply] ____ a. All marital assets and debts have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Simplified Dissolution of Marriage, Florida Family Law Form 12.901(h)(3) or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2)). ____ b. The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. ____ c. Petitioner should be awarded an interest in Respondent's property because: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [√ one only] ____ 1. Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. ____ 2. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Respondent has the ability to pay that support. Spousal support (alimony) is requested in the amount of $________ every ( ) week ( ) other week ( ) month, beginning {date} _____________ and continuing until {date or event} __________________________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): _____________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [√ if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. *51 SECTION III. OTHER 1. [If Petitioner is also the Wife, √ one only] ( ) yes ( ) no Petitioner/Wife wants to be known by her former name, which was {full legal name} _________________ ______________________________________________________________________________________ 2. Other relief {specify}: _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [√ all that apply] ____ 1. distributing marital assets and liabilities as requested in Section I of this petition; ____ 2. awarding spousal support (alimony) as requested in Section II of this petition; ____ 3. restoring Wife's former name as requested in Section III of this petition; ____ 4. awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by ________________, __________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA __________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} ________, {phone} ____________, helped {name} ___________, who is the petitioner, fill out this form. *52 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(b)(3), PETTION FOR DISSOLUTION OF MARIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPETY When should this form be used? This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have no marital assets and/or marital liabilities and they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a petition for simplified dissolution of marriage, Florida Family Law Form 12.901(a). However, you may file this form if all of the following are true: • You have no marital assets or marital debts. • Neither you nor your spouse is seeking support (alimony). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files *53 an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). With this form, you must also file the following: • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.) Final Judgment Form... These family law forms contain a Final Judgment of Dissolution of Marriage with No Property or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY I, {full legal name}____________________________________________, the *54 [√ one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [√ one only] ( ) is ( ) is not a member of the military service. The wife [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year}_________________________________________ Place of marriage: {city, state, country}____________________________________ Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this petition. 6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: [√ one only] ____ a. The marriage is irretrievably broken. ____ b. One of the parties has been adjudged mentally incapacitated for a period of 3 years before the filing of this petition. A copy of the Judgment of Incapacity is attached. 7. THERE ARE NO MARITAL ASSETS OR LIABILITIES. 8. PETITIONER FOREVER GIVES UP HIS/HER RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM RESPONDENT. 9. [If Petitioner is also the Wife, √ one only] ( ) yes ( ) no Petitioner/Wife wants to be known by her former name, which was {full legal name} _________________ ______________________________________________________________________________________ 10. Other relief {specify}: _______________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [√ all that apply] ____ 1. restoring Wife's former name as specified in paragraph 9 of this petition; ____ 2. awarding other relief as specified in paragraph 10 of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ *55 Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ STATE OF FLORIDA COUNTY OF___________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer}___________________________, a nonlawyer, located at {street} ______________, {city}______________, {state} _______, {phone} ___________, helped {name}_____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(c), AFFIDAVIT OF INDIGENCY When should this form be used? This form should be used by anyone in a family law case who is unable to pay court fees and costs and is requesting a waiver of those fees and costs. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. In addition, you must attach a Financial Affidavit, Florida Family Law Form 12.901(d), to this form. What should I do next? A copy of this form, along with all of the other necessary forms, must be mailed or hand delivered to your spouse in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ *56 Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. AFFIDAVIT OF INDIGENCY I, {full legal name} ___________________, being sworn, certify that the following statements are true: I am financially insolvent and unable to pay the charges, costs, or fees otherwise payable by law to the clerk of the circuit court or sheriff in this civil action. I make this claim because: [√ one only] ____ a. I am currently receiving public assistance in the amount of: $__________ per ( ) week ( ) month. My public assistance case number is: _______________ My financial affidavit, Florida Family Law Form 12.901(d), is attached. ____ b. I am unable to pay those clerk's fees and costs because of indigency, based on facts contained in my Financial Affidavit, Florida Family Law Form 12.901(d), which is attached. I CERTIFY THAT NO PERSON HAS BEEN PAID OR PROMISED ANY PAYMENT OF ANY REMUNERATION BY ME FOR SERVICES PEFORMED ON MY BEHALF IN CONNECTION WITH THIS ACTION OR PROCEEDING. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ______ Other party or his/her attorney: Name: ___________________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip: _______________________________________________________________ Fax Number: _____________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ ________________________________________ Signature of Party Printed Name: __________________________ Address: _______________________________ City, State, Zip: ______________________ Telephone Number: ______________________ Fax Number: ____________________________ STATE OF FLORIDA COUNTY OF___________________ Sworn to or affirmed and signed before me on ______________ by __________________ ___________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ____________________________________________________ [Print, type, or stamp commissioned name of notary.] *57 ____Personally known ____Produced identification Type of identification produced____________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}______________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} ____________, helped {name}____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(d), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) When should this form be used? This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is UNDER $50,000 per year. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see rule 12.285, Florida Family Law Rules of Procedure. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions. Hourly—If you are paid by the hour, you may convert your income to monthly as follows: Hourly amount × Hours worked per week = Weekly amount Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Daily—If you are paid by the day, you may convert your income to monthly as follows: Daily amount × Days worked per week = Weekly amount Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Weekly—If you are paid by the week, you may convert your income to monthly as follows: Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Bi-weekly—If you are paid every two weeks, you may convert your income to monthly as follows: Bi-weekly amount × 26 = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Bi-monthly—If you are paid twice per month, you may convert your income to monthly as follows: Bi-monthly amount × 2 = Monthly Amount *58 Expenses may be converted in the same manner. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (Under $50,000 Individual Gross Annual Income) I, {full legal name} _______________________, being sworn, certify that the following information is true: My Occupation: ____________________ Employed by: ___________________________________ Business Address: ___________________________________________________________________ Pay rate: $________________ every week ( ) every other week ( ) twice a month ( ) monthly ( ) other: __________________________________________________________________ [] Check here if unemployed and explain on a separate sheet your efforts to find employment. SECTION I. PRESENT MONTHLY GROSS INCOME: All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should be listed separately with separate dollar amounts. 1. Monthly gross salary or wages 1. $________ 2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 2. _________ 3. Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses required to produce income) ([] Attach sheet itemizing such income and expenses.) 3. _________ 4. Monthly disability benefits/SSI 4. _________ 5. Monthly Workers' Compensation 5. _________ 6. Monthly Unemployment Compensation 6. _________ 7. Monthly pension, retirement, or annuity payments 7. _________ 8. Monthly Social Security benefits 8. _________ 9. Monthly alimony actually received 9a. From this case: $______ 9b. From other case(s): ______ Add 9a and 9b 9. _________ 10. Monthly interest and dividends 10. _________ 11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) ([] Attach sheet itemizing such income and expense items.) 11. _________ *59 12. Monthly income from royalties, trusts, or estates 12. _________ 13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses 13. _________ 14. Monthly gains derived from dealing in property (not including nonrecurring gains) Any other income of a recurring nature (list source) 14. _________ 15. _________________________________________________________________ 15. _________ 16. _________________________________________________________________ 16. _________ 17. PRESENT MONTHLY GROSS INCOME (Add lines 1-16) TOTAL: 17. $________ PRESENT MONTHLY DEDUCTIONS: 18. Monthly federal, state, and local income tax (corrected for filing status and allowable dependents and income tax liabilities) a. Filing Status ________ b. Number of dependents claimed _________ 18. _________ 19. Monthly FICA or self-employment taxes 19. _________ 20. Monthly Medicare payments 20. _________ 21. Monthly mandatory union dues 21. _________ 22. Monthly mandatory retirement payments 22. _________ 23. Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship 23. _________ 24. Monthly court-ordered child support actually paid for children from another relationship 24. _________ 25. Monthly court-ordered alimony actually paid 25a. from this case: $_________ 25b. from other case(s): __________ Add 25a and 25b 25. _________ 26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES (Add lines 18 through 25) TOTAL: 26. $_________ PRESENT NET MONTHLY INCOME (Subtract line 26. from line 17) 27. $_________ SECTION II. AVERAGE MONTHLY EXPENSES A. HOUSEHOLD: Mortgage or rent $_________ Property taxes $_________ Utilities $_________ Telephone $_________ Food $_________ Meals outside home $_________ Maintenance/Repairs $_________ Other: ___________________________________ $_________ B. AUTOMOBILE Gasoline $_________ Repairs $_________ Insurance $_________ C. CHILD(REN)'S EXPENSES Day care $_________ Lunch money $_________ Clothing $_________ Grooming $_________ Gifts for holidays $_________ Medical/dental (uninsured) $_________ Other: ____________________________________ $_________ D. INSURANCE Medical/dental $_________ Child(ren)'s medical/dental $_________ E. OTHER EXPENSES NOT LISTED ABOVE Clothing $_________ Medical/Dental (uninsured) $_________ Grooming $_________ Entertainment $_________ Gifts $_________ Church/Charities $_________ Miscellaneous $_________ Other: ____________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ F. PAYMENTS TO CREDITORS MONTHLY CREDITOR: PAYMENT ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ ___________________________________________ $_________ *60 Life $__________ _______________________ $_________ Other: _____________________ $__________ _______________________ $_________ 28. TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above) $_________ SUMMARY 29. TOTAL PRESENT MONTHLY NET INCOME from line 17 of SECTION I. INCOME) 29. $_________ 30. TOTAL MONTHLY EXPENSES (from line 28 above) 30. $_________ 31. SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29. This is the amount of your surplus. Enter that amount here.) 31. $_________ 32. (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30. This is the amount of your deficit. Enter that amount here.) 32. ($______) SECTION III: ASSETS AND LIABILITIES Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning it belongs to only one of you and should not be divided. You should indicate to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if property/debt was owned/owed by one spouse before the marriage. See the instructions with this form and section 61.075(1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.) A. ASSETS: DESCRIPTION OF ITEM(S). List a description of each separate item owned by you (and/or your spouse, Current Fair Nonmarital if this is a petition for dissolution of marriage). Market Value (√ correct column) √ the box next to any asset(s) which you are requesting the judge award to you. husband wife [] Cash (on hand) $ [] Cash (in banks or credit unions) [] Stocks, Bonds, Notes [] Real estate: (Home) [] (Other) [] Automobiles [] Other personal property [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] Other [] [] [] [] [] [] [] √ here if additional pages are attached. Total Assets (add column B) $______ B. LIABILITIES: *61 DESCRIPTION OF ITEM(S). List a description of each separate debt owed by you if this is a petition Current Nonmarital for dissolution of marriate). Amount Owed (√ correct column) √ the box next to any debt(s) for which you believe you should be responsible. husband wife [] Mortgages on real estate $ [] Auto loans [] [] Charge/credit card accounts [] [] [] [] Other [] [] [] [] [] [] [] √ here if additional pages are attached. Total Debts (add column B) $_______ C. CONTINGENT ASSETS AND LIABILITIES INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, debts assumed by another), you must list them here. Possible Nonmarital Contingent Assets Value (√ correct column) √ the box next to any contingent asset(s) which you are requesting the judge award to you. husband wife [] $ [] Total Contingent Assets $________ Contingent Liabilities Possible Amount Nonmatrial Owed (√ correct column) √ the box next to any contingent debt(s) for which you believe you should be responsible. husband wife [] [] Total Contingent Liabilities $_________ SECTION IV: CHILD SUPPORT GUIDELINES WORKSHEET ( Florida Family Law Form 12.901(g), Child Support Guidelines Worksheet, MUST be filed in all cases in which the parties have a minor child in common, INCLUDING modifications of child support.) *62 [√ one only] ____ A Child Support Guidelines Worksheet IS being filed in this case. The parties have one or more minor children in common or one of the parties is requesting a modification of a previous court order regarding child support. ____ A Child Support Guidelines Worksheet IS NOT being filed in this case. There are no minor children common to the parties in this case or, if this case involves a modification of a previous court order, child support is not an issue. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ______________ Other party or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me ______________ on by _____________, ______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced____________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [~ fill in all blanks] I, {full legal name and trade name of nonlawyer}__________________________, a nonlawyer, located at {street} ______________, {city}________________, {state} ________, {phone} ____________, helped {name}____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.901(e), FAMILY LAW FINANCIAL AFFIDAVIT When should this form be used? This form should be used when you are involved in a family law case which requires a financial affidavit and your individual gross income is $50,000 OR MORE per year. Read the instructions at the beginning of each section because you may not be required to complete every section of the affidavit. *63 This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see rule 12.285, Florida Family Law Rules of Procedure. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). The affidavit must be completed using monthly income and expense amounts. If you are paid or your bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided below for making these conversions. Hourly—If you are paid by the hour, you may convert your income to monthly as follows: Hourly amounty × Hours worked per week = Weekly amount Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Daily—If you are paid by the day, you may convert your income to monthly as follows: Daily amount × Days worked per week = Weekly amount Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Weekly—If you are paid by the week, you may convert your income to monthly as follows: Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Bi-weekly—If you are paid every two weeks, you may convert your income to monthly as follows: Bi-weekly amount × 26 = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Bi-monthly—If you are paid twice per month, you may convert your income to monthly as follows: Bi-monthly amount × 2 = Monthly Amount Expenses may be converted in the same manner. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, *64 and __________________________________, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT ($50,000 or more individual Gross Annual Income) I, {full legal name}__________________________________, being sworn, certify that the following information is true: SECTION I. INCOME Read the instructions with this form; if they indicate that you must file this financial affidavit, start here. 1. Date of Birth: _____________ 2. Social Security Number: _______________________ 3. My occupation is: _______________________________________________________________ 4. I am currently [√ all that apply] ____ a. Unemployed Describe your efforts to find employment, how soon you expect to be employed, and the pay you expect to receive: _____________________________________________ ________________________________________________________________________________ ____ b. Employed by: ________________________________________________________________ Address: _______________________________________________________________________ City, State, Zip code: _________________________________________________________ Telephone Number: ______________________________________________________________ Pay rate: $_____________________ every week ( ) every other week ( ) twice a month ( ) monthly ( ) other: ___________________________________________________ If you are expecting to become unemployed or change jobs soon, describe the change you expect and why and how it will affect your income: __________________ ________________________________________________________________________________ [] check here if you currently have more than one job. List the information above for the second job(s) on a separate sheet and attach it to this affidavit. ____ c. Retired. Date of retirement: ____________________________ Employer from whom retired: ____________________________________________________ Address: _______________________________________________________________________ City, State, Zip code: ______________________ Telephone Number: ________________ LAST YEAR'S GROSS INCOME: Your Income Other Party's Income (if known) YEAR__________ $______________ $_____________ PRESENT MONTHLY GROSS INCOME: All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under ""other" should be listed separately with separate dollar amounts. 1. Monthly gross salary or wages 1. $________ 2. Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 2. __________ 3. Monthly business income from sources such as self-employment, partnerships, close corporations, and/or independent contracts (Gross receipts minus ordinary and necessary expenses required to produce income.) ([] Attach sheet itemizing such income and expenses.) 3. __________ 4. Monthly disability benefits/SSI 4. __________ 5. Monthly Workers' Compensation 5. __________ *65 6. Monthly Unemployment Compensation 6. _________ 7. Monthly pension, retirement, or annuity payments 7. _________ 8. Monthly Social Security benefits 8. _________ 9. Monthly alimony actually received 9a. From this case: $______ 9b. From other case(s): ______ Add 9a and 9b 9. _________ 10. Monthly interest and dividends 10. _________ 11. Monthly rental income (gross receipts minus ordinary and necessary expenses required to produce income) ([] Attach sheet itemizing such income and expense items.) 11. _________ 12. Monthly income from royalties, trusts, or estates 12. _________ 13. Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal living expenses 13. _________ 14. Monthly gains derived from dealing in property (not including nonrecurring gains) 14. _________ Any other income of a recurring nature (identify source) 15. _______________________________________________________________ 15. _________ 16. _______________________________________________________________ 16. _________ 17. PRESENT MONTHLY GROSS INCOME (Add lines 1-16) TOTAL: 17. $________ PRESENT MONTHLY DEDUCTIONS: All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for anything that is NOT paid monthly 18. Monthly federal, state, and local income tax (corrected for filing status and allowable dependents and income tax liabilities) a. Filing Status ________ b. Number of dependents claimed _________ 18. $________ 19. Monthly FICA or self-employment taxes 19. _________ 20. Monthly Medicare payments 20. _________ 21. Monthly mandatory union dues 21. _________ 22. Monthly mandatory retirement payments 22. _________ 23. Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship 23. _________ 24. Monthly court-ordered child support actually paid for children from another relationship 24. _________ 25. Monthly court-ordered alimony actually paid 25a. from this case: $_________ 25. _________ 25b. from other case(s): __________ Add 25a and 25b 26. TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES (Add lines 18 through 25) TOTAL: 26. $_________ 27. PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17) 27. $_________ SECTION II. AVERAGE MONTHLY EXPENSES Proposed/Estimated Expenses. If this is a dissolution of marriage case and your current expenses do not reflect what you will actually have to pay after your marriage ends, you should write ""estimate" next to each amount that is proposed/estimated. HOUSEHOLD: 1. Monthly mortgage or rent payments 1. $_________ 2. Monthly property taxes (if not included in mortgage) 2. _________ 3. Monthly insurance on residence (if not included in mortgage) 3. _________ *66 4. Monthly condominium maintenance fees and homeowner's association fees 4. _________ 5. Monthly electricity 5. _________ 6. Monthly water, garbage, and sewer 6. _________ 7. Monthly telephone 7. _________ 8. Monthly fuel oil or natural gas 8. _________ 9. Monthly repairs and maintenance 9. _________ 10. Monthly lawn care 10. _________ 11. Monthly pool maintenance 11. _________ 12. Monthly pest control 12. _________ 13. Monthly misc. household 13. _________ 14. Monthly food and grocery items 14. _________ 15. Monthly meals outside home 15. _________ 16. Monthly cable t.v. 16. _________ 17. Monthly alarm service contract 17. _________ 18. Monthly service contracts on appliances 18. _________ 19. Monthly maid service 19. _________ Other: 20. ________________________________________________________________ 20. _________ 21. ________________________________________________________________ 21. _________ 22. ________________________________________________________________ 22. _________ 23. ________________________________________________________________ 23. _________ 24. ________________________________________________________________ 24. _________ 25. SUBTOTAL (add lines 1 through 24) 25. $_______ AUTOMOBILE: 26. Monthly gasoline and oil 26. $_______ 27. Monthly repairs 27. _________ 28. Monthly auto tags and emission testing 28. _________ 29. Monthly insurance 29. _________ 30. Monthly payments (lease or financing) 30. _________ 31. Monthly rental/replacements 31. _________ 32. Monthly alternative transportation (bus, rail, car, pool, etc.) 32. _________ 33. Monthly tolls and parking 33. _________ 34. Other: _________________________________________________________ 34. _________ 35. SUBTOTAL (add lines 26 through 34) 35. $_______ MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP (other than court-ordered child support) 36. ________________________________________________________________ 36. $_______ 37. ________________________________________________________________ 37. _________ 38. ________________________________________________________________ 38. _________ 39. ________________________________________________________________ 39. _________ 40. SUBTOTAL (add lines 36 through 39) 40. $________ MONTHLY INSURANCE 41. Health insurance, excluding portion paid for any minor child(ren) of this relationship 41. $_______ 42. Life insurance 42. _________ 43. Dental insurance 43. _________ Other: 44. ________________________________________________________________ 44. _________ 45. ________________________________________________________________ 45. _________ 46. SUBTOTAL (add lines 41 through 45) 46. $_______ OTHER MONTHLY EXPENSES NOT LISTED ABOVE: 47. Monthly dry cleaning and laundry 47. $________ *67 48. Monthly clothing 48. _________ 49. Monthly medical, dental, and prescription (unreimbursed only) 49. _________ 50. Monthly psychiatric, psychological, and counselor (unreimbursed only) 50. _________ 51. Monthly non-prescription medications, cosmetics, toiletries, and sundries 51. _________ 52. Monthly grooming 52. _________ 53. Monthly gifts 53. _________ 54. Monthly pet expenses 54. _________ 55. Monthly club dues and membership 55. _________ 56. Monthly sports and hobbies 56. _________ 57. Monthly entertainment 57. _________ 58. Monthly periodicals/books/tapes/CD's 58. _________ 59. Monthly vacations 59. _________ 60. Monthly religious organizations 60. _________ 61. Monthly bank charges/credit card fees 61. _________ 62. Monthly education expenses 62. _________ Other: (include any usual and customary expenses not otherwise mentioned in the items listed above) 63. ________________________________________________________________ 63. _________ 64. ________________________________________________________________ 64. _________ 65. ________________________________________________________________ 65. _________ 66. ________________________________________________________________ 66. _________ 67. SUBTOTAL (add lines 47 through 66) 67. $________ MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made by you on outstanding balances) NAME OF CREDITOR(s): 68. ________________________________________________________________ 68. $_______ 69. ________________________________________________________________ 69. _________ 70. ________________________________________________________________ 70. _________ 71. ________________________________________________________________ 71. _________ 72. ________________________________________________________________ 72. _________ 73. ________________________________________________________________ 73. _________ 74. ________________________________________________________________ 74. _________ 75. ________________________________________________________________ 75. _________ 76. ________________________________________________________________ 76. _________ 77. ________________________________________________________________ 77. _________ 78. ________________________________________________________________ 78. _________ 79. ________________________________________________________________ 79. _________ 80. ________________________________________________________________ 80. _________ 81. SUBTOTAL (add lines 68 through 80) 81. $_______ 82. TOTAL MONTHLY EXPENSES: (add lines 25, 35, 40, 46, 67, and 81 of Section II, Expenses) 82. $_______ SUMMARY 83. TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME) 83. $_______ 84. TOTAL MONTHLY EXPENSES (from line 82 above) 84. $________ 85. SURPLUS (If line 83 is more than line 84, subtract line 84 from line 83. This is the amount of your surplus. Enter that amount here.) 85. $_______ 86. (DEFICIT) (If line 84 is more than line 83, subtract 83 from line 84. This is the amount of your deficit. Enter that amount here.) 86. ($______) *68 SECTION III: ASSETS AND LIABILITIES A. ASSETS (This is where you list what you OWN.) INSTRUCTIONS: STEP 1: In column A, list a description of each separate item owned by you (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an item. STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any item that you are requesting the judge award to you. STEP 3: In column B, write what you believe to be the current fair market value of all items listed. STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning it belongs to only one of you and should not be divided. You should indicate to whom you believe the item belongs. (Typically, you will only use Column C if property was owned by one spouse before the marriage. See the instructions with this form and section 61.075(1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.) A B C Current Fair Nonmarital ASSETS: DESCRIPTION OF ITEM(S) Market Value (√ correct column) √ the box next to any asset(s) which you are requesting the judge award to you. husband wife [] Cash (on hand) $ [] Cash (in banks or credit unions) [] [] Stocks/Bonds [] [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) [] [] [] [] [] [] Business interests [] [] [] *69 [] [] Automobiles [] [] [] [] Boats [] [] [] Other vehicles [] [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)'s, etc.) [] [] [] [] Furniture & furnishings in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] [] Other assets [] [] [] [] [] [] [] Total Assets (add column B) $______ B. LIABILITIES/DEBTS (This is where you list what you OWE.) INSTRUCTIONS: *70 STEP 1: In column A, list a description of each separate debt owed by you (and/or your spouse, if this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than one of an item. STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any debt(s) for which you believe you should be responsible. STEP 3: In column B, write what you believe to be the current amount owed for all items listed. STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning the debt belongs to only one of you and should not be divided. You should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the debt was owed by one spouse before the marriage. See the instructions with this form and section 61.075(1), Florida Statutes, for definitions of "marital" and "nonmarital" assets and liabilities.) B C A Current Nonmarital Amount Owed (√ correct column) LIABILITIES: DESCRIPTION OF ITEM(S) √ the box next to any debt(s) for which you believe husband wife you should be responsible. [] Mortgages on real estate: (Home) $ [] (Other) [] [] [] Charge/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/Credit Union loans [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] [] [] *71 [] [] Total Debts (add column B) $______ C. NET WORTH (excluding contingent assets and liabilities) Total Assets (enter total of Column B in Asset Table; Section A) $________ Total Liabilities (enter total of Column B in Liabilities Table; Section B) $________ TOTAL NET WORTH (Total Assets minus Total Liabilities) (excluding contingent assets and liabilities) $________ D. CONTINGENT ASSETS AND LIABILITIES INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, debts assumed by another), you must list them here. A B C Contingent Assets Nonmarital Possible Value (√ Correct Column) √ the box next to any contingent asset(s) which you are requesting the judge award to you. husband wife [] $ [] [] [] [] Total Contingent Assets $_______ A B C Contingent Liabilities Possible Amount Nonmarital Owed (√ correct column) √ the box next to any contingent debt(s) for which you believe you should be responsible. husband wife [] $ [] [] [] [] Total Contingent Liabilities $______ E. Has there been any agreement between you and the other party that one of you will take responsibility for a debt and will hold the other party harmless from that debt? ( ) yes ( ) no If yes, explain: ___________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ *72 __________________________________________________________________________________________ __________________________________________________________________________________________ ATTACHMENTS CHILD SUPPORT GUIDELINES WORKSHEET. (Child Support Guidelines Worksheet. Florida Family Law Form 12.901(g), MUST be filed in all cases in which the parties have one or more children in common, INCLUDING modifications of child support.) [√ one only] ____ A Child Support Guidelines Worksheet IS being filed in this case. The parties have one or more minor children in common or one of the parties is requesting a modification of a previous court order regarding child support. ____ A Child Support Guidelines Worksheet IS NOT being filed in this case. There are no minor children common to the parties in this case or, if this case involves a modification of a previous court order, child support is not an issue. I certify that a copy of this financial affidavit was: ( ) mailed, ( ) faxed and mailed, or ( ) hand delivered to the person(s) listed below on {date} ______ Other party or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, _________________________________________________ NOTARY PUBLIC-STATE OF FLORIDA _________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_________________________________, a nonlawyer, located at {street} ______________, {city}______________________, {state} ________, {phone} ____________, helped {name}___________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. *73 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(f), UNIFORM CHILD CUSTODY JURISDICTION ACT (UCCJA) AFFIDAVIT When should this form be used? This form should be used in any case involving custody of or visitation with any minor child(ren). This affidavit is required even if the custody and visitation of the minor child(ren) are not in dispute. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the begining of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see sections 61.130261.1354, Florida Statutes. Special notes... If you are the petitioner in an injunction for protection against domestic violence case and you have filed Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i), you should write "confidential" in any space on this form that would require you to write the address where you are currently living. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. UNIFORM CHILD CUSTODY JURISDICTION ACT (UCCJA) AFFIDAVIT I, {full legal name} __________________________, being sworn, certify that the following statements are true: 1. The number of minor child(ren) subject to this proceeding is __________ The name, social security number, place of birth, birth date, and sex of each child; the present address, periods of residence, and places where each child has lived within the past five (5) years; and the name, present address, and relationship to the child of each person with whom the child has lived during that time are: THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 : *74 Child's Full Legal Name: ____________________________ S.S. #___________________ Place of Birth: ____________ Date of Birth:________________ Sex: __________ Child's Residence for the past 5 years: Dates Address (including city Name and present address Relationship to (From/To) and state) where child lived of person child lived with child /present* / / / / / * If you are the petitioner in an injunction for protection against domestic violence case and you have filed Petitioner's Request for confidential Filing of Address, Florida Family Law Form 12.980(i), you should write "confidential" in any space on this form that would require you to enter the address where you are currently living. (Make as many copies of page 2 as necessary). THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # __________: Child's Full Legal Name: ____________________________ S.S. #___________________ Place of Birth: ____________ Date of Birth:________________ Sex: __________ Child's Residence for the past 5 years: Dates Address (including city Name and present address Relationship to (From/To) and state) where child lived of person child lived with child /present / / / / / THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # __________: Child's Full Legal Name: ____________________________ S.S. #___________________ Place of Birth: ____________ Date of Birth:________________ Sex: __________ Child's Residence for the past 5 years: Dates Address (including city Name and present address Relationship to (From/To) and state) where child lived of person child lived with child /present *75 / / / / / 2. Participation in custody proceeding(s): [√ one only] ____ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or custody proceeding in this or any other state, concerning custody of a child subject to this proceeding. ____ I HAVE participated as a party, witness, or in capacity in any other litigation or custody proceeding in this or another state, concerning custody of a child subject to this proceeding. Explain: a. Name of each child: ____________________________________________________________ b. Type of proceeding: ____________________________________________________________ c. Court and state: _______________________________________________________________ d. Date of court order or judgment (if any): ______________________________________ 3. Information about custody proceeding(s): [√ one only] ____ I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or claim to have custody or visitation rights with respect to any child subject to this proceeding. ____ I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this proceeding has (have) physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this proceeding: a. Name and address of person: _________________________________________________ ________________________________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. c. Name and address of person: _________________________________________________ ________________________________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. Name of each child: ____________________________________________________________ c. Name and address of person: _________________________________________________ ________________________________________________________________________________ ( ) has physical custody ( ) claims custody rights ( ) claims visitation rights. Name of each child: ____________________________________________________________ 5. Knowledge of prior child support proceedings: [√ one only] ____ The child(ren) described in this affidavit are NOT subject to existing child support order(s) in this or any state or territory. ____ The child(ren) described in this affidavit are subject to the following existing child support order(s): a. Name of each child: _________________________________________________________ b. Type of proceeding: _________________________________________________________ c. Court and address: __________________________________________________________ d. Date of court order/judgment (if any): ______________________________________ e. Amount of child support paid and by whom: ___________________________________ 6. I acknowledge that I have a continuing duty to advise this Court of any custody, visitation, child support, or guardianship proceeding (including dissolution of marriage, separate maintenance, child neglect, or dependency) concerning the child(ren) in this state or any other state about which information is obtained during this proceeding. *76 I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________ Other party or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, _______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _______________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer}________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} ____________, helped {name}_____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FAMILY LAW FORM 12.901(g), CHILD SUPPORT GUIDELINES WORKSHEET When should this form be used? You should complete this worksheet if child support is being requested in your case. If you know the income of the other party, this worksheet should accompany your financial affidavit. If you do not know the other party's income, this form must be completed after the other party files his or her financial affidavit, and serves a copy on you. This form should be typed or printed in black ink. After completing this form, you should sign file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. *77 Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see section 61.30, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). The chart below contains the guideline amounts that you should use when calculating child support. This amount is based on the number of children and the combined income of the parents, and it is divided between the parents in direct proportion to their income or earning capacity. From time to time, some of the amounts in the child support guidelines chart will change. Be sure you have the most recent version of the chart before using it. Because the guidelines are based on monthly amounts, it may be necessary to convert some income and expense figures from other frequencies to monthly. You should do this as follows: If payment is twice per month Payment amount × 2 = Monthly amount If payment is every two weeks Payment amount × 26 = Yearly amount due Yearly amount ÷ 12 = Monthly amount If payment is weekly Weekly amount × 52 = Yearly amount due Yearly amount ÷ 12 = Monthly amount If you or the other parent request that the court award an amount that is different than the guideline amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. CHILD SUPPORT GUIDELINES CHART Combined Monthly Available One Two Three Four Five Six Income Child Children Children Children Children Children 650.00 74 75 75 76 77 78 700.00 119 120 121 123 124 125 750.00 164 166 167 169 171 173 800.00 190 211 213 216 218 220 850.00 202 257 259 262 265 268 900.00 213 302 305 309 312 315 950.00 224 347 351 355 359 363 1000.00 235 365 397 402 406 410 1050.00 246 382 443 448 453 458 1100.00 258 400 489 495 500 505 1150.00 269 417 522 541 547 553 1200.00 280 435 544 588 594 600 1250.00 290 451 565 634 641 648 1300.00 300 467 585 659 688 695 1350.00 310 482 603 681 735 743 1400.00 320 498 623 702 765 790 *78 1450.00 330 513 642 724 789 838 1500.00 340 529 662 746 813 869 1550.00 350 544 681 768 836 895 1600.00 360 560 701 790 860 920 1650.00 370 575 720 812 884 945 1700.00 380 591 740 833 907 971 1750.00 390 606 759 855 931 996 1800.00 400 622 779 877 955 1022 1850.00 410 638 798 900 979 1048 1900.00 421 654 818 923 1004 1074 1950.00 431 670 839 946 1029 1101 2000.00 442 686 659 968 1054 1128 2050.00 452 702 879 991 1079 1154 2100.00 463 718 899 1014 1104 1181 2150.00 473 734 919 1037 1129 1207 2200.00 484 751 940 1060 1154 1234 2250.00 494 767 960 1082 1179 1261 2300.00 505 783 980 1105 1204 1287 2350.00 515 799 1000 1128 1229 1314 2400.00 526 815 1020 1151 1254 1340 2450.00 536 831 1041 1174 1279 1367 2500.00 547 847 1061 1196 1304 1394 2550.00 557 864 1081 1219 1329 1420 2600.00 568 880 1101 1242 1354 1447 2650.00 578 896 1121 1265 1379 1473 2700.00 588 912 1141 1287 1403 1500 2750.00 597 927 1160 1308 1426 1524 2800.00 607 941 1178 1328 1448 1549 2850.00 616 956 1197 1349 1471 1573 2900.00 626 971 1215 1370 1494 1598 2950.00 635 986 1234 1391 1517 1622 3000.00 644 1001 1252 1412 1540 1647 3050.00 654 1016 1271 1433 1563 1671 3100.00 663 1031 1289 1453 1586 1695 3150.00 673 1045 1308 1474 1608 1720 3200.00 682 1060 1327 1495 1631 1744 3250.00 691 1075 1345 1516 1654 1769 3300.00 701 1090 1364 1537 1677 1793 3350.00 710 1105 1382 1558 1700 1818 3400.00 720 1120 1401 1579 1723 1842 3450.00 729 1135 1419 1599 1745 1867 3500.00 738 1149 1438 1620 1768 1891 3550.00 748 1164 1456 1641 1791 1915 3600.00 757 1179 1475 1662 1814 1940 3650.00 767 1194 1493 1683 1837 1964 3700.00 776 1208 1503 1702 1857 1987 3750.00 784 1221 1520 1721 1878 2009 3800.00 793 1234 1536 1740 1899 2031 3850.00 802 1248 1553 1759 1920 2053 3900.00 811 1261 1570 1778 1940 2075 3950.00 819 1275 1587 1797 1961 2097 4000.00 828 1288 1603 1816 1982 2119 4050.00 837 1302 1620 1835 2002 2141 4100.00 846 1315 1637 1854 2023 2163 4150.00 854 1329 1654 1873 2044 2185 4200.00 863 1342 1670 1892 2064 2207 4250.00 872 1355 1687 1911 2085 2229 4300.00 881 1369 1704 1930 2106 2251 4350.00 889 1382 1721 1949 2127 2273 4400.00 898 1396 1737 1968 2147 2295 4450.00 907 1409 1754 1987 2168 2317 *79 4500.00 916 1423 1771 2006 2189 2339 4550.00 924 1436 1788 2024 2209 2361 4600.00 933 1450 1804 2043 2230 2384 4650.00 942 1463 1821 2062 2251 2406 4700.00 951 1477 1838 2081 2271 2428 4750.00 959 1490 1855 2100 2292 2450 4800.00 969 1503 1871 2119 2313 2472 4850.00 977 1517 1888 2138 2334 2494 4900.00 986 1530 1905 2157 2354 2516 4950.00 993 1542 1927 2174 2372 2535 5000.00 1000 1551 1939 2188 2387 2551 5050.00 1006 1561 1952 2202 2402 2567 5100.00 1013 1571 1964 2215 2417 2583 5150.00 1019 1580 1976 2229 2432 2599 5200.00 1025 1590 1988 2243 2447 2615 5250.00 1032 1599 2000 2256 2462 2631 5300.00 1038 1609 2012 2270 2477 2647 5350.00 1043 1619 2024 2283 2492 2663 5400.00 1051 1628 2037 2297 2507 2679 5450.00 1057 1638 2049 2311 2522 2695 5500.00 1064 1647 2061 2324 2537 2711 5550.00 1070 1657 2073 2338 2552 2727 5600.00 1077 1667 2085 2352 2567 2743 5650.00 1083 1676 2097 2365 2582 2759 5700.00 1089 1686 2109 2379 2597 2775 5750.00 1096 1695 2122 2393 2612 2791 5800.00 1102 1705 2134 2406 2627 2807 5850.00 1107 1713 2144 2418 2639 2820 5900.00 1111 1721 2155 2429 2651 2833 5950.00 1116 1729 2165 2440 2663 2847 6000.00 1121 1737 2175 2451 2676 2860 6050.00 1126 1746 2185 2462 2688 2874 6100.00 1131 1754 2196 2473 2700 2887 6150.00 1136 1762 2206 2484 2712 2900 6200.00 1141 1770 2216 2495 2724 2914 6250.00 1145 1778 2227 2506 2737 2927 6300.00 1150 1786 2237 2517 2749 2941 6350.00 1155 1795 2247 2529 2761 2954 6400.00 1160 1803 2258 2540 2773 2967 6450.00 1165 1811 2268 2551 2785 2981 6500.00 1170 1819 2278 2562 2798 2994 6550.00 1175 1827 2288 2573 2810 3008 6600.00 1179 1835 2299 2584 2822 3021 6650.00 1184 1843 2309 2595 2834 3034 6700.00 1189 1850 2317 2604 2845 3045 6750.00 1193 1856 2325 2613 2854 3055 6800.00 1196 1862 2332 2621 2863 3064 6850.00 1200 1868 2340 2630 2782 3074 6900.00 1204 1873 2347 2639 2882 3084 6950.00 1208 1879 2355 2647 2891 3094 7000.00 1212 1885 2362 2656 2900 3103 7050.00 1216 1891 2370 2664 2909 3113 7100.00 1220 1897 2378 2673 2919 3123 7150.00 1224 1903 2385 2681 2928 3133 7200.00 1228 1909 2393 2690 2937 3142 7250.00 1232 1915 2400 2698 2946 3152 7300.00 1235 1921 2408 2707 2956 3162 7350.00 1239 1927 2415 2716 2965 3172 7500.00 1243 1933 2423 2724 2974 3181 7450.00 1247 1939 2430 2733 2983 3191 7500.00 1251 1945 2438 2741 2993 3201 *80 7550.00 1255 1951 2446 2750 3002 3211 7600.00 1259 1957 2453 2758 3011 3220 7650.00 1263 1963 2461 2767 3020 3230 7700.00 1267 1969 2468 2775 3030 3240 7750.00 1271 1975 2476 2784 3039 3250 7800.00 1274 1981 2483 2792 3048 3259 7850.00 1278 1987 2491 2801 3057 3269 7900.00 1282 1992 2498 2810 3067 3279 7950.00 1286 1998 2506 2818 3076 3289 8000.00 1290 2004 2513 2827 3085 3298 8050.00 1294 2010 2521 2835 3094 3308 8100.00 1298 2016 2529 2844 3104 3318 8150.00 1302 2022 2536 2852 3113 3328 8200.00 1306 2028 2544 2861 3122 3337 8250.00 1310 2034 2551 2869 3131 3347 8300.00 1313 2040 2559 2878 3141 3357 8350.00 1317 2046 2566 2887 3150 3367 8400.00 1321 2052 2574 2895 3159 3376 8450.00 1325 2058 2581 2904 3168 3386 8500.00 1329 2064 2589 2912 3178 3396 8550.00 1333 2070 2597 2921 3187 3406 8600.00 1337 2076 2604 2929 3196 3415 8650.00 1341 2082 2612 2938 3205 3425 8700.00 1345 2088 2619 2946 3215 3435 8750.00 1349 2094 2627 2955 3224 3445 8800.00 1352 2100 2634 2963 3233 3454 8850.00 1356 2106 2642 2972 3242 3464 8900.00 1360 2111 2649 2981 3252 3474 8950.00 1364 2117 2657 2989 3261 3484 9000.00 1368 2123 2664 2998 3270 3493 9050.00 1372 2129 2672 3006 3279 3503 9100.00 1376 2135 2680 3015 3289 3513 9150.00 1380 2141 2687 3023 3298 3523 9200.00 1384 2147 2695 3032 3307 3532 9250.00 1388 2153 2702 3040 3316 3542 9300.00 1391 2159 2710 3049 3326 3552 9350.00 1395 2165 2717 3058 3335 3562 9400.00 1399 2171 2725 3066 3344 3571 9450.00 1403 2177 2732 3075 3353 3581 9500.00 1407 2183 2740 3083 3363 3591 9550.00 1411 2189 2748 3092 3372 3601 9600.00 1415 2195 2755 3100 3381 3610 9650.00 1419 2201 2763 3109 3390 3620 9700.00 1422 2206 2767 3115 3396 3628 9750.00 1425 2210 2772 3121 3402 3634 9800.00 1427 2213 2776 3126 3408 3641 9850.00 1430 2217 2781 3132 3414 3647 9900.00 1432 2221 2786 3137 3420 3653 9950.00 1435 2225 2791 3143 3426 3659 10000.00 1437 2228 2795 3148 3432 3666 IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and *81 __________________________________, Respondent. CHILD SUPPORT GUIDELINES WORKSHEET I, {full legal name} _____________________________________, certify that the following statements are true: FATHER MOTHER 1. PRESENT NET MONTHLY INCOME Enter the amount from line number 27, Section I of Florida Family Law Form 12.901(d) or (e), Financial Affidavit. 1a. $________ 1b. $________ 2. COMBINED PRESENT NET MONTHLY INCOME Add 1a and 1b. 2. $________ 3. BASIC MONTHLY OBLIGATION There is (are) {number} ____________ minor child(ren) common to the parties. Using the amount on line 2, enter the appropriate amount from the child support guidelines chart. 3. $________ 4. PERCENT OF FINANCIAL RESPONSIBILITY Divide the amount on line la. by the amount on line 2 to get Father's percentage financial responsibility. Enter answer on line 4a. 4a. $________% Divide the amount on line lb. by the amount on line 2 to get Mother's percentage financial responsibility. Enter answer on line 4b. 4b. $________% 5. SHARE OF BASIC MONTHLY OBLIGATION Multiply the number on line 3 by the percent on line 4a to get Father's share of basic obligation. Enter answer on line 5a. 5a. $________ Multiply the number on line 3 by the percent on line 4b to get Mother's share of basic obligation. Enter answer on line 5b. 5b. $________ 6. TOTAL MONTHLY CHILD CARE COSTS Child care costs should not exceed the level required to provide quality care from a licensed source for the child(ren). See section 61.30(7), Fla.Stat. for more information. 6. $________ 7. PERCENTAGE OF CHILD CARE COSTS *82 Multiply the amount on line 6 by .75 (to determine 75% of the total child care costs). Enter answer on line 7. 7. $________ Multiply the number on line 4a. by the amount on line 7 to get Father's share of the child care obligation. Enter answer on line 7a. 7a. $________ Multiply the number on line 4b. by the amount on line 7 to get Mother's share of the child care obligation. Enter answer on line 7b. 7b. $________ 8. TOTAL MONTHLY CHILD(REN)'S HEALTH INSURANCE COSTS This is only amounts paid for insurance on the child(ren). Enter answer on line 8. 8. $________ Multiply the number on 4a. by the amount on line 8 to get Father's share of the child(ren)'s health insurance obligation. Enter answer on line 8a. 8a. $________ Multiply the number on 4b. by the amount on line 8 to get Mother's share of the child(ren)'s health insurance obligation. Enter answer on line 8b. 8b. $________ 9. TOTAL MONTHLY OBLIGATION Add lines 5a, 7a, and 8a to determine Father's total obligation. Enter answer on line 9a. 9a. $________ Add lines 5b, 7b, and 8b to determine Mother's total obligation. Enter answer on line 9b. 9b. $________ 10. ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent are requesting the Court to award a child support amount that is more or less than the child support guidelines, you must complete and file Motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943. [√ one only] ____ a. Deviation from the guidelines amount is requested. The motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943, is attached. ____ b. Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943, is not attached. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________________ Other party or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ Date: ________________________________ *83 __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} ____________, helped {name}_____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(h)(1), MARTAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(b)(1), has been filed and the parties have reached an agreement on some or all of the issues at hand. This form should be typed or printed in black ink. Both parties must sign the agreement and have their signatures witnessed by a notary public. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or answer that were filed in this case. Special notes... With this form you must also file a Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if not already filed. This form does not act to transfer title to the property. Such transfer must be done by deed or supplemental final judgment. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT. IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, *84 and __________________________________, Respondent, MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) We, {Husband's full legal name} ________________________________________, and {Wife's full legal name} _____________________________________________, being sworn, certify that the following statements are true: 1. We were married to each other on {date} ________________________________ 2. Because of irreconcilable differences in our marriage (no chance of staying together), we have made this agreement to settle once and for all what we owe to each other and what we can expect to receive from each other. Each of us states that nothing has been held back, that we have honestly included everything we could think of in listing our assets (everything we own and that is owed to us) and our debts (everything we owe), and that we believe the other has been open and honest in writing this agreement. 3. We have both filed a Financial affidavit, Florida Family Law form 12.901(d) or (e). Because we have voluntarily made full and fair disclosure to each other of all our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law rules of Procedure. 4. Each of us agrees to execute and exchange any papers that might be needed to complete this agreement, including deeds, title certificates, etc. SECTION I. MARITAL ASSETS AND LIABILITIES A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any personal item(s) not listed below is the property of the party currently in possession of the item(s). 1. Wife shall receive as her own and Husband shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any title/deed/account described below is Current Fair wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stocks/Bonds [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) *85 [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishings in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] Other assets [] [] [] [] [] [] Total Assets to Wife $________ 2. Husband shall receive as his own and Wife shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any title/deed/account described below is Current Fair wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stock/Bonds *86 [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishings in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] Other assets [] [] [] [] Total Assets to Husband $________ *87 B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 1. Wife shall pay as her own the following and will not at any time ask Husband to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE (To avoid confusion at a later date, describe each item as Monthly Current clearly as possible. You do not need to list account numbers. Payment Amount Owed Where applicable, include whether then name on any mortgage, note, or account described below is wife's, husband's, or both.) [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Charge/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] [] [] Total debts to be paid by Wife $ $ 2. Husband shall pay as his own the following and will not at any time ask Wife to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND (To avoid confusion at a later date, describe each item as Monthly Current clearly as possible. You do not need to list account numbers. Payment Amount Owed Where applicable, include whether then name on any mortgage, note, or account described below is wife's, husband's, or both.) [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Charge/credit card accounts [] [] [] *88 [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] [] [] [] Total debts to be paid by Husband $ $ C. Contingent Assets and Liabilities (listed in Section III of our Financial Affidavits) will be divided as follows:: ______________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY). (If you have not agreed on this matter, write ""n/a" on the lines provided.) [√ one only] ____ 1.Each of us forever gives up any right to spousal support (alimony) that we may have. ____ 2. ( ) HUSBAND ( ) WIFE agrees to pay spousal support (alimony) in the amount of $________ every ( ) week ( ) other week ( ) month, beginning {date}___________ and continuing until {date or event}__________________________ Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any other specifics: __________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [√ if applies] Life Insurance in the amount of $__________ to secure the above support, will be provided by the obligor. SECTION III. CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION. (If you have not reached an agreement on any of these issues, write ""n/a" on the lines provided. The Court reserves the right to modify any agreement(s) concerning the minor child(ren).) *89 1. The parties' minor child(ren) are: Name Birth date _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2. Parental responsibility for the minor child(ren) will be: ____ a. shared {explain any exceptions} _________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____ b. sole to ( ) Father ( )Mother {explain reasons} ____________________________________________________________________________ ____________________________________________________________________________ 3. The primary residential parent will be ( ) Father ( )Mother and the other parent, will be the secondary residential parent OR the primary residential parent will be ( ) undesignated ( ) rotating. 4. Secondary Residential Responsibility, Visitation, or Time Sharing will be as follows: {explain schedule (days and times, holidays, etc.)}__________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ {explain how parents will communicate regarding arrangements or any other issues relating to the child(ren)}___________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ {explain how parents will handle situations when one parent is unable to meet the schedule, for example, notice requirements to the other parent} __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ {explain how the child(ren) will be exchanged, for example, location(s), by third parties, etc.}_________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ {explain any other agreed-upon arrangements}_____________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5. Neither parent shall take the child(ren) from the custody of the other parent or any child care provider or other person entrusted by the other parent with the care to the child(ren) without the agreement of the other party during the other party's time of parental responsibility of visitation. SECTION IV. CHILD SUPPORT *90 1. ( ) Mother ( ) Father will pay child support under Florida's child support guidelines, section 61.30, Florida Statutes, to the primary residential or sole parent named above. Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is completed and attached. This parent shall be obligated to pay child support in the amount of $___________, every ( ) week ( ) other week ( ) month, beginning {date} ____________ and continuing until modified by court order, the youngest child turns 18, becomes emancipated, marries, dies, otherwise becomes self-supporting or, if after the age of 18, until {date}___________ If the child support amount above deviates from the guidelines by 5% or more, explain the reason(s) here: _________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2. Child Support Arrearage. There currently is a child support arrearage of $___________ for retroactive child support and/or $____________ for previously ordered unpaid child support. The total of $________ in child support arrearage shall be repaid at the rate of $_________ every ( ) week ( ) other week ( ) month, beginning {date} ______________, until paid in full including statutory interest. 3. Health Insurance. ( ) Mother ( ) Father will maintain health insurance coverage for the parties' minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR ( ) Health insurance is not reasonably available at this time. Any uninsured/unreimbursed medical costs for the minor child(ren) shall be assessed as follows: ____ a. Shared equally by both parents. ____ b. Prorated according to the child support guideline percentages. ____ c. Other {explain}: _______________________________________________ ____________________________________________________________________________ As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 4. Dental Insurance. ( ) Mother ( ) Father will maintain ( ) dental insurance coverage for the parties' minor child(ren). The party providing coverage will provide insurance cards to the other party showing coverage. OR ( ) dental insurance is not reasonably available at this time. Any uninsured/unreimbursed dental costs for the minor child(ren) shall be assessed as follows: ____ a. Shared equally by both parents. ____ b. Prorated according to the child support guideline percentages. ____ c. Other {explain}:________________________________________________ ____________________________________________________________________________ As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance. ( ) Mother ( ) Father shall be required to maintain life insurance coverage for the benefit of the parties' minor child(ren) in the amount of $___________ until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. IRS Income Tax Deduction(s). the parent granted primary residential responsibility or sole parental responsibility of the parties' minor child(ren) shall have the benefit of any tax deductions for the child(ren) or as follows: *91 {explain} ______________________________________________________________ _________________________________________________________________________________ The other parent will convey any applicable IRS form regarding the income tax deduction. 7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, insurance coverage, life insurance to secure child support, orthodontic payments, college fund, etc.):___________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SECTION V. OTHER _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SECTION VI. We have not agreed on the following issues: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Husband Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced___________ *92 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} ____________, helped {Husband's name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Wife Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ______________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_____________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_______________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} ____________, helped {Wife's name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(h)(2),MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPEDENT OR MINOR CHILD(REN) When should this form be used? This form should be used when a Petition for Dissolution of Marriage with Property but no Dependent or Minor Child(ren), Florida Family Law Form 12.901(b)(2), has been filed and the parties have reached an agreement on some or all of the issues at hand. This form should be typed or printed in black ink. Both parties must sign the agreement and have their signatures witnessed by a notary public. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. *93 You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or answer that were filed in this case. Special notes... This form does not act to transfer title to the property. Such transfer must be done by deed or supplemental final judgment. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) We, {Husband's full legal name} _________________________________________, and {Wife's full legal name} _____________________________________________, being sworn, certify that the following statements are true: 1. We were married to each other on {date} ______________________ 2. Because of irreconcilable differences in our marriage (no chance of staying together), we have made this agreement to settle once and for all what we owe to each other and what we can expect to receive from each other. Each of us states that nothing has been held back, that we have honestly included everything we could think of in listing our assets (everything we own and that is owed to us) and our debts (everything we owe), and that we believe the other has been open and honest in writing this agreement. 3. We have both filed a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Because we have voluntarily made full and fair disclosure to each other of all our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law Rules of Procedure. 4. Each of us agrees to execute and exchange any papers that might be needed to complete this agreement, including deeds, title certificates, etc. *94 SECTION I. MARITAL ASSETS AND LIABILITIES A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any personal item(s) not listed below is the property of the party currently in possession of the item(s). 1. Wife shall receive as her own and Husband shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the CURRENT FAIR name on any title/deed/account described below is wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stocks/Bonds [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishings in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment *95 [] [] [] [] Other assets [] [] [] [] [] [] Total Assets to Wife $________ 2. Husband shall receive as his own and Wife shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the Current Fair name on any title/deed/account described below is wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stocks/Bonds [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishings in home [] *96 [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] Other assets [] [] [] [] Total Assets to Husband $________ B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 1. Wife shall pay as her own the following and will not at any time ask Husband to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any mortgage, note, or account described below is wife's, husband's, Monthly Current or both.) Payment Amount Owed [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Charge/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] Money you owe (not evidenced by a note) *97 [] [] Judgments [] [] Other [] [] [] [] Total debts to be paid by Wife $ $ 2. Husband shall pay as his own the following and will not at any time ask Wife to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any mortgage, note or account described below is wife's, husband's Monthly or both.) Payment [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Chart/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] [] [] [] Total debts to be paid by Husband $ $ C. Contingent Assets and Liabilities (listed in Section III of our Financial Affidavits) will be divided as follows: _______________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ *98 _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY). (If you have not agreed on this matter, write "n/a" on the lines provided.) [√ one only] ________________________________________________________________________________ ____ 1. Each of us forever gives up any right to spousal support (alimony) that we may have. ____ 2. ( ) HUSBAND ( ) WIFE agrees to pay spousal support (alimony) in the amount of $__________ every ( ) week ( ) other week ( ) month, beginning {date}__________ and continuing until {date or event} _______________ Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any other specifics: __________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [√ if applies] ( ) Life insurance in the amount of $__________ to secure the above support will be provided by the obligor. SECTION III. OTHER ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SECTION IV. We have not agreed on the following issues: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Husband Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced______________ *99 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}________________, a nonlawyer, located at {street} ________________________________, {city}____________, {state} ________, {phone} ____________, helped {Husband's name}_____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Wife Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_______________________, a nonlawyer, located at {street} ______________, {city}____________, {state} ________, {phone} _____________________________________, helped {Wife's name}_____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(h)(3), MARITAL SETTLEMENT AGREEMENT FOR SIMPLIFIED DISSOLUTION OF MARRIAGE When should this form be used? This form should be used when a Petition for Simplified Dissolution of Marriage, Florida Family Law Form 12.901(a), has been filed and the parties have reached an agreement on all of the issues at hand. This form should be typed or printed in black ink. Both parties must sign the agreement and have their signatures witnessed by a notary public. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). *100 Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see chapter 61, Florida Statutes, and the instructions for the petition which was filed in this case. Special notes... This form does not act to transfer title to the property. Such transfer must be done by deed or supplemental final judgment. Remember, a person who is NOT an attorney is called a, nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent MARITAL SETTLEMENT AGREEMENT FOR SIMPLIFIED DISSOLUTION OF MARRIAGE We, {Husband's full legal name} __________________________________________, and {Wife's full legal name} _____________________________________________, being sworn, certify that the following statements are true: 1. We were married to each other on {date} ________________________________ 2. Because of irreconcilable differences in our marriage (no chance of staying together), we have made this agreement to settle once and for all what we owe to each other and what we can expect to received from each other. Each of us states that nothing has been held back, that we have honestly included everything we could think of in listing our assets (everything we own and that is owed to us) and our debts (everything we owe), and that we believe the other has been open and honest in writing this agreement. 3. We have both filed a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Because we have voluntarily made full and fair disclosure to each other of all our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law Rules of Procedure. 4. Each of us agrees to execute and exchange any papers that might be needed to complete this agreement, including deeds, title certificates, etc. SECTION I. MARITAL ASSETS AND LIABILITIES A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any personal item(s) not listed below is the property of the party currently in possession of the item(s). 1. Wife shall receive as her own and Husband shall have no further rights or responsibilities regarding these assets: *101 ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the Current Fair name of any title/deed/account described below is wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stocks/Bonds [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidence by a note) [] [] [] Real estate: (Home) [] (Other) [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishing in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] Other assets [] *102 [] [] [] [] [] Total Assets to Wife $________ 2. Husband shall receive as his own and Wife shall have no further rights or responsibilities regarding these assets: ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the Current Fair name of any title/deed/account described below is wife's, husband's, or both.) Market Value [] Cash (on hand) $ [] Cash (in banks/credit unions) [] [] Stocks/Bonds [] [] Notes (money owed to you in writing) [] [] [] Money owed to you (not evidenced by a note) [] [] [] Real estate: (Home) [] (Other) [] [] Business interests [] [] Automobiles [] [] [] Boats [] Other vehicles [] [] Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) [] [] [] Furniture & furnishings in home [] [] Furniture & furnishings elsewhere [] [] Collectibles [] [] Jewelry *103 [] [] Life insurance (cash surrender value) [] [] Sporting and entertainment (T.V., stereo, etc.) equipment [] [] [] [] Other assets [] [] [] [] Total Assets to Husband $________ B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 1. Wife shall pay as her own the following and will not at any time ask Husband to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any mortgage, note, or account described below is wife's, husband's, Monthly Current or both.) Payment Amount Owed [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Charge/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] *104 [] [] [] [] Total debts to be paid by Wife $ $ 2. Husband shall pay as his own the following and will not at any time ask Wife to pay these debts/bills: LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND (To avoid confusion at a later date, describe each item as clearly as possible. You do not need to list account numbers. Where applicable, include whether the name on any mortgage, note, or account described below is wife's, husband's, Monthly Current or both.) Payment Amount Owed [] Mortgages on real estate: (Home) $ $ [] (Other) [] [] Charge/credit card accounts [] [] [] [] [] [] Auto loan [] Auto loan [] Bank/credit union loans [] [] [] [] [] Money you owe (not evidenced by a note) [] [] Judgments [] [] Other [] [] [] [] [] [] Total debts to be paid by Husband $ $ C. Contingent Assets and Liabilities (listed in Section III of our Financial Affidavits) will be divided as follows: _______________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ *105 _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY). Each of us forever gives up any right to spousal support (alimony) that we may have. SECTION III. OTHER __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Husband Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_______________________, a nonlawyer, located at {street} ________________________________, {city} ____________, {state} ________, {phone} ____________, helped {Husband's name}_____________, who is the [√ one only] ____ petitioner or____ respondent, fill out this form. I certify that I have been open and honest in entering into this settlement agreement. I am satisfied with this agreement and intend to be bound by it. Dated: _______________________________ __________________________________ Signature of Wife Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ *106 STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ___________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}______________________, a nonlawyer, located at {street} ____________________________________, {city}____________, {state} ________, {phone} ______________, helped {Husband's name}_____________, who is the [√ one only] ____ petitioner or____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.901(i), AFFIDAVIT OF CORROBORATING WITNESS When should this form be used? This form may be used to prove residency in a dissolution of marriage proceeding. To get a divorce in Florida, either the husband or the wife must have lived in Florida for at least 6 months before filing the petition. Residency may be proved by a valid Florida driver's license, Florida identification card, or voter's registration card (issue date of document must be at least 6 months before the date the case is actually filed with the clerk of the circuit court), or the testimony or affidavit of someone other than you or your spouse. This form is used to prove residency by affidavit. The person signing this form must know that you have lived in the State of Florida for at least 6 months before the date you signed your petition for dissolution of marriage. This form should be typed or printed in black ink, and signed in the presence of a notary public. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see section 61.021, Florida Statutes or section 61.052(2), Florida Statutes. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA *107 Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. AFFIDAVIT OF CORROBORATING WITNESS I, {full legal name} ______________________________________, being sworn, certify that the following statements are true: I am a resident of the State of Florida. I have known {name}____________ since {approximate date} ________________, (more than 6 months before the date of filing the petition in this action) and know of my own personal knowledge that this person has resided in the State of Florida for at least 6 months before the date of this affidavit. I have attached a copy of my Florida driver's license or Florida identification card to this affidavit. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Corroborating Witness Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}___________________________, a nonlawyer, located at {street} _________________________________________, {city} _______________, {state} _____________, {phone} __________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. *108 INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.901(j), NOTICE OF SOCIAL SECURITY NUMBER When should this form be used? This form must completed and filed by each party in all paternity, child support, and dissolution of marriage cases, regardless of whether the case involves a minor child(ren) and/or property. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see sections 61.052 and 61.13, Florida Statutes. Special notes... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF SOCIAL SECURITY NUMBER I, {full legal name} _____________________________________________________, certify that may social security number is ________________________________________ as required in section 61.052(7), sections 61.13(9) or (10), section 742.031(3), sections 742.032(1)-(3), and/or sections 742.10(1)-(2), Florida Statutes. Disclosure of my social security number shall be limited to the purpose of administration of the Title IV-D program for child support enforcement. Dated: _______________________________ __________________________________ Signature of Part Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ *109 Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}____________________________, a nonlawyer, located at {street}______________________________________________, {city},____________________, {state}_____________, {phone}______________, helped {name} ___________________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(a), ANSWER, WAIVER, AND REQUEST FOR COPY OF FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE When should this form be used? This form should be used when you have been served with a petition for dissolution of marriage and you do not wish to contest it or appear at a hearing. If you file this form, you are admitting all of the allegations in the petition, saying that you do not need to be notified of or appear at the final hearing, and that you would like a copy of the final judgment mailed to you. This form should be typed or printed in black ink, and your signature should be witnessed by a notary public. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? You have 20 days to answer after being served with the other party's petition. A copy of this form, along with all of the other forms required with this answer and waiver, must be mailed or hand delivered to the other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. Special notes... With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), if the case involves a dependent or minor child(ren). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if the case involves a dependent or minor child(ren). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you). • Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2), if you have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you, if not filed at the time of you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) *110 Child Custody... By filing this answer and waiver, you are agreeing to any child custody requests in the petition. The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you live. Listed below are some terms with which you should become familiar before completing your answer to the petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support... By filing this answer and waiver, you are agreeing to any child support requests in the petition. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Alimony... By filing this answer and waiver, you are agreeing to any alimony requests in the petition. Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in a counterpetition and should not use this form. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony. Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, custody, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. By filing this answer and waiver, you are agreeing to any requests in the petition regarding division of assets and liabilities. Final Judgment... You should receive a copy of the Final Judgment in the mail. If, for some reason you do not, you should call the clerk's office to request a copy. It is important for you to review a copy of the Final Judgment in your case to see what happened and to know what you must do and what you are entitled to receive. Nonlawyer... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law *111 Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. ANSWER, WAIVER, AND REQUEST FOR COPY OF FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE I, {full legal name} ______________________________, Respondent, being sworn, certify that the following information is true: 1. Respondent answers the Petition for Dissolution of Marriage filed in this action and admits all the allegations. By admitting all of the allegations in the petition, respondent agrees to all relief requested in the petition including any requests regarding child custody and visitation, child support, alimony, distribution of marital assets and liabilities, and temporary relief. 2. Respondent waives notice of hearing as well as all future notices in connection with the Petition for Dissolution of Marriage, as filed. Respondent also waives appearance at the final hearing. 3. Respondent requests that a copy of the Final Judgment of Dissolution of Marriage entered in this case be forwarded to Respondent at the address below. 4. If this case involves minor child(ren), a completed Uniform Child Custody jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this answer. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this answer. 6. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is filed with this answer. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date}________________ Other party or his/or attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and waiver and that the punishment for knowingly making a false statement includes fines and/or imprisonment. *112 Dated: _______________________________ __________________________________ Signature of Respondent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_____________________________, a nonlawyer, located at {street}________________________________________________, {city}_______________, {state} ______________, {phone}_____________, helped {name} ______________, who is the respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(b), ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE When should this form be used? This form should be used when you are responding to a petition for dissolution of marriage and you wish to admit or deny all of the allegations in the petition but you do not plan to file a counterpetition seeking relief. You can use this form to answer any petition for dissolution of marriage, whether or not there are minor child(ren). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. This must be done within 20 days of receiving the petition. What should I do next? A copy of this form, along with all of the other forms required with this answer, must be mailed or hand delivered to the other party in your case. You have 20 days to answer after being served with the other party's petition. After you file your answer, the case will generally proceed in one of the following two ways: UNCONTESTED... If you file an answer that agrees with everything in the other party's petition and you have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the final hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. *113 CONTESTED... If you file an answer which disagrees with or denies anything in the petition, and you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. See chapter 61, Florida Statutes, for more information. Special notes... With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), if the case involves a dependent or minor child(ren). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if the case involves a dependent or minor child(ren). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you). • Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2), if you have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) Child Custody ... If you and your spouse are unable to agree about with whom the child(ren) will live most of the time, a judge will decide for you. The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you live. Listed below are some terms with which you should become familiar before completing your answer to the petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact *114 Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for one or more children, you should request child support in a counterpetition, Florida Family Law Form 12.902(c)(1), and you cannot use this form. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in a counterpetition. Florida Family Law Form 12.902(c)(1)(with dependent or minor child(ren)), or Florida Family Law Form 12.902(c)(2)(no dependent or minor child(ren)). If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, custody, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities. Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and visitation with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a), or, if there are no dependent or minor child(ren), Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(a). For more information, see the instructions for these forms. Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(1), and Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(1), Final Judgment of Dissolution *115 of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(2), or Final Judgment of Dissolution of Marriage with No Property and No Dependent or Minor Child(ren), Florida Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent, ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE I, {full legal name} _____________________________________________, Respondent, being sworn, certify that the following information is true: 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ___________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} _____________________________________ 3. I currently am unable to admit or deny the allegations raised in the following paragraphs due to lack of information: {indicate section and paragraph number} _________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. If this case involves a dependent or minor child(ren), a completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law form 12.901(f), is filed with this answer. 5. If this case involves a dependent or minor child(ren), a completed Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is [√ one only] ( ) filed with this answer or ( ) will be filed after the other party serves his or her financial affidavit. 6. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this answer. *116 7. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), [√ one only] ( ) is filed with this answer or ( ) will be timely filed. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________ Petitioner or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Respondent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_____________________________, a nonlawyer, located at {street}_____________________________________________, {city} ___________________________, {state} ____________, {phone}___________, helped {name} _________________, who is the respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(c)(1), ANSWER TO PETITION AND COUNTERPETTION FOR DISSOLUTION OF MARIAGE WITH DEPENDENT OR MNOR CHILD(REN) When should this form be used? This form should be used when you are responding to a petition for dissolution of marriage with dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you. *117 This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows: The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), if you have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) Child Custody ... If you and your spouse are unable to agree about with whom the child(ren) will live most of the time, a judge will decide for you. The judge will decide the parenting arrangements based on the *118 child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation where you live. Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for one or more children, you should request child support in your counterpetition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony. Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, custody, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities. Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and visitation with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a). For more information, see the instructions for that form. *119 Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner/Counterrespondent, and __________________________________, Respondent/Counterpetitioner. ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name} _____________________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} _____________________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} _______________________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} __________________________________ ________________________________________________________________________________________________ *120 COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filling of this Petition for Dissolution of Marriage. 2. Petitioner [√ one only] ( ) is ( ) is not a member of the military service. Respondent [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ________________________________________ Place of marriage: {city, state, country} ___________________________________ Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. DEPENDENT OR MINOR CHILD(REN) [√ all that apply] ___ a. The wife is pregnant. Baby is due on: {date} ______________ ___ b. The minor (under 18) child(ren) common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ___ c. The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ The birth father(s) of the above minor child(ren) is (are) {name and address} ______________________________________________________________________________________ ______________________________________________________________________________________ ___ d. The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical disability are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ 5. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this counterpetition. You must complete and attach this form in a dissolution of marriage with minor child(ren). 6. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this counterpetition. 7. This counterpetition for dissolution of marriage should be granted because: [√ one only] ___ a. The marriage is irretrievably broken. ___ b. One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [√ one only] ___ 1. There are no marital assets or liabilities. *121 ___ 2. There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Form 12.901(d) or (e), to be filed in this case. [√ all that apply] ____ a. All marital assets and liabilities have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1)). ____ b. The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. ____ c. Respondent should be awarded an interest in Petitioner's property because: ________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [√ one only] ___ 1. Respondent forever gives up his/her right to spousal support (alimony) from Petitioner. ___ 2. Respondent requests that the Court order Petitioner to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the amount of $___________ every ( ) week ( ) other week ( ) month, beginning {date}________ and continuing until {date or event} ___________________________________________ Explain why the court should order Petitioner to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): __________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [√ if applies] ( ) Respondent requests life insurance on Petitioner's life, provided by Petitioner, to secure such support. SECTION III. CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain} ___________________________________________________________________ 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [√ one only] ___ a. shared by both Father and Mother. ___ b. awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: _____________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 3. Primary Residential Parent (Custody). It is in the best interests of the child(ren) that the primary residential parent be ( ) Father ( ) Mother ( ) undesignated ( ) rotating because: __________________________________________________ *122 _____________________________________________________________________________________ _____________________________________________________________________________________ 4. Visitation or Time Sharing. Respondent requests that the court order [√ all that apply] ___ a. no visitation. ___ b. limited visitation. ___ c. supervised visitation. ___ d. supervised or third-party exchange of child(ren). ___ e. visitation or time sharing as determined by the Court. ___ f. a visitation or time sharing schedule as follows: Explain the requested visitation or time sharing schedule: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Explain why this request is in the best interests of the child(ren): _____________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Has the above visitation or time sharing schedule been agreed to by the parties? ( ) yes ( ) no SECTION IV. CHILD SUPPORT [√ all that apply] ___ 1. Respondent requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law form 12.901(g), is, or will be filed. Such support should be ordered retroactive to: ___ a. the date of separate {date}___________ ___ b. the date of the filing of this petition. ___ c. other {date} ___________ {explain}______________________________ ___ 2. Respondent requests that the Court award child support to be paid beyond the age of 18 years because: ___ a. the following child(ren) {name(s)}________________________________________ is (are) dependent because of a mental or physical incapacity which began before the age of 18. {explain}_______________________________________ _____________________________________________________________________________________ ___ b. the following child(ren) {name(s)}_______________________________________ is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. ___ 3. Respondent requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Respondent understands that Motion to Deviate from Child Support Guidelines, Florida Family Law form 12.943, must be filed before the court will consider this request. ___ 4. Respondent requests that medical/dental insurance coverage for the minor child(ren) be provided by: [√ one only] ___ a. Father. ___ b. Mother. *123 ___ 5. Respondent requests that uninsured medical/dental expenses for the child(ren) be paid: [√ one only] ___ a. by Father. ___ b. by Mother. ___ c. by Father and Mother each paying one-half. ___ d. according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). ___ e. Other {explain}_____________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ___ 6. Respondent requests that life insurance to secure child support be provided by: ___ a. Father. ___ b. Mother. ___ c. Both. SECTION V. OTHER 1. [If Respondent is also the Wife, √ one only] ( ) yes ( ) no Respondent/Wife wants to be known by her former name, which was {full legal name} ______________________________________________________________________________________ 2. Other relief {specify}________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ SECTION VI. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Respondent requests that the Court enter an order dissolving the marriage and: [√ all that apply] ___ 1. distributing marital assets and liabilities as requested in Section I of this petition; ___ 2. awarding spousal support (alimony) as requested in Section II of this petition; ___ 3. establishing the primary residential parent (custody), parental responsibility, and visitation for the dependent or minor child(ren) common to both parties, as requested in Section III of this petition; ___ 4. establishing child support for the dependent or minor child(ren) common to both parties, as requested in Section IV of this section; ___ 5. restoring Wife's former name as requested in Section V of this petition; ___ 6. awarding other relief as requested in Section V of this petition; and any other terms the Court deems necessary. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________________ Petitioner or his/her attorney. Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ *124 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ ____________________________________________ Signature of Respondent/Counterpetitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, _____________________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _____________________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________, a nonlawyer, located at {street}____________________________________, {city}_____________________, {state} ____________, {phone}__________, helped {name} ___________________________, who is the respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(c)(2), ANSWER TO PETITION AND COUNTERPETTION FOR DISSOLUTION OF MARIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form should be used when you are responding to a petition for dissolution of marriage with property but no dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows: The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). *125 UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form, you must also file the following: • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2), if you have reached an agreement on any or all of the issues. • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony. Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities. Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family *126 Law Form 12.948(a). For more information, see the instructions for that form. Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Forms ... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner/Counterrespondent, and __________________________________, Respondent/Counterpetitioner. ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ____________________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ________________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition, and, therefore, deny those allegations: {indicate section and paragraph number} __________________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} _____________________________ ___________________________________________________________________________________________ *127 COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPETY BUT NO DEPENDENT OR MINOR CHILD(REN) 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. Petitioner [√ one only] ( ) is ( ) is not a member of the military service. Respondent [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ________________________________________ Place of marriage: {city, state, country} ___________________________________ Date of separation: {month, day, year}___________ ([]√ if approximate) 4. THERE IS NO MINOR (UNDER 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this counterpetition. 6. This counterpetition for dissolution of marriage should be granted because: [√ one only] ____ a. The marriage is irretrievably broken. ____ b. One of the parties has been adjudged mentally incapacitated for a period of 13 years prior to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [√ one only] ____ 1. There are no marital assets or liabilities. ____ 2. There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Form 12.901(d) or (e), to be filed in this case. [√ all that apply] ____ a. All marital assets and liabilities have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2)). ____ b. The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. ____ c. Respondent should be awarded an interest in Petitioner's property because: ________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [√ one only] ____ 1. Respondent forever gives up his/her right to spousal support (alimony) from Petitioner. ____ 2. Respondent requests that the Court order Petitioner to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the amount of $___________ every ( ) week ( ) other week ( ) month, beginning {date} ________ and continuing until {date or event} ___________________________________________________________. *128 Plain why the Court should order Petitioner to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): __________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [√ if applies] ( ) Respondent requests life insurance on Petitioner's life, provided by Petitioner, to secure such support. SECTION III. OTHER 1. [If Respondent is also the Wife, √ one only] ( ) yes ( ) no Respondent/Wife wants to be known by her former name, which was {full legal name}________ 2. Other relief {specify}: _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ SECTION IV. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Respondent requests that the Court enter an order dissolving the marriage and: [√ all that apply] ____ 1. distributing marital assets and liabilities as requested in Section I of this petition; ____ 2. awarding spousal support (alimony) as requested in Section II of this petition; ____ 3. restoring Wife's former name as requested in Section III of this petition; ____ 4. awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date}___________ Petitioner or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Respondent/Counter-petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ *129 Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_____________________________, a nonlawyer, located at {street}_____________________________________________, {city}______________________, {state} ____________, {phone} ____________, helped {name}_________________________, who is the respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(c)(3), ANSWER TO PETITION AND COUNTERPETTION FOR DISSOLUTION OF MARIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPETY When should this form be used? This form should be used when you are responding to a petition for dissolution of marriage with no dependent or minor child(ren) or property and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you such as restoring your former name. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows: The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counter-petition. *130 If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form, you must also file the following: • Affidavit of Corroborating Witness, Florida Family Law Form 12.901(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court). • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) Alimony ... By using this form, you are forever giving up your rights to spousal support (alimony) from petitioner. Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in an appropriate answer and counterpetition (see the other answer and counterpetition forms included in these forms for the appropriate form). Marital/Nonmarital Assets and Liabilities... By using this form, you are stating that there are no marital assets and/or liabilities. Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with No Property or Minor Child(ren) (Uncontested), Florida Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner/Counterrespondent, *131 and __________________________________, Respondent/Counterpetitioner. ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY I, {full legal name} ____________________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} _____________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} _____________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ________________________ ______________________________________________________________________________________ COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. Petitioner [√ one only] ( ) is ( ) is not a member of the military service. Respondent [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ________________________________________ Place of marriage: {city, state, country} ___________________________________ Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this counterpetition. 6. THIS COUNTERPETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: [√ one only] ____ a. The marriage is irretrievably broken. ____ b. One of the parties has been adjudged mentally incapacitated for a period of 3 years before the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. 7. THERE ARE NO MARITAL ASSETS OR LIABILITIES. 8. RESPONDENT FOREVER GIVES UP HIS/HER RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM PETITIONER. *132 9. [If Respondent is also the Wife, √ one only] ( ) yes ( ) no Respondent/Wife wants to be known by her former name, which was {full legal name} ___________ ______________________________________________________________________________________ 10. Other relief {specify}: _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Respondent requests that the Court enter an order dissolving the marriage and: [√ all that apply] ____ 1. restoring Wife's former name as specified in paragraph 9 of this petition; ____ 2. awarding other relief as specified in paragraph 10 of this petition; and any other terms the Court deems necessary. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________ Petitioner or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Respondent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ______________________________________ NOTARY PUBLIC—STATE OF FLORIDA _______________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced________________ *133 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_____________________________, a nonlawyer, located at {street}___________________________, {city} __________________________, {state} _______________, {phone}_________, helped {name}_____________________________, who is the respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.902(d), ANSWER TO COUNTERPETITION When should this form be used? This form should be used by a petitioner to respond to the respondent's counterpetition. You should use this form to admit or deny the allegations contained in the counterpetition. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the case is filed and keep a copy for your records. What should I do next? You have 20 days to answer after being served with the other party's counterpetition. A copy of this form must be mailed or hand delivered to the other party. To proceed with your case, you should refer to the instructions to your petition regarding setting a case for trial under "UNCOTESTED" and "CONTESTED." Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner/Counterrespondent, and __________________________________, Respondent/Counterpetitioner. ANSWER TO COUNTERPETITION I, {full legal name}___________________________________________, being sworn, certify that the following information is true: 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ___________________________________________________ *134 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} _____________________________________ 3. I am currently unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ________________________ ______________________________________________________________________________________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________ Respondent or his/her attorney: Name: ____________________________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Fax Number: ______________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ______________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer}_________________________, a nonlawyer, located at {street}__________________________________________, {city} ____________________, {state}_______, {phone}___________, helped {name}________________________________, who is the petitioner, fill out this form. *135 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.903(a), SUPPLEMENTAL PETITION TO MODIFY CUSTODY OR VISITATION AND OTHER RELIEF When should this form be used? This form should be used when you are asking the court to change current courtordered custody or visitation arrangements. The court can change an order granting shared parental responsibility, including a primary residential responsibility/custody order if the judge finds that there has been a substantial change in the circumstances of the parties and the change is in the child(ren)'s best interests. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file this form in the county where the original order was entered. If the order was entered in another state, or if the child(ren) live(s) in another state, you should speak with an attorney about where to file this form. You should file the original with the clerk of the circuit court and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party in your case of the supplemental petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the other party has 20 days to answer after being served with your supplemental petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counter-petition, *136 Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). • Notice of Social Security Number, Florida Family Law Form 12.901(j), if not previously filed. • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental petition, unless you and the other party have agreed not to exchange these documents.) Child Custody ... If you and the respondent are unable to agree about with whom the child(ren) will live most of the time, a judge will decide for you. The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation where you live. Listed below are some terms with which you should become familiar before completing your supplemental petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. *137 If you are requesting custody or primary residential responsibility for one or more children, you should request child support in your supplemental petition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Temporary Relief ... If you need temporary relief regarding parental responsibility and visitation with child(ren), or temporary child support, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a). For more information, see the instructions for that form. Settlement Agreement ... If you and the respondent are able to reach an agreement on any or all of the issues, you should file a Settlement Agreement. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Supplemental Final Judgment of Modification of Parental Responsibility/Visitation, Florida Family Law Form 12.993(a), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: __________________________ Division: __________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL PETITION TO MODIFY CUSTODY OR VISITATION AND OTHER RELIEF I, {full legal name}___________________________________________, being sworn, certify that the following information is true: *138 1. The parties to this action were granted a final judgment of ( ) dissolution of marriage ( ) paternity on {date}____________ A copy of the final judgment and any modification(s) is attached. 2. Paragraph(s)________________ of the ( ) final judgment or ( ) most recent modification thereof describes the present custody and/or visitation ordered. 3. Since the final judgment or last modification thereof, there has been a substantial change in circumstances, requiring a modification in custody or visitation. Those substantial changes are as follows: {explain}______________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. I ask the Court to modify the ( ) custody ( ) visitation as follows: {explain} ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 5. This modification is in the best interests of the child(ren) because: {explain} ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 6. If the requested modification is granted, Petitioner requests that child support be modified, consistent with the modification of custody or visitation. A Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is, or will be filed. 7. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 8. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this petition. 9. If not previously filed in this case, a completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this petition. 10. Other: _______________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party *139 Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}________________________, a nonlawyer, located at {street}_____________________________________________, {city} _________________________________, {state}_____________, {phone}____________, helped {name}_____________________________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.903(b), SUPPLMENTAL PETITION FOR MODIFCATION OF CHILD SUPPORT When should this form be used? This form should be used when you are asking the court to change a current courtordered child support obligation. The court can change a child support order if the judge finds that there has been a substantial change in the circumstances of the parties and the change is in the child(ren)'s best interests. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file this form in the county where the original order was entered. If the order was entered in another state, or if the child(ren) live(s) in another state, you should speak with an attorney about where to file this form. You should file the original with the clerk of the circuit court and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party in your case of the supplemental petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military *140 service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the other party has 20 days to answer after being served with your supplemental petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form, you must also file the following: • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). • Notice of Social Security Number, Florida Family Law Form 12.901(j), if not previously filed. • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental petition, unless you and the other party have agreed not to exchange these documents.) Child Support ... The court may order one parent to pay child support to assist the *141 other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Temporary Relief ... If you need temporary relief regarding child support, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a). For more information, see the instructions for that form. Settlement Agreement ... If you and the respondent are able to reach an agreement on any or all of the issues, you should file a Settlement Agreement. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Supplemental Final Judgment Modifying Child Support, Florida Family Law Form 12.993(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL PETITION FOR MODIFICATION OF CHILD SUPPORT *142 I, {full legal name}___________________________________________, being sworn, certify that the following information is true: 1. The parties to this action were granted a final judgment ( ) of dissolution of marriage ( ) of paternity ( ) for support unconnected with a dissolution of marriage on {date} _____________________ A copy of the final judgment and any modification(s) is attached. 2. Paragraph(s)____________ of the ( ) final judgment or ( ) most recent modification thereof establishes the present child support at $______________________ every ( ) week ( ) other week ( ) month, beginning on {date}_________________________ 3. Since the final judgment or most recent modification thereof, there has been a substantial change in circumstances, requiring a modification in child support. This change in circumstance is as follows: {explain}_________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. I ask the Court to modify child support as follows: {explain}________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 5. This change is in the best interests of the child(ren) because: {explain}____ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 6. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 7. If not previously filed in this case, a completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed. 8. A Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is, or will be, filed. 9. Other:________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. *143 Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, _____________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}_________________________, a nonlawyer, located at {street}_______________________________________________, {city} _______________________, {state}_________, {phone}____________, helped {name}_____________________________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.903(c), SUPPLMENTAL PETITION FOR MODIFCATION OF ALIMONY When should this form be used? This form should be used when you are asking the court to change a current courtordered alimony obligation. The court can change an alimony order if the judge finds that there has been a substantial change in the circumstances of the parties. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file this form in the county where the original order was entered. If the order was entered in another state, or if the child(ren) live(s) in another state, you should speak with an attorney about where to file this form. You should file the original with the clerk of the circuit court and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party in your case of the supplemental petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, *144 Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the other party has 20 days to answer after being served with your supplemental petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes. Special notes... With this form you must also file the following and serve a copy on the other party: • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. • Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the supplemental petition on the other party, if not filed at the time of the supplemental petition.) • Notice of Social Security Number, Florida Family Law Form 12.901(j), if not previously filed. • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the supplemental petition on the other party, if not filed at the time of the supplemental petition, unless you and the other party have agreed not to exchange these documents.) *145 Alimony ... In order to modify an order for alimony, a judge must find that there has been a substantial change in circumstances. Temporary Relief ... If you need temporary relief regarding modification of alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a), or Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(b), whichever is appropriate. For more information, see the instructions for those forms. Settlement Agreement ... If you and the respondent are able to reach an agreement on any or all of the issues, you should file a Settlement Agreement. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Supplemental Final Judgment Modifying Alimony, Florida Family Law Form 12.993(c), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL PETITION FOR MODIFICATION OF ALIMONY I, {full legal name}__________________________________________, being sworn, certify that the following information is true: 1. The parties to this action were granted a final judgment ( ) of dissolution of marriage ( ) for support unconnected with a dissolution of marriage on {date} _________________ A copy of the final judgment any modification(s) is attached. 2. Paragraph(s)_______________ of the ( ) final judgment or ( ) most recent modification thereof establishes the present alimony at $____________ every ( ) week ( ) other week ( ) month, beginning on {date}____________ *146 3. Since the final judgment or most recent modification thereof, there has been a substantial change in circumstances, requiring a modification in alimony. This change in circumstance is as follows: {explain}______________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. I ask the Court to modify alimony as follows: {explain} _____________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 5. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 6. If not previously filed in this case, a completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this supplemental petition. 7. Other: ________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, _______________________________________ NOTARY PUBLIC—STATE OF FLORIDA *147 ________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer}___________________________, a nonlawyer, located at {street}_________________________________________________, {city}_________________________, {state}__________, {phone}__________, helped {name}_____________________________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.903(d), ANSWER TO SUPPLEMENTAL PETITION When should this form be used? This form should be used when you are responding to a supplemental petition for modification of custody or visitation, for child support, or for alimony. This form is used to admit or deny all of the allegations in the supplemental petition if you do not plan to file a counterpetition. There is no form for a counterpetition to a supplemental petition in these Family Law Forms. If you want to file a counterpetition to a supplemental petition you will need to either seek legal assistance or create a form yourself. You may construct an answer and counterpetition using the pertinent sections contained in the Answer to Petition and Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.902(c)(1), or Answer to Petition and Counterpetition for Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Family Law Form 12.902(c)(2). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the case was filed and keep a copy for your records. This must be done within 20 days of receiving the supplemental petition. What should I do next? A copy of this form, along with all of the other forms required with this answer, must be mailed or hand delivered to the other party in your case. Regardless of whether you file a counterpetition, you have 20 days to answer after being served with the other party's supplemental petition. After you file your answer, the case will generally proceed in one of the following two ways: UNCONTESTED ... If you file an answer that agrees with everything in the other party's supplemental petition and you have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If you file an answer which disagrees with or denies anything in the supplemental petition, and you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. If you request the hearing, you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in *148 these instructions are defined there. See chapter 61, Florida Statutes, for more information. Special notes... With this form, you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), if the case involves child(ren). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if child support is an issue. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). • Notice of Social Security Number, Florida Family Law Form 12.901(j), if not previously filed. • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the supplemental petition on you, if not filed at the time you file your answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the supplemental petition on you, if not filed at the time of you file your answer, unless you and the other party have agreed not to exchange these documents.) Child Custody ... If this case involves child custody issue and if you and the other party are unable to agree about with whom the child(ren) will live most of the time, a judge will decide for you. The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. Some circuits may require the completion of a parenting course before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation where you live. Listed below are some terms with which you should become familiar before completing your supplemental petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary Residential Responsibility • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support ... If this case involves child support issues, the court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of *149 both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Temporary Relief ... If you need temporary relief regarding parental responsibility and visitation with child(ren), child support or alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a) or, if you need temporary relief regarding alimony and there are no dependent or minor child(ren), you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(a), For more information, see the instructions for these forms. Settlement Agreement ... If you and the other party are able to reach an agreement on any or all of the issues, you should file a Settlement Agreement. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(1), or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.901(h)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing. Final Judgment Form ... These family law forms contain a Supplemental Final Judgment of Modification of Parental Responsibility/Visitation, Florida Family Law Form 12.993(a), a Supplemental Final Judgment Modifying Child Support, Florida Family Law Form 12.993(b), and a Supplemental Final Judgment Modifying Alimony, Florida Family Law Form 12.993(c), which the judge may use, as appropriate. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. *150 ANSWER TO SUPPLEMENTAL PETITION I, {full legal name} __________________________________________, being sworn, certify that the following information is true: 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Supplemental Petition and, therefore, admit those allegations: {indicate section and paragraph number} __________________________________________ ___________________________________________________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Supplemental Petition and, therefore, deny those allegations: {indicate section and paragraph number} ______________________________ ____________________________________________________________________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ______________________________ ____________________________________________________________________________________________ 4. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this answer, if one has not been previously filed in this case. [√ if applies] ____ 6. This case involves custody or visitation with a minor child(ren), and a completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this answer. ____ 7. This case involves child support, and a completed Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is filed or will be filed with the court. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________ Petitioner or his/her attorney: Name: _________________________________________________________________________________ Address: ______________________________________________________________________________ City, State, Zip: _____________________________________________________________________ Fax Number: ___________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and that the punishment of knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ ______________________________________________ Signature of Respondent Printed Name: ________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Telephone Number: ____________________________ Fax Number: __________________________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, *151 _______________________________________ NOTARY PUBLIC—STATE OF FLORIDA _________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, located at {street} ________________________________________________, {city} ________________________, {state} ___________, {phone} _________, helped {name} _____________________________, who is the respondent, fill out this form. INSTRUCTIONS FOR FAMILY LAW FORM 12.904(a), PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form may be used to ask the court to enter a support order if you and your spouse are separated, and your spouse has the ability to contribute to you and your minor child(ren), but has failed to do so. You can only use this form if a dissolution of marriage has not been filed and the child(ren) live primarily with you. If a petition for dissolution of marriage has been filed, you should file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form. This petition cannot address the issues of property, debts, custody, or visitation. It only deals with alimony and child support. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party in your case of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. *152 If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see section 61.09, Florida Statutes. Special notes... With this form you must also file the following: • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.) • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if you are asking that child support be ordered in the final judgment. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.) • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines *153 Worksheet, Florida Family Law Form 12.901(g). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Temporary Relief ... If you need temporary relief regarding child support or temporary alimony, you may file a Motion for Temporary Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(a). For more information, see the instructions for that form. Final Judgment Form ... These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren), Florida Family Law Form 12.994(a), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name} _____________________________________________, the [√ one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes. 2. Petitioner [√ one only] ( ) is ( ) is not a member of the military service. Respondent [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ________________________________________ Place of marriage: {city, state, country} ___________________________________ Date of separation: {month, day, year} _____________ ([]√ if approximate) 4. MINOR CHILD(REN) [√ all that apply] *154 ____ a. The wife is pregnant. The baby is due on: {date} ____________________ ____ b. The minor (under 18) child(ren) common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ ____ c. The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ The birth father(s) of the above minor child(ren) is (are) {name and address} ___________________________________________________________________________________ ___________________________________________________________________________________ ____ d. The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical disability are: Name Place of Birth Birth date Sex ______________________________ ______________________ _______________ __________ ______________________________ ______________________ _______________ __________ 5. A completed Notice of Social Security Number, Florid Family Law Form 12.901(j), is filed with this petition. 6. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 7. A completed Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is, or will be, filed. SECTION I. SPOUSAL SUPPORT (ALIMONY) [√ one only] ____ 1. Petitioner does not request spousal support (alimony) from Respondent at this time. ____ 2. Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do so. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requested. Spousal support (alimony) is requested in the amount of $_______ every ( ) week ( ) other week ( ) month, beginning {date} ______, and continuing until {date or event} ______ ______________________________________________________________________________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): ___________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ [√ if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. *155 SECTION II. CHILD SUPPORT Respondent has the ability to contribute to the maintenance of his or her minor child(ren) and has failed to do so. Petitioner has custody of the minor child(ren) or the child(ren) has (have) primary residence with Petitioner. [√ all that apply] ____ 1. Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. ____ 2. Petitioner requests that the Court award child support to be paid beyond the age of 18 years because: ____ a. the following child(ren), {name(s)} _________________________________, is (are) dependent because of a mental or physical incapacity which began prior to the age of 18 {explain}: _________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ____ b. the following child(ren), {name(s)} __________________________________ is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. ____ 3. Petitioner requests that medical/dental insurance coverage for the minor child(ren) be provided by: [√ one only] ____ a. Father. ____ b. Mother. ____ 4. Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: [√ one only] ____ a. by Father. ____ b. by Mother. ____ c. by Father and Mother each paying one-half. ____ d. according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). ____ e. Other {explain}: ___________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ____ 5. Petitioner requests that life insurance to secure child support be provided by: ____ a. Father. ____ b. Mother. ____ c. Both. SECTION III. OTHER RELIEF _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the order for support.) Petitioner requests that the Court enter an order establishing support and: [√ all that apply] ____ a. awarding spousal support (alimony) as requested in Section I of this petition; *156 ____ b. establishing child support for the minor child(ren) common to both parties, as suggested in Section II of this petition; ____ c. awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ ___________________________________ Signature of Petitioner Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ___________________________________________ NOTARY PUBLIC-STATE OF FLORIDA ____________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________________, a nonlawyer, located at {street} ______________, {city} _________________, {state} _______, {phone} __________, helped {name} _____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FAMILY LAW FORM 12.904(b), PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form may be used if you and your spouse are separated, but a dissolution of marriage has not been filed, and you are requesting alimony. If a petition for dissolution has been filed, you should file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(a), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form. This petition does not address the issues of property or debts. It only deals with alimony. This form should be typed or printed in black ink. After completing this form, you should sing the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party in your case of the petition. If you know where he or she lives, *157 you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution for Marriage with No Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.902(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see section 61.09, Florida Statutes. Special notes... With this form you must also file the following: • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.) *158 • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimoly. Temporary Relief ... If you need temporary relief regarding alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(a). For more information, see the instructions for that form. Final Judgment Form ... These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Family Law Form 12.994(b), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} __________________________________________, the [√ one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes. 2. Petitioner [√ one only] ( ) is ( ) is not a member of the military service. Respondent [√ one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ________________________________________ Place of marriage: {city, state, country} ___________________________________ *159 Date of separation: {month, day, year} ___________ ([]√ if approximate) 4. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 5. A completed Notice of Social Security Number Florida Family Law Form 12.901(j), is, or will be filed. SECTION I. SPOUSAL SUPPORT (ALIMONY) ____ 1. Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do so. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting. Spousal support (alimony) is requested in the amount of $_______ every ( ) week ( ) other week ( ) month, beginning {date} _____, and continuing until {date or event} ___________ __________________________________________________________________________________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): ________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ [√ if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION II. OTHER RELIEF __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ SECTION III. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the order for support.) Petitioner requests that the Court enter an order establishing support and: [√ all that apply] ____ a. awarding spousal support (alimony) pursuant to Section I of this petition; ____ b. awarding other relief as specified in Section II of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, *160 _____________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________, a nonlawyer, located at {street} ____________________________________, {city} ______________________________________________________________, {state} ______________, {phone} ____________________________, helped {name} ____________________________________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.905, PETITION FOR GRANDPARENT VISITATION When should this form be used? This form should be used when grandparents are requesting visitation in one of the following circumstances: • The mother and/or father of the child(ren) with whom visitation is requested are/is deceased. • The parents of the child(ren) with whom visitation is requested are divorced. • The mother or father of the child(ren) with whom visitation is requested has deserted the child(ren). • The parents of the child were not married when the child(ren) was born and did not marry after the child(ren)'s birth, and paternity has been established. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the child(ren) lives (live) and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the other party(ies) of the petition. If you know where he and/or she lives, you must use personal service. If you absolutely do not know where he and/or she lives, you may use constructive service. However, if constructive service is used, the court may only grant limited relief, if any. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), striking through "for Dissolution of Marriage" and inserting "for Grandparent Visitation." The law regarding constructive service is very complex and you may wish to consult an attorney regarding these issues. If personal service is used, the respondent(s) has (have) 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party(ies) of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If, the respondent(s) file(s) an answer that agrees with everything *161 in your petition or an answer and waiver, and you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party(ies) of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent(s) file(s) an answer that disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have filed all of the required papers. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Some circuits may require the completion of mediation before a final hearing may be set. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see chapter 752 and 61.13(2)(b)2.c., Florida Statutes. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, __________________________________, Grandparent(s), and __________________________________, __________________________________, Respondent(s). PETITION FOR GRANDPARENT VISITATION I/We, {full legal name(s)} _________________________________________, being sworn, certify that the following information is true: 1. This is a request for grandparent(s) visitation, under chapter 752, Florida Statutes. 2. The minor grandchild(ren) has (have) been living in the State of Florida within the jurisdiction of this Court. 3. I/We desire visitation with the following minor grandchild(ren). Name Birth date Age Sex ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ *162 ______________________________________________________________________________ ______________________________________________________________________________ 4. The [√ one only] ( ) mother ( ) father of my (our) grandchild(ren) is my (our) [√ one only] ( ) son ( ) daughter. A copy of the my (our) child's (respondent's) birth certificate is attached. 5. [√ all that apply]: ___ a. The ( ) mother ( ) father of the grandchild(ren) has (have) died. ___ b. The other and father of the grandchild(ren) are divorced. ___ c. The ( ) mother ( ) father of the grandchild(ren) has (have) deserted the grandchild(ren). ___ d. The parents were not married when the grandchild(ren) was (were) born and did not marry after the grandchild(ren)'s birth, and paternity has been established. 6. I/We are requesting the following visitation: {explain} ________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 7. It is in the best interests of the grandchild(ren) that the grandparent(s) be allowed reasonable rights of visitation with the grandchild(ren). This is in the grandchild(ren)'s best interests because: {explain} ____________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Grandparent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by ___________, _____________________________________________ NOTARY PUBLIC-STATE OF FLORIDA _____________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] *163 I, {full legal name and trade name of nonlawyer} ___________________________________________, a nonlawyer, located at {street} ___________________, {city} ______________________, {state} ________, {phone} ____________, helped {name} ____________________, who is the (one of the) petitioner(s), fill out this form. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Grandparent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ____________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _____________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________________, a nonlawyer, located at {street} ___________________, {city} ___________, {state} _________, {phone} ___________, helped {name} ____________, who is the (one of the) petitioner(s), fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.910(a), SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL When should this form be used? This form should be used to obtain personal service on the other party when you begin your lawsuit. Service is required for all documents filed in your case. Service means giving a copy of the required papers to the other party using the procedure that the law requires. Generally, there are two ways to make service: (1) personal service, or (2) service by mail or hand delivery. A third method for service is called constructive service; however, the relief a court may grant may be limited in a case where constructive service has been used. The law requires that certain documents be served by personal service if personal service is possible. Personal service means that a summons (this form) and a copy of the forms you are filing with the court that must be personally served are delivered by a deputy sheriff or private process server • directly to the other party, or • to someone over the age of fifteen with whom the other party lives. *164 Personal service is required for all petitions, including petitions for modification. You cannot serve these papers on the other party yourself or by mail or hand delivery. Personal service must be made by the sheriffs department in the county where the other party lives or works or by a private process server certified in the county where the other party lives or works. In many counties, there are private process servers who, for a fee, will personally serve the summons and other documents that require personal service. You should look under "process servers" in the yellow pages of the telephone book for a list of private process servers in your area. You may use a private process server to serve any paper required to be personally served in a family law case except a petition for injunction for protection against domestic or repeat violence. How do I start? When you begin your lawsuit, you need to complete this form (summons) and a Process Service Memorandum, Florida Family Law Form 12.910(b). The forms should be typed or printed legibly in black ink. Next, you will need to take these forms and, if you have not already done so, file your petition with the clerk of the circuit court in the county where you live. You should keep a copy of the forms for your records. The clerk will sign the summons, and then the summons, a copy of the papers to be served, and the process service memorandum must be delivered to the appropriate sheriffs office or to a private process server for service on the other party. IF THE OTHER PARTY LIVES IN THE COUNTY WHERE SUIT IS FILED: Ask the clerk in your county about any local procedures regarding service. Generally, if the other party lives in the county in which you are filing suit and you want the sheriffs department to serve the papers, you will file the summons along with a Process Service Memorandum, Florida Family Law Form 12.910(b), with the clerk and the clerk will forward those papers to the sheriff for service. Make sure that you attach a copy of the papers you want personally served to the summons. You may also need to provide the sheriff with a stamped envelope addressed to you. This will allow the sheriff to send the proof of service to you, after the sheriff serves your papers on the other party. However, in some counties the sheriff may send the proof of service directly to the clerk. If you are instructed to supply a self-addressed, stamped envelope and you receive the proof of service, you should file the proof of service with the clerk after you receive it from the sheriff. Also, you will need to find out how much the sheriff charges to serve the papers. Personal checks are not accepted. You should attach to the summons a cashier's check or money order made payable to the sheriff, and either give it to the clerk for delivery to the sheriff or send all of the paperwork and the fee to the sheriff yourself. The clerk will tell you which procedure to use. The costs for service may be waived if you are indigent. If you want a private process server to serve the other party, you should still bring the summons to the clerk's office and have the clerk sign it for you. You should deliver the summons, along with the copy of your initial petition and any other papers to be served, and a Process Service Memorandum, Florida Family Law Form 12.910(b), to the private process server. The private process server will charge you a fee for serving the papers. After service is complete, proof of service by the private process server must be filed with the clerk. You should discuss how this will occur with the private process server. IF THE OTHER PARTY LIVES IN ANOTHER COUNTY: If the other party lives in another county, service needs to be made by a sheriff in the county where the other party lives or by a private process server certified in the county where the other party lives. Make sure that you attach a copy of the papers you want personally served to the summons as well as the Process Service Memorandum, Florida Family Law Form 12.910(b). If you want the sheriff to serve the papers, the clerk may send your papers to that sheriffs office for you, or you may have to send the papers yourself The clerk will tell you which procedure to use. *165 Either way, you will need to provide the sheriff with a stamped envelope addressed to you. This will allow the sheriff to send the proof of service to you, after the sheriff serves your papers on the other party. You should file the proof of service with the clerk after you receive it from the sheriff. Also, you will need to find out how much the sheriff charges to serve the papers. Personal checks are not accepted. You should attach to the summons a cashier's check or money order made payable to the sheriff, and either give it to the clerk for delivery to the sheriff or send all of the paperwork and the fee to the sheriff yourself. The clerk will tell you which procedure to use. The costs for service may be waived if you are indigent. If you want a private process server to serve the other party, you should still bring the summons to the clerk's office where the clerk will sign it for you. You should deliver the summons, along with the copy of your initial petition and any other papers to be served, and a Process Service Memorandum, Florida Family Law Form 12.910(b), to the private process server. The private process server will charge you a fee for serving the papers. After service is complete, proof of service by the private process server must be filed with the clerk. You should discuss how this will occur with the private process server. IF THE OTHER PARTY CANNOT BE LOCATED OR DOES NOT LIVE IN FLORIDA: If, after you have made a diligent effort to locate the other party, you absolutely cannot locate the other party, you may serve the other party by publication. Service by publication is also known as constructive service. You may also be able to use constructive service if the other party does not live in Florida. However, Florida courts have only limited jurisdiction over a party that is served by constructive service and may have only limited jurisdiction over a party living outside of Florida regardless of whether that party is served by constructive or personal service; that is, the judge's power to order the other party to do certain things may be limited. For example, the judge may be able to grant your request for a divorce, but the judge may not be able to address issues such as child support, spousal support (alimony), or division of property or debts. Regardless of the type of service used, if the other party once lived in Florida but is living outside of Florida now, you should include in your petition a statement regarding the length of time the party lived in Florida, if any, and when. For example: "Respondent last lived in Florida from {date} __________ to {date} __________." This area of the law is very complex and you may need to consult with an attorney regarding the proper type of service to be used in your case if the other party does not live in Florida or cannot be located. What happens when the papers are served on the other party? The date and hour of service are written on the original summons and on all copies of it by the person making the service. The person who delivers the summons and copies of the petition must file a proof of service with the clerk or provide a proof of service to you for filing with the court. It is your responsibility to make sure the proof of service has been returned to the clerk and placed in your case file. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information regarding service of process, see chapters 48 and 49, Florida Statutes, and rule 1.070, Florida Rules of Civil Procedure, as well as the instructions for Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), and Affidavit of Diligent Service and Inquiry, Family Law Form 12.913(b), for further information. Special notes ... If you have been unable to obtain proper service on the other party within 120 days after filing your lawsuit, the court will dismiss your lawsuit against the other party unless you can show the court a good reason why service was not made within 120 days. *166 For this reason, if you had the local sheriff serve the papers, you should check with the clerk every couple of weeks after completing the service papers to see if service has been completed. You may need to supply the sheriff with a new or better address. If you had a private process server or a sheriff in another county serve the papers, you should be in contact with that person or sheriff until you receive proof of service from that person or sheriff. You should then file the proof of service with the clerk immediately. If the other party fails to respond, i.e., fails to file a written response with the court, within 20 days after the service of the summons, you are entitled to request a default. See the instructions to Motion for Default, Florida Family Law Form 12.922(a), and Default, 12.922(b), for further information. You will need to file Nonmilitary Affidavit, Florida Law Form 12.912(b), before a default may be granted. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL ORDEN DE COMPARECENCIA: SERVICIO PERSONAL EN UN INDIVIDUO CITATION: L'ASSIGNATION PERSONAL SUR UN INDIVIDUEL TO/PARA/A: {enter other party's full legal name} _____________________________, {address(including city and state)/location for service} _________________________, IMPORTANT A lawsuit has been filed against you. You have 20 calendar days after this summons is served on you to file a written response to the attached complaint/petition with the clerk of this circuit court, located at: {street address} __________________________________________________________________, A phone call will not protect you. Your written response, including the case number given above and the names of the parties, must be filed if you want the Court to hear your side of the case. If you do not file your written response on time, you may lose the case, and your wages, money, and property may be taken thereafter without further warning from the Court. There are other legal requirements. You may want to call an attorney right away. If you do not know an attorney, you may call an attorney referral service or a legal aid office (listed in the phone book). If you choose to file a written response yourself, at the same time you file your written response to the Court, you must also mail or take a copy of your written response to the party serving this summons at: *167 {Name and address of party serving summons} ________________________________________ _____________________________________________________________________________________________ Copies of all court documents in this case, including orders, are available at the Clerk of the Circuit Court's office. You may review these documents, upon request. You must keep the Clerk of the Circuit Court's office notified of your current address. (You may file Notice of Current Address, Florida Family Law Form 12.915.) Future papers in this lawsuit will be mailed to the address on record at the clerk's office. WARNING: Rule 12.285, Florida Family Law Rules of Procedure, requires certain automatic disclosure of documents and information. Failure to comply can result in sanctions, including dismissal or striking of pleadings. IMPORTANTE Usted ha sido demandado legalmente. Tiene veinte (20) dias, contados a partir del recibo de esta notificacion, para contestar la demanda adjunta, por escrito, y presentarla ante este tribunal. Localizado en:_______________________ Una Ilamada telefonica no lo protegera. Si usted desea que el tribunal considere su defensa, debe presentar su respuesta por escrito, incluyendo el numero del caso y los nombres de las partes interesadas. Si usted no contesta la demanda a tiempo, pudiese perder el caso y podria ser despojado de sus ingresos y propiedades, o privado de sus derechos, sin previo aviso del tribunal. Existen otros requisitos legales. Si lo desea, usted puede consultar a un abogado inmediatamente. Si no conoce a un abogado, puede Hamar a una de las oficinas de asistencia legal que aparecen en la guia telefonica. Si desea responder a la demanda por su cuenta, al mismo tiempo en que presente su respuesta ante el tribunal, usted debe enviar por correo o entregar una copia de su respuesta a la persona denominada abajo. Si usted elige presentar personalmente una respuesta por escrito, en el mismo momento que usted presente su respuesta por escrito al Tribunal, usted debe enviar por correo o llevar una copia de su respuesta por escrito a la parte entregando esta orden de comparencencia a: Nombre y direcction de la parte que entrega la orden de comparencencia: _________________ ____________________________________________________________________________________________ Copias de todos los documentos judiciales de este caso, incluyendo las ordenes, estan disponibles en la oficina del Secretario de Juzgado del Circuito [Clerk of the Circuit Court's office]. Estos documentos pueden ser revisados a su solicitud. Usted debe de manener informada a la oficina del Secretario de Juzgado del Circuito de su direcction actual. (Usted puede presenter__________ el Formulario: Ley de Familia de la Florida 12.915, [ Florida Family Law Form 12.915], Notificacion de la Direccion Actual [Notice of Current Address]. Los papelos que se presenten en el futuro en esta demanda judicial seran env ados por correo a la direccion que este registrada en la oficina del Secretario. ADVERTENCIA: Regla 12.285 (Rule 12.285), de las Reglas de Procedimiento de Ley de Familia de la Florida [Florida Family Law Rules of Procedure], requiere cierta revelaction automatica de documentos e informaction. El incumplimient, puede resultar en sanciones, incluyendo la desestimacion o anulacion de los alegatos. *168 IMPORTANT Des poursuites judiciaries ont ete entreprises contre vous. Vous avez 20 jours consecutifs a partir de la date de l'assignation de cette citation pour deposer une reponse ecrite a la plainte ci-jointe aupres de ce tribunal. Qui se trouve a: $L' Adresse$ ________________________ Un simple coup de telephone est insuffisant pour vous proteger; vous etes obliges de deposer votre reponse ecrite, avec mention du numero de dossier ci-dessus et du nom des parties nommees ici, si vous souhaitez que le tribunal entende votre cause. Si vous ne deposez pas votre reponse ecrite dans le delai requis, vous risquez de perdre la cause ainsi que votre salaire, votre argent, et vos biens peuvent etre saisis par la suite, sans aucun preavis ulterieur du tribunal. Il y a d'autres obligations juridiques et vous pouvez requerir les services immediats d'un avocat. Si vous ne connaissez pas d'avocat, vous pourriez telephoner a un service de reference d'avocats ou a un bureau d'assistance juridique (figurant a l'annuaire de telephones). Si vous choisissez de deposer vous-meme une reponse ecrite, il vous faudra egalement, en meme temps que cette formalite, faire parvenir ou expedier une copie au carbone ou une photocopie de votre reponse ecrite a la partie qui vous depose cette citation. Nom et adresse de la partie qui depose cette citation: __________________________________ Les photocopies de tous les documents tribunals de cette cause, y compris des arrets, sort disponible au bureau du greffier. Vous pouvez revue ces documents, sur demande. Il faut aviser le greffier de votre adresse actuelle. (Vous pouvez deposer Florida Family Law Form 12.915, Notice of Current Address.) Les documents de l'avenir de ce proces seront envoyer a l' adresse que vous donnez au bureau du greffier. ATTENTION: La regle 12.285 des regles de procedure du droit de la famine de la Floride exige que l'on remette certains renseignements et certains documents `a la partie adverse. Tout refus de les fournir pourra donner lieu a des sanctions, y compris le rejet ou la suppression d'un ou de plusieurs actes de procedure. THE STATE OF FLORIDA TO EACH SHERIFF OF THE STATE: You are commanded to serve this summons and a copy of the complaint in this lawsuit on the above-named person. DATED:__________ CLERK OF THE CIRCUIT COURT (SEAL) By: __________________________ Deputy Clerk INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.910(b), PROCESS SERVICE MEMORANDUM When should this form be used? You should use this form to give the sheriffs department (or private process server) instructions for serving the other party in your case with the Summons: Personal Service on an Individual, Florida Family Law Form 12.910(a), and other papers to be served. On this form, you can tell the sheriffs department the best times to find the person at work and/or at home. You can also include a map to the other person's home or work place to help the sheriff find the person and deliver the summons. Do not forget to attach to the summons a copy of *169 your initial petition and any other papers you want personally served on the other party. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and attach a copy to the Summons: Personal Service on an Individual, Florida Family Law Form 12.910(a). You should also keep a copy for your records. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. You should read the instructions for Summons: Personal Service on an Individual, Florida Family Law Form 12.910(a), for additional information. Special notes ... If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter your address, telephone, and fax information at the bottom of this form. Instead, write "confidential" in the spaces provided for that information and file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i). Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. PROCESS SERVICE MEMORANDUM TO: ( ) Sheriff of _____________ County, Florida; ______________________ Division ( ) Private process server: ___________________________________________________ Please serve the {name of document(s)} ___________________________________ ___________________________________________________________________________________ in the above-styled cause upon: Party: {full legal name} _________________________________________________ Address or location for service: __________________________________________________ ___________________________________________________________________________________ Work Address:______________________________________________________________________ ___________________________________________________________________________________ If the party to be served owns, has, and/or is known to have guns or other weapons, describe what type of weapon(s): __________________________________________________ SPECIAL INSTRUCTIONS:______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ *170 Dated: _______________________________ ______________________________________________ Signature of Party *Printed Name: ____________________ *Address: _________________________ *City, State, Zip: ________________ *Telephone Number: ________________ *Fax Number: ______________________ *If this is a domestic violence case, do not enter this information if your address or telephone number need to be kept confidential for safety reasons; instead write "confidential" in the spaces provided and file Florida Family Law Form 12.980(i), Petitioner's Request for Confidential Filing of Address. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _______________________________________, a nonlawyer, located at {street} __________________, {city} _____________________, {state} _________, {phone} ___________, helped {name} ____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.912(a), MEMRANDUM FOR CERTIFICATE OF MILITARY SERVICE When should this form be used? This form should be used if you DO NOT KNOW whether the other party in your case is on active duty in a branch of the military service of the United States. Fill out this form and mail one copy to each of the military offices at the addresses on the form. You may be charged a service fee by each military service branch for their response. To assist you in determining the amount of each military branch's fee, phone numbers are listed below. You will need to call each number to find out their fee for this search. Even if you believe that the other party has never or would never join the military, you must show the court proof that he or she is not a member of the military. Therefore, you may need to use this form to provide the court with such proof. See the instructions for the Nonmilitary Affidavit, Florida Family Law Form 12.912(b), for additional information. COAST GUARD: U.S. Coast Guard Commander (CGPC-ADM-3), Coast Guard Personnel Command, 2100 2nd St., S.W., Room 1616, Washington, D.C. 20593, Phone:(202) 267-1340 AIR FORCE: AFPC MSIMDL, 550 C Street, W., Suite 50, Randolph AFB, TX 78150-4752, Phone: (210) 652-5775 NAVY: BUPERS, PERS 02116, 2 Navy Annex, Washington, D.C. XXXXX-XXXX, Phone: (703) 614-5011 or (703) 614-9221 MARINE CORPS.: USMC-CMC, HQMMMSB-10, 2008 Elliot Road, Room 201, Quantico, VA XXXXX-XXXX, Phone: (703) 784-3941 PUBLIC HEALTH SERVICE: Surgeon General, U.S. Public Health Service, Div. of Comm., Off. Personnel, 5600 Fishers Lane, Room 4-21, Rockville, MD 20857, Phone: (301) 594-2963 ARMY: Army World Wide Locator, U.S. Army Enlisted Records and Evaluation Center, 8899 East 56th Street, Indianapolis, IN XXXXX-XXXX, Phone: (703) 325-3732 This form should be typed or printed in black ink. You should complete this form for each branch of the United States' military listed above, and mail the form to each branch with a check for the appropriate amount and a stamped, self-addressed envelope. You should keep a copy of the form for your records. After you have received a verification of nonmilitary status from each branch, you will need to attach those verifications to a Nonmilitary Affidavit, Florida Family Law Form 12.912(b), for filing with the clerk. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person *171 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. MEMORANDUM FOR CERTIFICATE OF MILITARY SERVICE TO: ( ) U.S. Coast Guard Commander (CGPC-ADM-3), Coast Guard Personnel Command, 2100 2nd St., S.W., Room 1616, Washington, D.C. 20593 ( ) AFPC MSIMDL, 550 C Street, W., Suite 50, Randolph AFB, TX 78150-4752 ( ) BUPERS, PERS 02116, 2 Navy Annex, Washington, D.C. XXXXX-XXXX ( ) USMC-CMC, HQMC-MMSB-10, 2008 Elliot Road, Room 201, Quantico, VA XXXXX-XXXX ( ) Surgeon General, U.S. Public Health Service, Div. of Comm., Off. Personnel, 5600 Fishers Lane, Room 4-21, Rockville, MD 20857 ( ) Army World Wide Locator, U.S. Army Enlisted Records and Evaluation Center, 8899 East 56th Street, Indianapolis, IN XXXXX-XXXX RE: ________________________________ _________________________________ {Name of Respondent} {Respondent's Social Security Number} This case involves a family matter. It is imperative that a determination be made whether the above-named individual, who has an interest in these proceedings, is presently in the military service of the United States, and the dates of induction and discharge, if any. This information is requested under section 581 of the Soldiers' and Sailors' Civil Relief Act of 1940, as amended. Please supply a verification as soon as possible. My check for $______ for your search fee and a self-addressed, stamped envelope are enclosed. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________, a nonlawyer, located at {street} ______________, {city} ___________, {state} _______, {phone} _________, helped {name} __________, who is the petitioner, fill out this form. *172 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.912(b), NONMILITARY AFFIDAVIT When should this form be used? You should use this form when ALL of the following statements are true: • The other person in your case has been served, whether by personal service or constructive service. • The other person in your case has not responded to your petition. • You are requesting that the court enter a default judgment against the other person. • You ABSOLUTELY KNOW FOR CERTAIN that the other person is NOT in the military service. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You must file the original of this form with the clerk of the circuit court when you file your Motion for Default, Florida Family Law Form 12.922(a). You must also attach copies of all verifications of nonmilitary service that you received from each branch of the United States' military service. You should keep a copy for your records. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NONMILITARY AFFIDAVIT I, {full legal name} ______________________, being sworn, certify that the following information is true: [√ all that apply] ____ 1. I know of my own personal knowledge that Respondent is not on active duty in the armed services of the United States. ____ 2. I have inquired of the armed services of the United States and the U.S. Public Health Service to determine whether the Respondent is a member of the armed services and am attaching certificates stating that Respondent is not now in the armed services. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. DATED: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ *173 City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF __________________ Sworn to or affirmed and signed before me on ______________ by _____________, ____________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ____________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} ______________, {city} ___________, {state} _______, {phone} __________, helped {name} __________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.913(a), NOTICE OF ACTION FOR DISSOLUTION OF MARRIAGE When should this form be used? This form may be used to obtain constructive service (also called service by publication) in a dissolution of marriage case if you do not know where your spouse lives or if your spouse lives outside Florida and you are unable to obtain personal service. However, if you use constructive service, the court may grant only limited relief because its jurisdiction is limited. For example, the court can grant your divorce but cannot decide issues of child support, spousal support (alimony), or division of property or debts. This is a complicated area of the law and you may wish to consult an attorney before using constructive service. You should complete this form by typing or printing the appropriate information in black ink. You should insert your spouse's name and last known address and then file this form with the clerk of the circuit court in the county where your petition for dissolution of marriage was filed. You must also complete and file an Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b). You should keep a copy for your records. After the Affidavit of Diligent Search and Inquiry, Florida Family Law Form 12.913(b), is filed, the clerk will sign this form. The form must then be given to a qualified local newspaper to be published for four consecutive weeks. When in doubt, ask the clerk which newspapers in your area are "qualified." The newspaper will charge you for this service. If you cannot afford to pay the cost of publication of this notice in a qualified newspaper, you may ask the clerk to post the notice at a place designated for such postings. You will need to file an Affidavit of Indigency, Florida Family Law Form 12.901(c). If the clerk determines that you cannot afford these costs, the clerk will post the notice of action. In Dade, Broward, and Duval counties, you may ask the clerk to publish your notice without charge. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.070, *174 Florida Family Law Rules of Procedure, and rule 1.070, Florida Rules of Civil Procedure. Special notes ... If the other party fails to respond to your petition within the time limit stated in the notice of action that is published or posted, you are entitled to request a default. (See Motion for Default, Florida Family Law Form 12.922(a), and Default, Florida Family Law Form 12.922(b).) Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF ACTION FOR DISSOLUTION OF MARRIAGE TO: {name of Respondent} _______________________________________________ {Respondent's last known address} ______________________________________ YOU ARE NOTIFIED that an action has been filed against you and that you are required to serve a copy of your written defenses, if any, to it on {name of Petitioner} _______________________________________________________________, whose address is ________________________________________________________________ on or before {date} _________________________, and file the original with the clerk of this Court at {clerk's address} ________________________________, before service on Petitioner or immediately thereafter. If you fail to do so, a default may be entered against you for the relief demanded in the petition. Copies of all court documents in this case, including orders, are available at the Clerk of the Circuit Court's office. You may review these documents upon request. You must keep the Clerk of the Circuit Court's office notified of your current address. (You may file Notice of Current Address, Florida Family Law Form 12.915.) Future papers in this lawsuit will be mailed to the address on record at the clerk's office. WARNING: Rule 12.285, Florida Family Law Rules of Procedure, requires certain automatic disclosure of documents and information. Failure to comply can result in sanctions, including dismissal or striking of pleadings. Dated: _______________________________ CLERK OF THE CIRCUIT COURT By: ______________________________ Deputy Clerk *175 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} _____________, {city} ______________, {state} _______, {phone} __________, helped {name} _________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.913(b), AFFIDAVIT OF DILIGENT SEARCH AND INQUIRY When should this form be used? This form is to be used with Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), to obtain constructive service (also called service by publication) in a dissolution of marriage case. This form includes a checklist of places you can look for information on the location of your spouse. While you do not have to look in all of these places, the court must believe that you have made a very serious effort to get information about your spouse's location and that you have followed up on any information you received. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original and a Notice of Action for Dissolution of Marriage, Florida Family Law Form 12.913(a), with the clerk of the circuit court in the county where your petition for dissolution of marriage is filed. You should keep a copy for your records. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.070, Florida Family Law Rules of Procedure and rule 1.070(e) and (f), Florida Rules of Civil Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. AFFIDAVIT OF DILIGENT SEARCH AND INQUIRY I, {full legal name} _____________________________, being sworn, certify that the following information is true: 1. have made diligent search and inquiry to discover the name and current residence of Respondent: {Specify details of search} Refer to checklist below and identify all actions taken (any additional information included *176 such as the date the action was taken and the person with whom you spoke is helpful) (attach additional sheet if necessary): [√ all that apply] ____ United States Post Office inquiry through Freedom of Information Act for current address or any relocations. ____ Last known employment of Respondent, including name and address of employer. You should also ask for any addresses to which W-2 Forms were mailed, and, if a pension or profit-sharing plan exists, then to any addresses to which any pension or plan payment is and/or has been mailed. ____ Unions from which Respondent may have worked or that governed particular trade or craft. ____ Regulatory agencies, including professional or occupational licensing. ____ Names and addresses of relatives and contacts with those relatives, and inquiry as to Respondent's last known address. You are to follow up any leads of any addresses where Respondent may have moved. Relatives include, but are not limited to: parents, brothers, sisters, aunts, uncles, cousins, nieces, nephews, grandparents, great-grandparents, former in-laws, stepparents, stepchildren. ____ Information about the Respondent's possible death and, if dead, the date and location of the death. ____ Telephone listings in the last known locations of Respondent's residence. ____ Internet at http://www.switchboard.com or other Internet people finder or the library checked for me. ____ Law enforcement arrest and/or criminal records in the last known residential area of Respondent. ____ Highway Patrol records in the state of Respondent's last known address. ____ Department of Motor Vehicle records in the state of Respondent's last known address. ____ Department of Corrections records in the state of Respondent's last known address. ____ Title IV-D (child support enforcement) agency records in the state of Respondent's last known address. ____ Hospitals in the last known area of Respondent's residence. ____ Utility companies, which include water, sewer, cable TV, and electric in the last known area of Respondent's residence. ____ Letters to the Armed Forces of the U.S. and their response as to whether or not there is any information about Respondent. (See Memorandum for Certificate of Military Service, Florida Family Law Form 12.912(a).) ____ Tax Assessor's and Tax Collector's Office in the area where Respondent last resided. ____ Other: {explain} ___________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 2. The age of Respondent is [√ one only] ( ) known {enter age}_________ or ( ) unknown. 3. Respondent's current residence [√ one only] ____ a. Respondent's current residence is unknown to me. ____ b. Respondent's current residence is in some state or country other than Florida, and Respondent's last known address is: ____________________________________ _____________________________________________________________________________________ ____ c. The Respondent, having residence in Florida, has been absent from Florida for more than 60 days prior to the date of this affidavit, or conceals him(her)self so that process cannot be served personally upon him or her, and I believe there is no person in the state upon whom service of process would bind this absent or concealed Respondent. *177 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF__________________ Sworn to or affirmed and signed before me on ______________ by _____________, ____________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _____________________________________________ [Print, type, or stamp commissioned name of notary.] ____Personally known ____Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, located at {street} ______________, {city} ___________, {state} _______, {phone} _________, helped {name} ____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.914, CERTIFCATE OF SERVICE When should this form be used? After the petition has been properly served (through either a personal service or constructive service), both parties must send copies of all additional documents or papers they file with the clerk to the other party or his or her attorney, if he or she has one. Each time you file a document, you must certify that you provided the other party with a copy. Many of the Florida Family Law Forms already have a place above the signature line for this certification. It looks like this: I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand-delivered to the person(s) listed below on {date} _______________ Other party or his/her attorney: Name: ___________________________________________ Address: ________________________________________ City, State, Zip: _______________________________ Fax Number: _____________________________________ If a form you are filing has a certificate, you do not need to file a separate Certificate of Service, Florida Family Law Form 12.914. However, each time you file a document that does not have a certificate like the one above, you must file a Certificate of Service, Florida Family Law Form 12.914, and send a copy of the document to the other party. This includes letters to the judge. This form should be typed or printed in black ink. After completing this form (giving the name of each form, document, or paper filed), you should sign the form before a notary public. You should file the original with the *178 clerk of the circuit court in the county where your case was filed and keep a copy for your records. The copy you are providing to the other party must be mailed (postmarked) or delivered to the opposing party or his or her attorney on the same day indicated on the certificate of service. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For more information, see rule 1.080, Florida Rules of Civil Procedure and rule 12.080, Florida Family Law Rules of Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. CERTIFICATE OF SERVICE I certify that a copy of {name of document(s)} _____________________________ _______________________________________________________________________________________ was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person listed below on {date} ____________________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ ___________________________________ Signature of Party Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________, a nonlawyer, located at {street} ______________, {city} ______________, {state} ________, {phone} ____________, helped {name} __________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. *179 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.915, NOTICE OF CURRENT ADDRESS When should this form be used? This form should be used to inform the clerk and the other party of your current address or any change of address. It is very important that the court and the other party in your case have your correct address. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to any other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF CURRENT ADDRESS I, {full legal name} _____________________________________, being sworn, certify that my current address is: {street} _________________________________ {City} ____________ {State} ______________ {Zip} __________ {Telephone No.} ___________ {Fax No.} ______________________ I understand that I must keep the clerk's office notified of my current address and that all future papers in this lawsuit will be mailed to the address on record at the clerk's office. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand-delivered to the person(s) listed below on {date} ________________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ ___________________________________ Signature of Party *180 STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on ______________ by _____________, _______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _______________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________, a nonlawyer, located at {street} ______________, {city} ______________, {state} ________, {phone} ____________, helped {name} __________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORMS 12.920(a), MOTION FOR REFERRAL TO GENERAL MASTER 12.920(b), ORDER OF RFERRAL TO GENERAL MASTER and 12.920(c), NOTICE OF HEARING BEFORE GENERAL MASTER When should these forms be used? A general master is an attorney appointed by a judge to take testimony and recommend decisions on certain matters connected with a divorce. These recommendations are then reviewed by the judge and are generally approved unless contrary to the law or the facts of the case. The primary purposes of having general masters hear family law matters are to reduce the costs of litigation and to speed up cases. Either party may request that their case, or portions of their case, be heard by a general master by filing Motion for Referral to General Master, Florida Family Law Form 12.920(a). You must also prepare and submit an Order of Referral to General Master, Florida Family Law Form 12.920(b), to submit to the judge assigned to your case. Many times, the court, either on its own motion or under current administrative orders of the court, may refer your case to a general master. Even in those instances, you may be required to prepare and submit an Order of Referral to General Master, Florida Family Law Form 12.920(b), to the judge. Once a general master has been appointed to your case, the general master will assign a time and place for a hearing as soon as reasonably possible after the referral is made. The general master will give notice of that hearing to each of the parties directly or will direct a party or attorney in the case to file and serve a notice of hearing on the other party. If you are asked to send the notice of hearing, you will need to use the form entitled Notice of Hearing Before General Master, Florida Family Law Form 12.920(c). Regardless of who prepares the notice of hearing, the moving party (the one who requested referral to the general master) is required to have the notice properly served on the other party. These forms should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? If you are filing a Motion for Referral to General Master, Florida Family Law Form 12.920(a), you need to send or deliver your motion directly to the judge assigned to your case, along with an Order of Referral to General Master, Florida Family Law Form 12.920(b), and an addressed, stamped envelope for each party in the case. *181 The judge will then either grant or deny the motion, usually without a hearing. If you are required to submit a Order of Referral to General Master, Florida Family Law Form 12.920(b), to the judge assigned to your case, you will need to send or deliver the order directly to the judge, along with addressed, stamped envelopes for each party in the case. The party who prepares any of these forms must file the original with the clerk of the circuit court. A copy of the motion must be mailed or hand delivered to any other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.490, Florida Family Law Rules of Procedure. Special notes ... IMPORTANT: After the judge refers your case to a general master, either party (including the party who was required to prepare and submit the Order of Referral) may object to the referral within 10 days of the date that the referral is made (if the Order of Referral is served by mail, the parties have an additional 5 days within which to object to the referral). Every litigant is entitled to have his or her case heard by a judge. However, before you decide to object to an Order of Referral to General Master, you should consider the potential extra costs and time delays that may result from having a judge hear your case instead of a general master. You may want to speak with an attorney in your area who can assist you in making a more informed decision regarding whether you should file an objection to an Order of Referral to General Master. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION FOR REFERRAL TO GENERAL MASTER I, {full legal name} __________________________________________, request that the Court enter an order referring this case to a general master. The case should be referred to a general master on the following issues: {explain} ______________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________ Other party or his/her attorney: Name: ____________________________________ *182 Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________________, a nonlawyer, located at {street} ______________, {city} ____________________, {state} ________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. Form 12.920(b) IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER OF REFERRAL TO GENERAL MASTER THIS CASE IS REFERRED TO THE GENERAL MASTER on the following issues: 1. _______________________________________________________________________________________ 2. _______________________________________________________________________________________ 3. _______________________________________________________________________________________ 4. _______________________________________________________________________________________ AND ANY OTHER MATTER RELATED THERETO. IT IS FURTHER ORDERED that the above issues are referred to General Master {name} ____________________________________, for further proceedings, under rule 12.490 of the Florida Family Law Rules of Procedure and current administrative orders of the Court. Financial Affidavits, Family Law Form 12.901(d) or (e), shall be filed in accordance with Florida Family Law Rule of Procedure 12.285. The General Master is authorized to administer oaths and conduct hearings, which may include taking of evidence, and shall file a report and recommendations that contain findings of fact, conclusions of law, and the name of the court reporter, if any. *183 The General Master shall assign a time for the proceedings as soon as reasonably possible after this referral is made and shall give notice to each of the parties either directly or by directing counsel or a party to file and serve a notice of hearing. Counties within the State of Florida may have different rules. Please consult the ( ) Clerk of the Court ( ) Family Law Intake Staff ( ) other _____________________________ relating to this procedure. A REFERRAL TO A GENERAL MASTER REQUIRES THE CONSENT OF ALL PARTIES. YOU ARE ENTITLED TO HAVE THIS MATTER HEARD BY A JUDGE. IF YOU DO NOT WANT TO HAVE THIS MATTER HEARD BY THE GENERAL MASTER, YOU MUST FILE A WRITTEN OBJECTION TO THE REFERRAL WITHIN 10 DAYS OF THE TIME OF SERVICE OF THIS ORDER. IF THE TIME SET FOR THE HEARING IS LESS THAN 10 DAYS AFTER SERVICE OF THIS ORDER, THE OBJECTION MUST BE MADE BEFORE THE HEARING. IF THIS ORDER IS SERVED WITHIN THE FIRST 20 DAYS AFTER SERVICE OF PROCESS, THE TIME TO FILE AN OBJECTION IS EXTENDED TO THE TIME WITHIN WHICH A RSPONSIVE PLEADING IS DUE. FAILURE TO FILE A WRITTEN OBJETION WITHIN THE APPLICABLE TIME PERIOD IS DEEMED TO BE A CONSENT TO THE REFERRAL. If either party files a timely objection, this matter shall be returned to the undersigned judge with a notice stating the amount of time needed for hearing. REVIEW OF THE REPORT AND RECOMMENDATIONS MADE BY THE GENERAL MASTER SHALL BE BY EXCEPTIONS AS PROVIDED IN RULE 12.490(f), FLORIDA FAMILY LAW RULES OF PROCEDURE. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT EXCEPTIONS. YOU ARE ADVISED THAT IN THIS CIRCUIT: ____ a. electronic recording is provided by the court. A party may provide a court reporter at that party's expense. ____ b. a court reporter is provided by the court. SHOULD YOU WISH TO SEEK REVIEW OF THE REPORT AND RECOMENDATION MADE BY THE GENERAL MASTER, YOU MUST FILE ECEPTIONS IN ACCORDANCE WITH RULE 12.490(f), FLORIDA FAMILY LAW RULES OF PROCEDURE. YOU WILL BE REQUIRED TO PROVIDE THE COURT WITH A RECORD SUFFICIENT TO SUPPORT YOUR ECEPTIONS, OR YOUR EXCEPTIONS WILL BE DENIED. A RECORD ODINARILY INCLUDES A WRITTEN TRANSCRIPT OF ALL RELEVANT PROCEEDINGS. THE PERSON SEEKING REVIEW MUST HAVE THE TRANSCRIPT PREPARED IF NECESSARY FOR THE COURT'S REVIEW. ORDERED on ____________________________________ _______________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) General Master *184 Form 12.920(c) IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF HEARING BEFORE GENERAL MASTER [ fill in all blanks] TO: ______________________________________________________________________________________ ______________________________________________________________________________________ There will be a hearing before General Master {name of general master} ______________________, on {date} _______________, at {time} ______________m., in Room __________ of the ________________________________________________________________________ Courthouse, on the following issues: _____________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ____________ hour(s)/ __________ minutes have been reserved for this hearing. PLEASE GOVERN YOURSELF ACCORDINGLY. This part to be filled out by the court or filled in with information you have obtained from the court: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} __________________________________________________________________________, {address} _____________________________________, {telephone} ________________ ________________________, within 2 working days of your receipt of this Notice of Hearing. If you are hearing or voice impaired, call TDD 1-800-955-8771. SHOULD YOU WISH TO SEEK REVIEW OF THE REPORT AND RECOMENDATION MADE BY THE GENERAL MASTER, YOU MUST FILE ECEPTIONS IN ACCORDANCE WITH RULE 12.490(f), FLORIDA FAMILY LAW RULES OF PROCEDURE. YOU WILL BE REQUIRED TO PROVIDE THE COURT WITH A RECORD SUFFICIENT TO SUPPORT YOUR ECEPTIONS, OR YOUR EXCEPTIONS WILL BE DENIED. A RECORD ODINARILY INCLUDES A WRITTEN TRANSCRIPT OF ALL RELEVANT PROCEEDINGS. THE PERSON SEEKING REVIEW MUST HAVE THE TRANSCRIPT PREPARED IF NECESSARY FOR THE COURT'S REVIEW. YOU ARE HEREBY ADVISED THAT IN THIS CIRCUIT: ____ a. electronic recording is provided by the court. A party may provide a court reporter at that party's expense. ____ b. a court reporter is provided by the court. If you are represented by an attorney or plan to retain an attorney for this matter you should notify the attorney of this hearing. If this matter is resolved, the moving party shall contact the General Master's Office to cancel this hearing. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________________ *185 Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} ______________, {city} _________________, {state} ________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.921, NOTICE OF HEARING (CHILD SUPPORT EFORCEMENT HEARING OFFICER) When should this form be used? A child support enforcement hearing officer is an attorney who has been appointed by administrative order of the court to take testimony and recommend decisions in cases involving the establishment, enforcement, and/or modification of child support. If your case only involves issues pertaining to child support, you cannot object to the referral of your case to a hearing officer. Use this form anytime you have set a hearing before a child support enforcement hearing officer and have been instructed to send notice of the hearing to the other party. Before you fill out this form, you should coordinate a hearing time and date with the hearing officer and the other party. If the Department of Revenue is a party to the case, you may need to schedule your hearing time with the attorney for the Department of Revenue. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, See rule 12.941, Florida Family Law Rules of Procedure. Special notes ... An attorney who has been appointed by the court to serve as a child support enforcement hearing officer can also be appointed to serve as a general master. If your case involves only child support issues, your case properly may be referred to a general master acting as a child support enforcement hearing officer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last *186 page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF HEARING (CHILD SUPPORT ENFORCEMENT HEARING OFFICER) TO: {name of other party} ________________________________________________ There will be a hearing before Child Support Enforcement Hearing Officer {name} _______________, on {date} _____________, at {time} ________m., in Room ___________ of the ____________________________________________________________________ County Courthouse, on the following issues: ___________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ ____________ hour(s)/ ___________ minutes have been reserved for this hearing. This part to be filled out by the court or filled in with information you have obtained from the court: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} ________________________________________ {address} ___________________________________ {telephone} _______________ within 2 working days of your receipt of this Notice of Hearing. If you are hearing or voice impaired, call TDD 1-800-955-8771. If you are represented by an attorney or plan to retain an attorney for this matter, you should notify the attorney of this hearing. If this matter is resolved, the moving party shall contact the hearing officer's office to cancel this hearing. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ *187 Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} ________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM(S) 12.922(a), MOTION FOR DEFAULT and 12.922(b), DFAULT When should these forms be used? If the other party has failed to file or serve any documents within 20 days after the date of service of your petition, you may ask the clerk of the circuit court to enter a default against him or her by filling out this form and filing it with the court. Generally, a default allows you to obtain an earlier final hearing to finish your case. Once the default is signed by the clerk, you can request a trial or final hearing in your case. To obtain a default, you will need to complete Motion for Default, Florida Family Law Form 12.922(a). You will then need to file your motion for default along with the Default, Florida Family Law Form 12.922(b), so that the clerk can enter a default for you if your motion is proper. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where you filed your petition and keep a copy for your records. What should I do next? After the default has been entered, you must ask for a hearing, so that the judge can consider your petition. To do this, you must contact the clerk's office, family law intake staff, or judicial assistant to schedule a hearing and file a Notice of Hearing (General), Florida Family Law Form 12.923, with the clerk. A copy of the notice of hearing must be mailed or hand-delivered to each party in the case. You must send a notice of final hearing to the defaulted party. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 1.500, Florida Rules of Civil Procedure, concerning defaults and rule 1.140, Florida Rules of Civil Procedure, concerning the time within which a party can file an answer or other responsive pleading to a petition. See also rule 12.080, Florida Family Law Rules of Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ *188 __________________________________, Petitioner, and __________________________________, Respondent. MOTION FOR DEFAULT TO THE CLERK OF THE CIRCUIT COURT: PLEASE ENTER A DEFAULT AGAINST RESPONDENT WHO HAS FAILED TO RESPOND TO THE PETITION. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________________, a nonlawyer, located at {street} ______________, {city} ____________________, {state} ________, {phone} ____________, helped {name} _____________, who is the petitioner, fill out this form. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. DEFAULT A default is entered in this action against Respondent for failure to serve or file a response or any paper as is required by law. Dated: _______________________________ *189 CLERK OF THE CIRCUIT COURT (SEAL) By: ___________________________________ Deputy Clerk I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ ________________________________ Signature of Petitioner Printed Name: __________________ Address: _______________________ City, State, Zip: ______________ Telephone Number: ______________ Fax Number: ____________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________, a nonlawyer, located at {street} ______________, {city} ______________, {state} ________, {phone} ____________, helped {name} ____________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.922(c), MOTION TO SET ASIDE DEFAULT OR DFAULT JUDGMENT When should this form be used? If a default or default judgment has been entered against you, and you believe, because of a mistake, inadvertence, excusable neglect, newly discovered evidence, or fraud, that it should not have been entered against you, you can use this form to request that the court set aside the default or default judgment. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the default was entered and keep a copy for your records. What should I do next? After you file this form with the clerk and serve a copy on the other party in the case, you must schedule a hearing so that the court can consider your motion. You should contact the clerk, family law intake staff, or judicial assistant to schedule a hearing. Once you have scheduled the hearing date and time, you will need to complete and send out a notice for that hearing. To do so, use Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.540, Florida Family Law Rules of Procedure, and rules 1.500(d) and 1.540(b), Florida Rules of Civil Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person *190 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION TO SET ASIDE DEFAULT OR DEFAULT JUDGMENT I, {full legal name} ______________________________________________________, request that the Court enter an order to set aside the ( ) Default ( ) Default Judgment entered against me and that I be given the opportunity to present my views. The Court should do this because: 1. I became aware of this Default/Default Judgment on {date} ___________________ 2. I found out about this in the following manner $explain how you found out$: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 3. I did not answer or appear at the hearing because: ___________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 4. If I am given an opportunity, these are the defenses and arguments that I would like to tell the court about: ________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ *191 City, State, Zip: ________________________ Fax Number: ______________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Respondent Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on ______________ by _____________, _______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA _______________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced_______________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _______________________________________, a nonlawyer, located at {street} ______________, {city} _______________________, {state} ______, {phone} _________, helped {name} __________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.923, NOTICE OF HEARING (GENERAL) When should this form be used? Anytime you have set a hearing before a judge, you must send notice of the hearing to the other party. IMPORTANT: If your hearing has been set before a general master, you should use Notice of Hearing Before General Master, Florida Family Law Form 12.920(c). If your hearing has been set before a child support enforcement hearing officer, you should use Notice of Hearing (Child Support Hearing Officer), Florida Family Law Form 12.921. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case was filed keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. If a default has been entered, you must still send this form to the other party to notify the other party of the final hearing. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information on serving notices of *192 hearing, see rule 1.090(d), Florida Civil Rules of Procedure. Special notes ... To set a hearing date and time, you will usually have to make a good-faith effort to coordinate a mutually convenient date and time for you, the other parties in the case, and the judge, except in certain emergency situations. Some circuits may have additional procedural requirements that you must follow when you notify the court and other parties of your scheduled hearing. Therefore, before you complete this form, you should contact the clerk's office, family law intake staff, or judicial assistant for information regarding the proper procedure to follow. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF HEARING (GENERAL) [√ fill in all blanks] TO: {name of other party} _______________________________________________________ There will be a hearing before Judge {name} _________________________________, on {date} _____________, at {time} ______________m., in Room of the Courthouse, on the following issues: ________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _____________ hour(s)/ __________ minutes have been reserved for this hearing. This part to be filled out by the court or to be filled in with information you obtained from the court: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________________________________________________________________, {address} ___________________________________________, {telephone} ____________, within 2 working days of your receipt of this Notice of Hearing. If you are hearing or voice impaired, call TDD 1-800-955-8771. If you are represented by an attorney or plan to retain an attorney for this matter, you should notify the attorney of this hearing. If this matter is resolved, the moving party shall contact the judge's office to cancel this hearing. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _____________ *193 Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ _________________________________ Signature of Party Printed Name: ___________________ Address: ________________________ City, State, Zip: _______________ Telephone Number: _______________ Fax Number: _____________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} __________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.924, NOTICE FOR TRIAL When should this form be used? Generally, the court will have trials (or final hearings) on contested cases. This form is to be used to notify the court that your case is ready to be set for trial. Before setting your case for trial, certain requirements such as completing mandatory disclosure and filing certain papers and having them served on the other party must be met. These requirements vary depending on the type of case and the procedures in your particular circuit. In some circuits you must complete mediation or a parenting course before you can set a final hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. Other circuits may require that you set the trial using an Order Setting Trial. Contact the clerk of the court, family law intake staff, or judicial assistant to determine how the judge assigned to your case sets trials. For further information, you should refer to the instructions for the type of form you are filing. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.440, Florida Family Law Rules of Procedure. Special notes ... These family law forms contain orders and final judgments, which the judge may use. You should ask the clerk of court, family law intake staff, or judicial assistant if you need to bring one of these forms with you to the hearing or trial. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer *194 helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE FOR TRIAL Pursuant to rule 12.440, Florida Family Law Rules of Procedure, the party signing below states that the case is ready to be set for trial. The estimated time needed for the parties to present their cases is: {hours} ____________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _____________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________________________, a nonlawyer, located at {street} ______________, {city} ______________________, {state} __________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.927, NOTICE OF VOLUNTARY DISMISSAL When should this form be used? If you are the petitioner in a case and you wish to discontinue (dismiss) the case, you may use this form to request that the court dismiss your petition. If you are the respondent in a case and you have filed a counterpetition, you may use this form to request that the court dismiss your counterpetition. WARNING: If your case involves both a petition and a counterpetition, a notice of *195 voluntary dismissal filed by one party will NOT dismiss the other party's petition or counterpetition. The other party also must file a notice of voluntary dismissal for the entire case to stop completely. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or handdelivered to each party in the case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.420, Florida Family Law Rules of Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF VOLUNTARY DISMISSAL I, {full legal name} ________________________________, give notice that: [√ one only] ____ a. I am the Petitioner in this case and I voluntarily dismiss my petition. ____ b. I am the Respondent in this case and I voluntarily dismiss my counterpetition. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ______________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ *196 City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________________, a nonlawyer, located at {street} ______________, {city} ___________________, {state} __________, {phone} __________, helped {name} ____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.930(a), NOTICE OF SERVICE OF STANDARD FAMILY LAW INTERROGATORIES When should this form be used? You should use this form to tell the court that you are asking the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. The standard family law interrogatories are designed to supplement the information provided in the Financial Affidavit, Florida Family Law Forms 12.901(d) or (e). You should carefully read the standard interrogatory forms, Florida Family Law Form 12.930(b) and (c), to determine which questions, if any, the other party needs to answer in order to provide you with information not covered by the financial affidavit forms. This form should be typed or printed in black ink. You must indicate whether you are sending the interrogatories for original and enforcement proceedings or the interrogatories for modification proceedings. You must also indicate which questions you are asking the other party to answer. After completing this form you should file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. What should I do next? A copy of this form, along with two copies of the appropriate interrogatories, Florida Family Law Form 12.930(b) or (c), must be mailed or hand delivered to the other party in your case. You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the, answers to you. His or her answers may be written on as many separate sheets of paper as necessary. He or she should number each page and indicate which question(s) he or she is answering, and be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure, and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person *197 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF SERVICE OF STANDARD FAMILY LAW INTERROGATORIES I, {full legal name} ____________________________________, have on {date} ____________, served upon {name of person served} _____________________________________________________________, to be answered under oath within 30 days after service, the Standard Family Law Interrogatories for [√ one only] ( ) Original or Enforcement Proceedings ( ) Modification Proceedings I am requesting that the following standard questions be answered: [√ all that apply] ______ 1 ______ 2 ______ 3 ______ 4 ______ 5 ______ 6 ______ 7 Background Education Employment Assets Liabilities Miscellaneous Long Form Information Affidavit In addition, I am requesting that the attached {#} ______ questions be answered. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________ Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} __________, {phone} ____________, helped {name} _____________, who is the [√ one only] ____ petitioner or ____ respondent, fill out this form. *198 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.930(b), STADARD FAMILY LAW INTERROATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS When should this form be used? This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.) The questions in this form should be used in original proceedings or enforcement proceedings and are meant to supplement the information provided in the Financial Affidavit, Florida Family Law Forms 12.901(d) or (e). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them. This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send 2 copies of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Forms 12.930(a), to the other party. You should also keep a copy for your records. You do not need to file this form with the clerk of the circuit court. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Forms 12.930(a), to tell the court that you have sent this form to the other party. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure, and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure. Special notes ... In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print legibly your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge. You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also *199 must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE __________JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: ____________________________ Division: ____________________________ __________________________________, Petitioner, and __________________________________, Respondent. STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES I am requesting that the following standard questions be answered: [√ all that apply] ______ 1 ______ 2 ______ 3 ______ 4 ______ 5 ______ 6 ______ 7 Background Education Employment Assets Liabilities Miscellaneous Long Form Information Affidavit In addition, I am requesting that the attached {#}__________ questions be answered. The answers to the following questions are intended to supplement the information provided in the Financial Affidavits, Florida Family Law Forms 12.901(d) or (e). You should answer the group of questions indicated in the above shaded box. The questions should be answered in the blank space provided below each separately numbered question. If sufficient space is not provided, you may attach additional papers with the answers and refer to them in the space provided in the interrogatories. You should be sure to make a copy for yourself. Each question must be answered separately and as completely as the available information permits. All answers are to be made under oath or affirmation as to their truthfulness. I, {name of person answering interrogatories} ______________________________, being sworn, certify that the following information is true: 1. BACKGROUND INFORMATION: a. State your full legal name and any other name by which you have been known. b. State your present residence and telephone numbers. c. State your place and date of birth. 2. EDUCATION: a. List all business, commercial, and professional licenses that you have obtained. b. List all of your education including, but not limited to, vocational or specialized training, including the following: (1) name and address of each educational institution. (2) dates of attendance. (3) degrees or certificates obtained or anticipated dates of same. *200 3. EMPLOYMENT: a. For each place of your employment or self-employment during the last 3 years, state the following: (1) name, address, and telephone number of your employer. (2) dates of employment. (3) job title and brief description of job duties. (4) starting and ending salaries. (5) name of your direct supervisor. (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. b. Other than as an employee, if you have been engaged in or associated with any business, commercial, or professional activity within the last 3 years that was not detailed above, state for each such activity the following: (1) name, address, and telephone number of each activity. (2) dates you were connected with such activity. (3) position title and brief description of activities. (4) starting and ending compensation. (5) name of all persons involved in the business, commercial, or professional activity with you. (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. c. If you have been unemployed at any time during the last 3 years, state the dates of unemployment. If you have not been employed at any time in the last 3 years, give the information requested above in question 3.a for your last period of employment. 4. ASSETS: a. Real Estate. State the street address of all real property that you own or owned during the last 3 years. For each property, state the following: (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest. (2) the purchase price, the cost of any improvements made since it was purchased, and the amount of any depreciation taken. (3) the fair market value on the date of your separation from your spouse. (4) the fair market value on the date of the filing of the petition for dissolution of marriage. *201 b. Tangible Personal Property. List all items of tangible personal property that are owned by you or in which you have had any interest during the last 3 years including, but not limited to, motor vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose fair market value exceeds $100. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest. (3) the date you acquired your interest. (4) the purchase price. (5) the present fair market value. (6) the fair market value on the date of your separation from your spouse. (7) the fair market value on the date of the filing of the petition for dissolution of marriage. c. Intangible Personal Property. Other than the financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in the answer to interrogatory 4.d below, list all items of intangible personal property that are owned by you or in which you have had any ownership interest (including closed accounts) within the last 3 years, including but not limited to, partnership and business interests (including good will), stocks, stock funds, mutual funds, bonds, bond funds, real estate investment trust, receivables, certificates of deposit, notes, mortgages, and debts owed to you by another entity or person. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest and the names and addresses of the persons and entities who are indebted to you. (3) the date you acquired your interest. (4) the purchase price, acquisition cost, or loaned amount. (5) the fair market value or the amounts you claim are owned by or owed to you: (a) presently, at the time of answering these interrogatories. (b) on the date of your separation from your spouse. (c) on the date of the filing of the petition for dissolution of marriage. You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. However, if the date of acquisition, the purchase price and the market valuations are not clearly reflected in the periodic statements which are furnished then these questions must be answered separately. You do not have to resubmit any periodic statements previously furnished under rule 12.285 (Mandatory Disclosure). d. Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. *202 (3) account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) highest balance within each of the preceding 3 years. (6) lowest balance within each of the preceding 3 years. You may comply with this interrogatory (4.d) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. You do not have to resubmit account statements previously furnished pursuant to rule 12.285 (Mandatory Disclosure). e. Closed Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) closed within the last 3 years, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) date account was closed. f. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the following: (1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one the following: (a) identification of the estate, trust, insurance policy, or annuity. (b) the nature, amount, and frequency of any distributions of benefits. (c) the total value of the beneficiaries' interest in the benefit. (d) whether the benefit is vested or contingent. (2) If you have established any trust or are the trustee of a trust, state the following: (a) the date the trust was established. (b) the names and addresses of the trustees. (c) the names and addresses of the beneficiaries. (d) the names and addresses of the persons or entities who possess the trust documents. (e) each asset that is held in each trust, with its fair market value. g. Canceled Life Insurance Policies. For all policies of life insurance within the preceding 3 years that you no longer hold, own, or have any interest in, state the following: (1) name of company that issued the policy and policy number. (2) name, address, and telephone number of agent who issued the policy. (3) amount of coverage. (4) name of insured. (5) name of owner of policy. (6) name of beneficiaries. (7) premium amount. *203 (8) date the policy was surrendered. (9) amount, if any, of monies distributed to the owner. h. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and telephone numbers of your accountant, bookkeeper, and any other persons who possess your financial records, and state which records each possesses. i. Safe Deposit Boxes, Lock Boxes, Vaults, Etc. For all safe deposit boxes, lock boxes, vaults, or similar types of depositories, state the following: (1) The names and addresses of all banks, depositories, or other places where, at any time during the period beginning 3 years before the initiation of the action, until the date of your answering this interrogatory, you did any of the following: (a) had a safe deposit box, lock box, or vault. (b) were a signatory or co-signatory on a safe deposit box, lock box, or vault. (c) had access to a safe deposit box, lock box, or vault. (d) maintained property. (2) The box or identification numbers and the name and address of each person who has had access to any such depository during the same time period. (3) All persons who have possession of the keys or combination to the safe eposit box, lock box, or vault. (4) Any items removed from any safe deposit boxes, lock boxes, vaults, or similar types of depositories by you or your agent during that time, together with the present location and fair market value of each item. (5) All items in any safe deposit boxes, lock boxes, vaults, or similar types of depositories and fair market value of each item. 5. LIABILITIES: a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and other obligations (other than credit cards and charge accounts) listed in your Financial Affidavit, indicate for each the following: (1) name and address of the creditor. (2) name in which the obligation is or was incurred. (3) loan or account number, if any. (4) nature of the security, if any. (5) payment schedule. (6) present balance and current status of your payments. (7) total amount of arrearage, if any. (8) balance on the date of your separation from your spouse. (9) balance on the date of the filing of the petition for dissolution of marriage. You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). *204 b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of the creditor. (2) name in which the account is or was maintained. (3) names of each person authorized to sign on the accounts. (4) account numbers. (5) present balance and current status of your payments. (6) total amount of arrearage, if any. (7) balance on the date of your separation from your spouse. (8) balance on the date of the filing of the petition for dissolution of marriage. (9) highest and lowest balance within each of the preceding 3 years. You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). c. Closed Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) closed with no remaining balance, within the last 3 years, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each creditor. (2) name in which the account is or was maintained. (3) account numbers. (4) names of each person authorized to sign on the accounts. (5) date the balance was paid off. (6) amount of final balance paid off. You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure) 6. MISCELLANEOUS: a. If you are claiming a special equity in any assets, list the asset, the amount claimed as special equity, and all facts upon which you rely in your claim. b. If you are claiming an asset or liability is nonmarital, list the asset or liability and all facts upon which you rely in your claim. *205 c. If the mental or physical condition of a spouse or child is an issue, identify the person and state the name and address of all health care providers involved in the treatment of that person for said mental or physical condition. d.If custody of minor children is an issue, state why, and the facts that support your contention that you should be the primary residential parent or have sole parental responsibility of the child(ren). 7. LONG FORM AFFIDAVIT: If you filed the short form affidavit, Form 12.901(d), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.901(e), you must do so within the time to serve the answers to these interrogatories. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ I understand that I am swearing or affirming under oath to the truthfulness of the answers to these interrogatories and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on __________ by ___________, ______________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ______________________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced ___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} ________, {phone} ____________, helped {name} _____________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. *206 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.930(c), STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEINGS When should this form be used? This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.) The questions in this form should be used in modification proceedings and are meant to supplement the information provided in the Financial Affidavits, Florida Family Law Forms 12.901(d) or (e). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them. This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send two copies of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Forms 12.930(a) to the other party. You should also keep a copy for your records. You do not need to file this form with the clerk of the circuit court. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Forms 12.930(a), to tell the court that you have sent this form to the other party. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure. Special notes ... In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge. You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and *207 telephone number on the bottom of the last page of every form he or she helps you complete. _______________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA Case No.: _______________________________ Division: _______________________________ __________________________________, Petitioner, and __________________________________, Respondent. STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEDINGS TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES I am requesting that the following standard questions be answered: [√ all that apply] _____ 1 _____ 2 _____3 _____4 _____5 _____6 _____7 Background Education Employment Assets Liabilities Miscellaneous Long Form Information Affidavit In addition, I am requesting that the attached {#}__________ questions be answered. The answers to the following questions are intended to supplement the information provided in the Financial Affidavits, Florida Family Law Forms 12.901(d) or (e). You should answer the group of questions indicated in the above shaded box. The questions should be answered in the blank space provided below each separately numbered question. If sufficient space is not provided, you may attach additional papers with the answers and refer to them in the space provided in the interrogatories. You should be sure to make a copy for yourself. Each question must be answered separately and as completely as the available information permits. All answers are to be made under oath or affirmation as to their truthfulness. I, (name of person answering interrogatories) ___________________________ being sworn, certify that the following information is true: 1. BACKGROUND INFORMATION: a. State your full legal name and any other name by which you have been known. b. State your present residence and telephone numbers. c. State your place and date of birth. 2. EDUCATION: a. List all business, commercial, and professional licenses that you have obtained since the entry of the Final Judgment sought to be modified. b. List all of your education since the entry of the Final Judgment sought to be modified including, but not limited to, vocational or specialized training, including the following: (1) name and address of each educational institution. *208 (2) dates of attendance. (3) degrees or certificates obtained or anticipated dates of same. 3. EMPLOYMENT: a. For each place of your employment or self-employment since the entry of the Final Judgment sought to be modified, state the following: (1) name, address, and telephone number of your employer. (2) dates of employment. (3) job title and brief description of job duties. (4) starting and ending salaries. (5) name of your direct supervisor. (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. b. Other than as an employee, if you have been engaged in or associated with any business, commercial, or professional activity since the entry of the Final Judgment sought to be modified that was not detailed above, state for each such activity the following: (1) name, address, and telephone number of each activity. (2) dates you were connected with such activity. (3) position title and brief description of activities. (4) starting and ending compensation. (5) name of all persons involved in the business, commercial, or professional activity with you. (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. c. If you have been unemployed at any time since the entry of the Final Judgment sought to be modified, state the dates of unemployment. If you have not been employed at any time since the entry of the Final Judgment sought to be modified, give the information requested above in question 3.a for your last period of employment. 4. ASSETS: a. Real Estate. State the street address of all real property that you own or owned during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. For each property, state the following: (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest. (2) the present fair market value. *209 b. Tangible Personal Property. List all items of tangible personal property that are owned by you or in which you have had any interest during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including, but not limited to, motor vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose fair market value exceeds $100. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest. (3) the present fair market value. c. Intangible Personal Property. Other than the financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in the answer to interrogatory 4.d below, list all items of intangible personal property that are owned by you or in which you have had any ownership interest (including closed accounts) within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including, but not limited to, partnership and business interests (including good will), stocks, stock funds, mutual funds, bonds, bond funds, real estate investment trusts, receivables, certificates of deposit, notes, mortgages, and debts owed to you by another entity or person. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest and the names and addresses of the persons and entities who are indebted to you. (3) the present fair market value or the amounts you claim are owned by or owed to you, at the time of answering these interrogatories. You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if snorter. However, if the date of acquisition, the purchase price, and the market valuations are not clearly reflected in the periodic statements which are furnished, then these questions must be answered separately. You do not have to resubmit any periodic statements previously furnished under rule 12.285 (Mandatory Disclosure). d. Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) account numbers. (4) names of each person authorized to make withdrawals from the accounts. *210 (5) highest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. (6) lowest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You may comply with this interrogatory (4.d) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). e. Closed Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) closed within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) date account was closed. f. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the following: (1) if you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one the following: (a) identification of the estate, trust, insurance policy, or annuity. (b) the nature, amount, and frequency of any distributions of benefits. (c) the total value of the beneficiaries' interest in the benefit. (d) whether the benefit is vested or contingent. (2) if you have established any trust or are the trustee of a trust, state the following: (a) the date the trust was established. (b) the names and addresses of the trustees. (c) the names and addresses of the beneficiaries. (d) the names and addresses of the persons or entities who possess the trust documents. (e) each asset that is held in each trust, with its fair market value. g. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and telephone numbers of your accountant, bookkeeper, and any other persons who possess your financial records, and state which records each possesses. *211 5. LIABILITIES: a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and other obligations (other than credit cards and charge accounts) listed in your Financial Affidavit, indicate for each the following: (1) name and address of the creditor. (2) name in which the obligation is or was incurred. (3) loan or account number, if any. (4) nature of the security, if any. (5) payment schedule. (6) present balance and current status of your payments. (7) total amount of arrearage, if any. You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of the creditor. (2) name in which the account is or was maintained. (3) name of each person authorized to sign on the accounts. (4) account numbers. (5) present balance and current status of your payments. (6) total amount of arrearage, if any. (7) highest and lowest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). c. Closed Credit Cards and Charge Accounts. As to all financial accounts (credit card, charge accounts, or other such accounts) closed with no remaining balance, within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each creditor. (2) name in which the account is or was maintained. (3) account numbers. (4) name of each person authorized to sign on the accounts. *212 (5) date the balance was paid off. (6) amount of final balance paid off. You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). 6. MISCELLANEOUS: a. If you are claiming a diminished earning capacity since the entry of the Final Judgment sought to be modified as grounds to modify alimony or deviate from the child support established in your case, describe in detail how your earning capacity is lowered and state all facts upon which you rely in your claim. If unemployed, state how, why, and when you lost your job. b. If you are claiming a change in a mental or physical condition since the entry of the Final Judgment sought to be modified as grounds to modify alimony or change the child support established in your case, describe in detail how your mental and/or physical capacity has changed and state all facts upon which you rely in your claim. Identify the change in your mental and/or physical capacity, and state the name and address of all health care providers involved in the treatment of this mental or physical condition. c. If you are requesting a change in shared or sole parental responsibility, primary residency, the parenting schedule, or any combination thereof, for the minor child(ren), describe in detail the change in circumstances since the entry of the Final Judgment sought to be modified that you feel justify the requested change. State when the change of circumstances occurred, how the change of circumstances affects the child(ren), and why it is in the best interests of the child(ren) that the Court make the requested change. Attach your parenting schedule. d. If you do not feel the requested change in shared or sole parental responsibility, primary residency, the parenting schedule, or any combination thereof, for the minor child(ren) is in their best interests, describe in detail any facts since the entry of the Final Judgment sought to be modified that you feel justify the Court denying the requested change. State, in your opinion, what change, if any, of the parenting arrangement is justified or agreeable to you and why it is in the best interests of the child(ren). 7. LONG FORM AFFIDAVIT:. If you filed the short form affidavit, Form 12.901(d), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.901(e), you must do so within the time to serve the answers to these interrogatories. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ *213 I understand that I am swearing or affirming under oath to the truthfulness of the answers to these interrogatories and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF __________________ Sworn to or affirmed and signed before me on __________ by _________, __________________________________ NOTARY PUBLIC—STATE OF FLORIDA __________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced ___________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} ______________, {city} ____________, {state} ________, {phone} ____________, helped {name} _____________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. INSTRUCTIONS FOR FAMILY LAW FORMS 12.931(a), NOTICE OF PRDUCTION FROM NONPARTY and 12.931(b), SUBPOENA FOR PRODUTION OF DOCUMENTS FROM NOPARTY When should these forms be used? These forms should be used if you need copies of documents (for a purpose relating to your case) from a nonparty in your case. Both forms should be typed or printed in black ink. Notice of Production from Nonparty, Florida Family Law Form 12.931(a), is used to notify the other party in your case that in 10 days you are going to subpoena documents from a nonparty. Subpoena for Production of Documents from Nonparty, Florida Family Law Form 12.931(b), is the actual subpoena directing the nonparty to produce specific documents. You must file the originals of these forms with the clerk of the circuit court. A copy of these forms must be mailed or hand delivered to any other party in your case. What should I do next? Ten days after you serve the Notice of Production from Nonparty, Florida Family Law Form 12.931(a), on the other party in your case (15 days if service is by mail), you should ask the clerk of the court to sign the subpoena. You should contact the deputy sheriff or private process server and have the subpoena personally served on the person named in the subpoena. *214 Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. Because these papers must also comply with rule 12.280, Florida Family Law Rule of Procedure, and rules 1.280, 1.350, 1.351, and 1.410, Florida Rules of Civil Procedure, you also should read those rules. Special notes ... If the other party in your case objects in writing within 10 days (allow an additional 5 days if served by mail) of service of the Notice of Production from Nonparty, Florida Family Law Form 12.931(a), you may not use this procedure to obtain documents from the nonparty unless and until the court orders otherwise. The nonparty receiving the subpoena may charge you a reasonable fee for copies of the documents. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. NOTICE OF PRODUCTION FROM NONPARTY TO: ______________________________________________________________ {all parties} YOU ARE NOTIFIED that, after 10 days from the date of service of this notice, the undersigned will apply to the clerk of this Court for issuance of the attached subpoena directed to {name of person, organization, or agency} _______________________, who is not a party, to produce the items listed at the time and place specified in the subpoena. Objections to the issuance of this subpoena must be filed with the clerk of the circuit court within 10 days. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney (if represented) Other ______________________________________ _________________________________________ Printed Name Printed Name ______________________________________ _________________________________________ Address Address ______________________________________ _________________________________________ City State Zip City State Zip ______________________________________ _________________________________________ Telephone (area code and number) Telephone (area code and number) ______________________________________ _________________________________________ Fax (area code and number) Fax (area code and number) Dated: _______________________________ *215 __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} __________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ___________________________________________________________________________ Form 12.931(b) ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY THE STATE OF FLORIDA TO: _______________________________________________________________________ YOU MUST go to {place} ____________________________________________, on {date} ______, at {time} __________, a.m./p.m. and bring you at that time and place the following: _____________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ These items will be inspected and may be copied at that time. You will not have to leave the original items. You may obey this subpoena by providing readable copies of the items to be produced to the party or his/her attorney whose name appears on this subpoena on or before the scheduled date of production. You may condition the preparation of the copies upon payment in advance of the reasonable cost of preparation. If you mail or deliver the copies to the attorney whose name appears on this subpoena before the date indicated above, you do not have to appear in person. You may be in contempt of court if you fail to: (1) appear as specified; (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena. You can only be excused by the person whose name appears on this subpoena and, unless excused by that person or the Court, you shall respond as directed. Dated: ________________________________ CLERK OF THE CIRCUIT COURT (SEAL) *216 By: ______________________________ Deputy Clerk This part is to be filled out by the court or filled in with information you have obtained from the court: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _________________________________, {address} ____________________________________________, {telephone} __________, within 2 working days of your receipt of this subpoena. If you are hearing or voice impaired, call TDD 1-800-955-8771. I CERTIFY that I gave notice to every other party to this action of my intent to serve a subpoena upon a person who is not a party to this action directing that person to produce documents or things without deposition. I also certify that no objection under Florida Rule of Civil Procedure 1.351 has been received by the undersigned within 10 days of service of this notice, if service was by hand delivery or appropriate facsimile transmission, and within 15 days if service was by mail. Dated:__________________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________, a nonlawyer, located at {street} __________________, {city} ________, {state} ________, {phone} ____________, helped {name} _____, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.932, CERTIFCATE OF COMPLIANCE WITH MANDATORY DISCLOSURE When should this form be used? Mandatory disclosure requires each party in a dissolution of marriage case to provide the other party with certain financial information and documents. These documents must be provided by mail or hand delivery to the other party within 45 days of service of the petition for dissolution of marriage or supplemental petition for modification on the respondent. The mandatory disclosure rule applies to all original and supplemental dissolution of marriage cases, except simplified dissolution of marriage cases and cases where the respondent is served by constructive service and does not answer. You should use this form to notify the court and the other party that you have complied with the mandatory disclosure rule. Each party must provide the other party with the documents listed in section 2 of this form if the relief being sought is permanent regardless of whether it is an initial or supplemental proceeding. The financial affidavit is the only document that must be filed with the court and sent to the other party; all other documents should be sent to the other party but not filed with the court. If your individual gross annual income is under $50,000, you should complete the Family Law Financial Affidavit (Short Form), Florida Family Law Form 12.901(d). If your individual gross annual income is $50,000 or more, you should complete *217 the Family Law Financial Affidavit, Florida Family Law Form 12.901(e). In addition, there are separate mandatory disclosure requirements that apply to temporary financial hearings, which are listed in section 1 of this form. The party seeking temporary financial relief must serve these documents on the other party with the notice of temporary financial hearing. The responding party must either deliver the required documents to the party seeking temporary financial relief on or before 5:00 p.m., 2 business days before the hearing on temporary financial relief, or mail (postmark) them to the party seeking temporary financial relief 7 days before the hearing on temporary financial relief. Any documents that have already been served under the requirements for temporary or initial proceedings, do not need to be re-served again in the same proceeding. If a supplemental petition is filed, seeking modification, then the mandatory disclosure requirements begin again. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. A copy of this form must be mailed or hand delivered to any other party in your case. What should I do next? After you have provided the other party all of the financial information and documents and have filed this form certifying that you have complied with this rule, you are under a continuing duty to promptly give the other party any information or documents that change your financial status or that make the information already provided inaccurate. Refer to the instructions regarding the petition in your case to determine how you should proceed after filing this form. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.285, Florida Family Law Rules of Procedure. Special notes ... You may provide copies of required documents; however, the originals must be produced for inspection if the other party requests to see them. Although the financial affidavits are based on individual gross income, either party may ask the other party to complete the Family Law Financial Affidavit, Florida Family Law Form 12.901(e), by serving the appropriate interrogatory form (see Standard Family Law Interrogatories, Florida Family Law Forms 12.930(b)(original proceedings) or (c) (modification proceedings).) Any portion of the mandatory disclosure rule may be modified by order of the judge or agreement of the parties. Therefore, you and your spouse may agree that you will not require each other to produce the documents required under the mandatory disclosure rule. This exception does not apply to the Financial Affidavit, Florida Family Law Form 12.901(d) or (e), which is required in all cases and cannot be waived. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and *218 __________________________________, Respondent. CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE I, {full legal name}_____________________________________, certify that I have complied with the mandatory disclosure required by Florida Family Law Rule 12.285 as follows: 1. FOR TEMPORARY FINANCIAL RELIEF, ONLY: The date the following documents were served: _____________________________ [√ all that apply] ___ a. Financial Affidavit (Filing of a Financial Affidavit cannot be waived.) ( ) Florida Family Law Form 12.901(d) (short form) ( ) Florida Family Law Form 12.901(e) (long form) ___ b. Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if child support involved. ___ c. ( ) All personal (1040) federal tax, gift tax, and intangible personal property tax returns for the preceding year; or ( ) Transcript of tax returns as provided by IRS form 4506; or ( ) IRS forms W-2, 1099, and K-l for the past year because the income tax return for the past year has not been prepared. ___ d. Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. 2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF: The date the following documents were served: _____________________________ [√ all that apply] ___ a. Financial Affidavit (Filing of a Financial Affidavit cannot be waived.) ( ) Florida Family Law Form 12.901(d) (short form) ( ) Florida Family Law Form 12.901(e) (long form) ___ b. Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if child support is involved. ___ c. ( ) All personal (1040) federal and state income returns, gift tax returns, and intangible personal property tax returns for the preceding 3 years; ( ) IRS forms W-2, 1099, and K-l for the past year because the income tax return for the past year has not been prepared. ___ d. Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. ___ e. A statement identifying the source and amount of all income for the 3 months before the service of the financial affidavit, if not reflected on the pay stubs produced. ___ f. All loan applications and financial statements prepared for any purpose or used for any purpose within the 12 months preceding the service of the financial affidavit. ___ g. All deeds to real estate in which I presently own or owned an interest within the past 3 years. All promissory notes in which I presently own or owned an interest within the last 12 months. All present leases in which I own an interest. ___ h. All periodic statements for the last 3 months for all checking accounts and for the last year for all savings accounts, money market funds, certificates of deposit, etc. ___ i. All brokerage account statements for the last 12 months. ___ j. Most recent statement for any pension, profit sharing, deferred compensation, or retirement plan (for example, IRA, 401 (k), 403(b), SEP, KEOGH, etc.) and summary plan description for any such plan in which I am participant or alternate payee. *219 ___ k. The declarations page, the last periodic statement, and the certificate for any group insurance for all life insurance policies insuring my life or the life of my spouse. ___ l. All health and dental insurance cards covering either of me or my spouse and/or our dependent child(ren). ___ m. Corporate, partnership, and trust tax returns for the last 3 tax years, in which I have an ownership or interest greater than or equal to 30%. ___ n. All credit cards and charge account statements and other records showing the my (our) indebtedness as of the date of the filing of this action and for the prior 3 months. All promissory notes on which I presently owe or owed within the past year. All lease agreements I presently owe. ___ o. All premarital and marital agreements between the parties to this case. ___ p. If a modification proceeding, all written agreements entered into between the parties at any time since the order to be modified was entered. ___ q. All documents and tangible evidence relating to claims for special equity or nonmarital status of an asset or debt. ___ r. Any court order directing that I pay or receive spousal support (alimony) or child support. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.941(a), VERIFIED MOTION FOR TEMPORARY IJUNCTION TO PREVENT REMOAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES When should this form be used? You should use this form if you want the court to enter an order that your minor child(ren) is (are) not to be removed from the State of Florida while a case involving the child(ren)'s custody is pending, that passport services for the minor child(ren) be prohibited, and/or that existing passports be turned over to you. This form should be typed or printed in black ink. If you want the court to enter an ex parte order, without giving the other side advance notice of the hearing, you should explain your reasons in paragraph 5 of this form. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where your case is pending and keep a copy for your records. You should also ask the clerk to process your motion though their emergency procedures. *220 What should I do next? If the court enters an order without advance notice to the other party, you should take a certified copy of the order to the sheriffs office for further assistance. You must have this form and the court's order, served by personal service on the other party. You should read the court's order carefully. Look for directions in the order that apply to you and note the time and place of the hearing scheduled in the order. You should go to the hearing with whatever evidence you have regarding your motion. If the court will not enter an order without advance notice to the other side, you should check with the clerk of court, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing on your motion, unless the court sets a hearing in its order denying your request for an ex parte hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923 or other appropriate notice of hearing form, and use personal service to notify the other party of your motion, the court's order, if any, and the hearing. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see chapter 61, Florida Statutes, and rule 1.610, Florida Rules of Civil Procedure. Special notes ... If you have an attorney, your attorney must certify in writing the efforts that have been made to give the other party notice, if no notice is given. The court may require you to post a bond as a condition of the injunction. With this form you must also file the following, if you have not already done so, and provide a copy to the other party: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). Temporary Injunctions ... These family law forms contain a Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (Ex Parte), Florida Family Law Form 12.941(b), which the judge may use if he or she enters an order without a hearing, and a Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (After Notice), Florida Family Law Form 12.941(c), which the judge may use if he or she enters an order after a hearing. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and *221 __________________________________, Respondent. VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES ( ) Petitioner ( ) Respondent requests the Court to enter a temporary injunction to prevent removal of the following listed minor child(ren) from the jurisdiction of this Court and deny passport services for the child(ren) and says: 1. The minor ehild(ren) subject to this request is (are): Name Birth date _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. The child(ren) has (have) been a resident(s) of ______ County, Florida since {date} ______. 3. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this motion. 4. It is in the best interest of the minor child(ren) that the Court order the following: [√ all that apply] ___ a. The child(ren) not be removed from the jurisdiction of this Court while litigation is pending because: ________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ b. Passport services for the minor child(ren) be prohibited because: ____ _______________________________________________________________________ _______________________________________________________________________ ___ c. Existing passports for the minor child(ren) be immediately turned over to ( ) Petitioner ( ) Respondent because: ________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. This motion should be granted ( ) within ( ) without notice to the other party. {If without notice, explain why there would be immediate and irreparable harm if the other party is given notice.} _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ WHEREFORE, ( ) Petitioner ( ) Respondent requests the following from the Court: *222 [√ all that apply] ___ a. enter a temporary injunction to prevent removal of the child(ren) named above from the jurisdiction of this Court while this action is pending; ___ b. enter an order denying passport services for the minor child(ren); ___ c. enter an order requiring that any existing passports for the minor child(ren) be immediately delivered to ( ) Petitioner ( ) Respondent; ___ d. enter a temporary injunction without notice to the other party. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________ or ( ) was not delivered to the person(s) listed below because _______________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF ____________________ Sworn to or affirmed and signed before me on ________ by ________. __________________________________ NOTARY PUBLIC—STATE OF FLORIDA __________________________________ [Print, type, or stamp commissioned name of notary.] ____ Personally known ____ Produced identification Type of identification produced ____________ If the party filing this motion is represented by an attorney, the attorney must complete the following: I, the undersigned attorney for the movant, hereby certify in that the following efforts have been made to give notice, {if no efforts have been made, why} ____ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________ Signature *223 __________________________________ Florida Bar Number __________________________________ Printed Name IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} ____________, {city} ______________________, {state} __________, {phone} _________________, helped {name} _____________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ___________________________________________________________________________ Form 12.941(b) ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (EX PARTE) Upon verified motion of ( ) Petitioner ( ) Respondent, the Court has jurisdiction of the parties and the subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that: NOTICE OF HEARING This Temporary Injunction to Prevent Removal of Child(ren) has been issued without prior notice to Respondent. Pursuant to Rule 1.610, Florida Rules of Civil Procedure, the other party may file a motion to dissolve or modify this temporary injunction and a hearing will be scheduled within 5 days of that motion. [√ if applies] ___ If no motion to dissolve is filed, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} ______________, at ______ a.m/p.m., when the Court will consider whether the Court should continue, modify, or dissolve this Temporary Injunction to Prevent Removal of Child(ren) and/or Denial of Passport Services, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {name} ______________________________________________, at {room name/number, location, address, city} ____________________________ __________________________________________________________________________, Florida. If Petitioner and/or Respondent do (does) not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be issued, including the imposition of court costs. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at not cost to you, to the provision of certain assistance. Please contact {name} _______________________________, *224 {address} __________________________________________, {telephone} _________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-S00-955-8771. FINDING 1. It appears from specific facts shown by verified motion that immediate and irreparable injury, loss, or damage will result to the minor child(ren) if a temporary injunction is not issued without notice to the other party. 2. ( ) Petitioner's ( ) Respondent's attorney has certified in writing any efforts made to give notice The reasons why notice should not be given are: _______________________ ______________________________________________________________________, ______________________________________________________________________, ______________________________________________________________________, TEMPORARY INJUNCTION [√ all that apply] ___ 1. The following child(ren) shall not be removed from the jurisdiction of this Court during the pendency of this proceeding, or until further order of this Court: Name Birth date _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent shall not apply for any passport services on behalf of the child(ren). ___ 3. ( ) Petitioner ( ) Respondent shall immediately deliver any existing passports for the child(ren) to {name} _________________________________________. 4. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 5. Violation of this injunction may constitute criminal contempt of court. 6. Bond. ___ a. Bond is waived because this injunction is issued solely to prevent physical injury or abuse of a natural person. ___ b. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $___________ with the clerk of this Court. 7. Expiration. This injunction shall remain in effect until the minor child(ren) reaches the age of 18, until the hearing scheduled herein, if any, or {date} ____________________, whichever occurs first, unless modified by further order of this Court. ORDERED on {date} ________________, at {time} ____________. __________________________________ CIRCUIT JUDGE *225 COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Office of Citizenship-Legal Assistance Passport Services United States Department of State 1425 "K" Street, N.W., Room 300 Washington, D.C. XXXXX-XXXX ___________________________________________________________________________ Form 12.941(c) ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (AFTER NOTICE) Upon verified motion of ( ) Petitioner ( ) Respondent, the Court has jurisdiction of the parties and the subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that: [√ all that apply] ___ 1. The following minor child(ren) shall not be removed from the jurisdiction of this Court during the pendency of this proceeding, or until further order of this Court: Name Birth date ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent shall not apply for any passports or passport services on behalf of the child(ren). ___ 3. ( ) Petitioner ( ) Respondent shall immediately deliver any existing passports for the child(ren) to {name} ________________________________________. 4. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 5. Violation of this injunction may constitute criminal contempt of court. 6. Bond. *226 ___ a. Bond is waived because this injunction is issued solely to prevent physical injury or abuse of a natural person. ___ b. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $___________ with the clerk of this Court. 7. Expiration. This temporary injunction shall remain in effect until the minor child(ren) reaches the age of 18, or until {date} __________________________________, not to exceed one year from the date of this order, whichever occurs first, unless modified by further order of this Court. ORDERED on {date} ________________, at {time} ________________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Office of Citizenship-Legal Assistance Passport Services United States Department of State 1425 "K" Street, N.W., Room 300 Washington, D.C. XXXXX-XXXX INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.941(d), MOTION TO MODIFY OR DISSOLVE TEMPRARY INJUNCTION When should this form be used? If a temporary injunction, either ex parte or after a hearing, has been entered against you, you may use this form to ask the court to modify or dissolve that injunction. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the injunction was entered and keep a copy for your records. You should ask the clerk to process your motion through their emergency procedures. A hearing will be held within 5 working days. You should ask for the date and time of your hearing and should file Notice of Hearing (General), Florida Family Law Form 12.923 or other appropriate notice of hearing form, and send a copy to the other party. What should I do next? A copy of this form must be mailed or hand delivered to the other party, along with a notice of hearing. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see chapter 61, Florida Statutes, and rule 1.610, Florida Rules of Civil Procedure. Special notes ... With this form you must also file the following, if you have not already done so: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), if the custody of a minor child(ren) is at issue. Order ... These family law forms contain an Order Dissolving Temporary Injunction, N Florida Family Law Form 12.941(e), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person *227 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A non-lawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION TO MODIFY OR DISSOLVE TEMPORARY INJUNCTION ( ) Petitioner ( ) Respondent requests the court to enter an order ( ) dissolving the temporary injunction issued in the above styled case ( ) modifying the temporary injunction issued in the above styled case in the following manner: _______ ___________________________________________________________________________ ___________________________________________________________________________ I am the party against whom this temporary injunction has been granted and under rule 12.610, Florida Rules of Civil Procedure, I request that a hearing be held within 5 days after the filing of this motion. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} ___________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ___________________________________________________________________________ Form 12.941(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA *228 Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER DISSOLVING TEMPORARY INJUNCTION Upon ( ) Petitioner's ( ) Respondent's motion and after hearing, the Court, being fully advised in the premises, ORDERS that the temporary injunction entered on {date} __________________________ in the above-styled case is hereby dissolved. ORDERED on {date} _________________, at {time} ___________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Office of Citizenship-Legal Assistance Passport Services United States Department of State 1425 ""K" Street, N.W., Room 300 Washington, D.C. XXXXX-XXXX INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.942(a), MOTION FOR APPOINTMENT OF GUARIAN AD LITEM When should this form be used? This form may be used by either party in a family law case involving custody, parental responsibility, visitation, or paternity of a minor child(ren) to request that the judge appoint a guardian ad litem to represent the best interests of the minor child(ren). You should use this form if you feel that your child(ren) needs someone other than you to ensure that both the judicial system and the other party (ies) act in the best interests of the child(ren). A guardian ad litem may be a volunteer who has been trained and certified by the State of Florida Guardian ad Litem Program or an attorney who is a member in good standing with The Florida Bar. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. It is possible that there will be a hearing on your motion. The judge may want to hear the reasons you feel an appointment of a guardian ad litem is necessary, or, the other party may object to your motion. If a hearing is required, check with the clerk of court, family law court staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate *229 notice of hearing form, and provide a copy to the other party. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. You may also want to contact the Guardian ad Litem Program office in your area or see sections 61.401-105, Florida Statutes. Special notes ... Order ... These family law forms contain an Order Appointing a Guardian ad Litem, Florida Family Law Form 12.942(b), which the judge may use. You should check with the clerk, family law intake staff, of judicial assistant to see if you need to bring a blank order form with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you or complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION FOR APPOINTMENT OF GUARDIAN AD LITEM ( ) Petitioner ( ) Respondent requests that the court enter an order appointing a guardian ad litem with all powers, privileges, and responsibilities authorized in section 61.403, Florida Statutes, and state: 1. The following minor child(ren) is (are) subject to this proceeding: Name Birth date Age Sex Location/Address ____________________ _______________ _________ _______ __________________________ ____________________ _______________ _________ _______ __________________________ ____________________ _______________ _________ _______ __________________________ ____________________ _______________ _________ _______ __________________________ ____________________ _______________ _________ _______ __________________________ 2. Verified allegations of child abuse or neglect as defined in section 415.503(3), Florida Statutes, ( ) HAVE ( ) HAVE NOT been made in this case. 3. The matters before the Court regarding the minor child(ren) are: ___ a. sole/shared parental responsibility ___ b. primary/secondary residential parent ___ c. visitation ___ d. other: _____________________________________________________________ 4. It is in the best interests of the minor child(ren) that a guardian ad litem be appointed to advance the best interests of the minor child(ren) because: *230 _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: _________________________________ Address: ______________________________ City, State, Zip: _____________________ Fax Number: ___________________________ Dated: ________________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [√ fill in all blanks] I, {full legal name and trade name of nonlawyer} __________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ____________________________________________________________________________ Form 12.942(b) ____________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER APPOINTING GUARDIAN AD LITEM Upon ( ) Petitioner's ( ) Respondent's ( ) Court's own motion to appoint guardian ad litem for the minor child(ren) herein and the court finding that ___ a. verified allegations of child abuse or neglect as defined in section 415.503(3), Florida Statutes, have been made and are determined to be well-founded, OR ___ b. it is otherwise in the best interests of the child(ren) that guardian ad litem be appointed to advance the best interests of the minor child(ren) because: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ *231 _____________________________________________________________________ _____________________________________________________________________ ________________________________________, it is thereupon ORDERED as follows: 1. A guardian ad litem shall be appointed for the minor child(ren), {name(s)} _____________________________________________________________________ ____________________________________________________________________, now residing at {street address} __________________________. 2. The State of Florida Guardian ad Litem Program for the ___ Judicial Circuit shall assign a certified guardian ad litem for the minor child(ren). Upon filing of the Notice of Acceptance, the guardian ad litem can be served c/o Guardian ad Litem Program, {address} ________________________________________ _____________________________________________________________________ Pursuant to the State of Florida Guardian ad Litem Standards of Operation adopted by the Supreme Court of Florida, if the Guardian ad Litem Program is appointed in the absence of a well founded allegation of abuse or neglect, an automatic discharge by the Court will occur upon filing of a Motion to Discharge by the Program if the Program does not have sufficient volunteer and/or supervisory resources available to accommodate this appointment OR {name} _______________, an attorney in good standing with The Florida Bar, is appointed to serve as a private guardian ad litem for the above minor child(ren). The fees of the private guardian shall be paid by: ( ) Petitioner ( ) Respondent ( ) each party equally ( ) other, {specify} ______________ ____________________________________________________________________. 3. the guardian ad litem is a party to any judicial proceeding from the date of this order until the date of discharge and shall have all of the powers, privileges, and responsibilities authorized in section 61.403, Florida Statutes, to the extent necessary to advance the best interests of the minor child(ren). 4. The guardian ad litem must be provided with copies of all pleadings, notices, stipulations, and other documents filed in this action and is entitled to reasonable notice before any action affecting the child(ren) is taken by either of the parties, their counsel, or the Court. The guardian ad litem is entitled, through counsel, to be present at any depositions, hearings, or other proceedings concerning the minor child(ren). 5. The guardian ad litem may investigate the allegations of the pleadings affecting the minor child(ren), and after proper notice may interview witnesses or any other person having information concerning the welfare of the minor child(ren). 6. the guardian ad litem shall maintain any information received from any source described in section 61.403(2), Florida Statutes, as confidential and shall not disclose such information except in reports to the Court served upon both parties to this cause and their counsel, or as directed by the Court. 7. The parties, or any other person entrusted by the parties with the care of the minor child(ren) shall allow the guardian ad litem access to the minor child(ren) at reasonable times and locations and no person shall obstruct the guardian ad litem from the minor child(ren). 8. The guardian ad litem shall submit his or her recommendations to the court regarding any stipulation or agreement, whether incidental, temporary, or permanent, which affects the interest or welfare of the minor child(ren); *232 within 10 days after the date the stipulation or agreement is served upon the guardian ad litem. 9. The guardian ad litem shall file a written report with the Court, which may include recommendations and a statement of the wishes of the minor child(ren). The report must be filed and served on all parties at least 20 days prior to the hearing at which it will be presented unless the court waives such time period. The guardian ad litem's report shall address the following areas, subject to any conditions ordered by this Court: ___ a. parental responsibility of child(ren); ___ b. residence of child(ren); ___ c. visitation, including times and locations; ___ d. appearance of child(ren) at depositions/hearings; ___ e. relocation; ___ f. best interests of child(ren) regarding scientific tests; and/or ___ g. other ________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ This appointment is subject to the following conditions: ____________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 10. The guardian ad litem is automatically discharged without further order 30 days after the entry of a final order or judgment in this proceeding, unless otherwise ordered by the court. ORDERED on __________________________________________________________ __________________________________ CIRCUIT JUDGE Copies to: Petitioner (or his or her attorney) Respondent (or his or her attorney) ___ Guardian ad Litem Program ___ Other: ___________________________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.943, MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES When should this form be used? Child support in Florida is determined by the child support guidelines found in section 61.30, Florida Statutes. The court, at its discretion, may raise or lower the child support guidelines amount by up to 5%. In addition, the court may raise or lower the guidelines support amount by more than 5%, if written reasons are given for the adjustment. The court may make these additional adjustments based on certain considerations, which are reflected in this form. You should review this form to determine if any of the reasons for adjusting the child support guidelines amount apply to your situation and you should complete this form only if you want the court to order more child support or less child support than the amount required by the child support guidelines. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. *233 Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see section 61.30, Florida Statutes. Special notes ... More information on the child support guidelines as well as a chart for converting income and expenses to monthly amounts if paid or incurred on other than a monthly basis is contained in the instructions to Florida Family Law Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). With this form you must also file the following, if not already filed: • Florida Family Law Financial Affidavit, Florida Family Law Form 12.901(d) or (e). • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you should file this worksheet as soon as you receive a copy of his or her financial affidavit.) Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following: SECTION I [√ one only] ___ a. MORE child support than the amount required by the child support guidelines. The Court should order MORE child support than the amount required by the child support guidelines because of: [√ all that apply to your situation] ___ 1. Extraordinary medical, psychological, educational, or dental expenses; ___ 2. Seasonal variations in one or both parent's income; ___ 3. Age(s) of the child(ren), taking into consideration the greater needs of older child(ren); ___ 4. Special needs that have been met traditionally within the family budget even though the fulfilling of those needs will cause support to exceed the guidelines; ___ 5. Refusal of the nonresidential parent to become involved in the activities of the child(ren); *234 ___ 6. Due consideration given to the primary residential parent's homemaking services; ___ 7. Total available assets of mother, father, and child(ren); ___ 8. Impact of IRS dependency exemption and waiver of that exemption; ___ 9. Residency of subsequently born or adopted child(ren) with the obligor, including consideration of the subsequent spouse's income; and/or ___ 10. Any other adjustment that is needed to achieve an equitable result, which may include reasonable and necessary expenses jointly incurred during the marriage. Explain any items marked above: _____________________________________ _____________________________________________________________________ _____________________________________________________________________ ___ b. LESS child support than the amount required by the child support guidelines. The Court should order LESS child support than the amount required by the child support guidelines because of: [√ all that apply to your situation] ___ 1. Extraordinary medical, psychological, educational, or dental expenses; ___ 2. Independent income of child(ren), excluding the child(ren)'s SSI income; ___ 3. Payment of both child support and spousal support to a parent that regularly has been paid and for which there is a demonstrated need; ___ 4. Seasonal variations in one or both parent's income; ___ 5. Age of child(ren), taking into consideration the greater needs of older child(ren); ___ 6. The child(ren) spend(s) a substantial amount of time with the nonresidential parent, thereby reducing expenses of the primary residential parent; ___ 7. Due consideration given to the primary residential parent's homemaking services; ___ 8. Visitation with nonresidential parent for more than 28 consecutive days; ___ 9. Total available assets of obligee, obligor, and child(ren); ___ 10. Impact of IRS dependency exemption and waiver of that exemption; ___ 11. Application of the child support guidelines requires the obligor to pay more than 55% of gross income for a single support order; and/or ___ 12. Any other adjustment that is needed to achieve an equitable result, which may include reasonable and necessary expenses jointly incurred during the marriage. Explain any items marked above:______________________________________ _____________________________________________________________________ _____________________________________________________________________ SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES List the total of any independent income or assets of the child(ren) common to both parties (income from Social Security, gifts, stocks/bonds, employment, trust fund(s), investment(s), etc.). Attach an explanation. TOTAL VALUE OF ASSETS OF CHILD(REN) $_________ TOTAL MONTHLY INCOME OF CHILD(REN) $_________ SECTION III. EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should be listed separately with separate dollar amounts. 1. Monthly nursery, babysitting, or other child care 1. $________ *235 2. Monthly after-school care 2. $_________ 3. Monthly school tuition 3. $_________ 4. Monthly school supplies, books, and fees 4. $_________ 5. Monthly after-school activities 5. $_________ 6. Monthly lunch money 6. $_________ 7. Monthly private lessons/tutoring 7. $_________ 8. Monthly allowance 8. $_________ 9. Monthly clothing 9. $_________ 10. Monthly uniforms 10. $_________ 11. Monthly entertainment (movies, birthday parties, etc.) 11. $_________ 12. Monthly health and dental insurance premiums 12. $_________ 13. Monthly medical, dental, prescription charges (unreimbursed) 13. $_________ 14. Monthly psychiatric/psychological/counselor (unreimbursed) 14. $_________ 15. Monthly orthodontic (unreimbursed) 15. $_________ 16. Monthly grooming 16. $_________ 17. Monthly non-prescription medications/cosmetics/toiletries/sundries 17. $_________ 18. Monthly gifts from children to others (other children, relatives, teachers, etc.) 18. $_________ 19. Monthly camp or other summer activities 19. $_________ 20. Monthly clubs (Boy/Girl Scouts, etc.) or recreational fees 20. $_________ 21. Monthly visitation expenses (for nonresidential parent) Explain: ______________________________________________________ 21. $_________ 22. Monthly insurance (life, etc.) {explain}: ____________ 22. $_________ Other {explain}: 23. _______________________________________________________________ 23. $_________ 24. _______________________________________________________________ 24. $_________ 25. _______________________________________________________________ 25. $_________ 26. TOTAL EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES (add lines 1 through 25) 26. $========= I have filed, will file, or am filing with this form the following additional documents: 1. Florida Family Law Financial Affidavit, Florida Family Law form 12.901(d) or (e). 2. Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ *236 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.944(a), MOTION FOR TESTIMONY AND ATTENANCE OF MINOR CHILD(REN) When should this form be used? Rule 12.407, Florida Family Law Rules, provides that minor children may not be deposed (have their deposition taken) or brought to court to appear as a witness or to attend a hearing, or subpoenaed to appear at a hearing without prior order of the court. This rule applies in all cases except when there is an emergency or the case is an uncontested adoption. You should use this form to request that the court enter an order authorizing a minor child(ren) to appear at a court proceeding. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to any other party(ies) in your case, including the guardian ad litem, if one has been appointed. It is possible that there will be a hearing on your motion. The judge may want to hear the reasons you feel this motion should be granted, or the other party may object to your motion. If a hearing is required, check with the clerk of court, judicial assistant, or family law intake staff for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form, and provide a copy to any other party. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.407, Florida Family Law Rules of Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. *237 MOTION FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN) ( ) Petitioner ( ) Respondent requests that the Court enter an order authorizing one or more of the actions listed below related to the following minor child(ren): Name Birth date Age ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ [√ all that apply] ___ 1. Minor child(ren), {name(s)} _____________________________________, be subpoenaed to appear at hearing now scheduled for {date}_________. ___ 2. Minor ehild(ren), {name(s)} _____________________________________, attend deposition of {name(s)} ____________________ now scheduled for {date} ____________ at {location} _____________________________. ___ 3. Minor child(ren)'s, {name(s)} _______________________________________, deposition be taken on {date} _____________ at {location} ____________. ___ 4. Minor child(ren), {name(s)} _________________________________________, be brought to court to attend hearing now scheduled for {date} _________, at {locations} _____________________________________________________. ___ 5. Minor child(ren), {name(s)} _________________________________________, be brought to court to testify in a hearing now scheduled for {date} ____________ at {location} _________________________________________. The Court should do this because: _________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. *238 Form 12.944(b) ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. ORDER FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN) Upon motion of ( ) Petitioner ( ) Respondent for testimony or attendance of minor child(ren) in these proceedings, and the court finding that a showing of good cause has been made in support of the motion, it is ORDERED that [√ all that apply] ___ 1. Minor child(ren), {name(s)} _____________________________________, be subpoenaed to appear at hearing now scheduled for {date} ________. ___ 2. Minor child(ren), {name(s)} _____________________________________, attend deposition of {name(s)} ____________________ now scheduled for {date} _______________ at {location} ___________________________ ____________________________________________________________________. ___ 3. Minor child(ren)'s, {name(s)} ___________________________________, deposition be taken on {date} ______________ at {location} _____ ___ 4. Minor child(ren), {name(s)} _____________________________________, be brought to court to attend hearing now scheduled for {date} __________ at {location} scheduled ___ 5. Minor child(ren), {name(s)} _____________________________________, be brought to court to testify in a hearing now scheduled for {date} ___ at {location}_______________________________________________________. If the minor child or the person bringing the child is a person with a disability who needs any accommodation in order to participate in this proceeding, the child is entitled, at no cost, to the provision of certain assistance. Please contact {name} ____________________________________________________, {address} _____________________________________________, {telephone} _______, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. Conditions or limitations concerning the minor child(ren), if any, include: _____ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________. ORDERED on ____________________________________________________________. *239 __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.945(a), EMERGECY VERIFIED MOTION FOR CHILD PICK-UP ORDER When should this form be used? You may use this form to request that the court enter an order directing the sheriff or other law enforcement officer to take a minor child(ren) from the person who currently has physical possession of the child(ren) and deliver the child(ren) to your physical custody. This form should only be used in an emergency by a person who has a pre-existing legal right to physical possession of a minor child. This means that you already have a court order awarding you legal custody of the child(ren) OR you are the birth mother of one or more children born out of wedlock and no court order has addressed any other person's parental rights. Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. This form should be typed or printed in black ink. This form presumes that you want the court to enter an ex parte order without giving the other side advance notice of the hearing. You should explain your reasons for why such an ex parte order should be entered in paragraph 7 of this form. After completing this form, you should sign the form before a notary public. You should file the original, along with all of the other forms required, with the clerk of the circuit court in the county where the child(ren) is (are) physically located and keep a copy for your records. You should also ask the clerk to process your motion though their emergency procedures. What should I do next? If the court enters an order without advance notice to the other party, you should take a certified copy of the order to the sheriff's office for further assistance. You must have this form and the court's order served by personal service on the other party. You should read the court's order carefully. The order may require the sheriff to place the child(ren) somewhere other than in your physical possession. Look for directions in the order that apply to you and note the time and place of the hearing scheduled in the order. You should go to the hearing with whatever evidence you have regarding your motion. If the court will not enter an order without advance notice to the other side, you should check with the clerk of court, judicial assistant, or family law intake staff for information on the local procedure for scheduling a hearing on your motion, unless the court sets a hearing in its order denying your request for an ex parte hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923, and use personal service to notify the other party of your motion, the court's order, if any, and the hearing. Special notes ... With this form you must also file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • A certified copy of the court order showing that you have legal custody of the child(ren), if any. OR A certified copy of the Child(ren)'s birth certificate, if you are the birth mother of a child born out of wedlock and no court order addressing paternity exists. *240 OR A certified copy of any judgment establishing paternity or custody of the minor child(ren). Order ... These family law forms contain an Order to Pick-Up Minor Child(ren), Florida Family Law Form 12.945(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. EMERGENCY VERIFIED MOTION FOR CHDLD PICK-UP ORDER I, {full legal name} ______________________________________, being sworn, certify that the following information is true: 1. This is a motion to enforce existing custody rights (as an operation of law or court-ordered) regarding the following minor child(ren): Name Sex Birth date Race Physical Description _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. Currently, the child(ren) subject to this motion is (are) in the physical possession of {full legal name} ______________________ whose address or present physical location is: _________________________________________ _______________________________________________________________________ This individual's relationship to the minor child(ren) is: _______________________________________________________________________ 3. I ( ) am ( ) am not married to the person named in paragraph 2. 4. Custody status of minor child(ren). I have a superior right to custody of the minor child(ren) over the person named in paragraph 2 because: *241 [√ all that apply]: ___ a. Custody has been established by a court. A final judgment or order awarding custody of the minor child(ren) was made on {date} _________, in {name of court} _______________________________________________________ {case number} ________. This order awarded primary physical custody of the minor child(ren) to me. The final judgment or order applies to the following minor child(ren): {list of name(s) of the child(ren) or write "all"} ____ _______________________________________________________________________ A certified copy of said final judgment or order is attached, has not been modified, and is still in effect. [/ if applies] ( ) This order is an out-of-state court order which is entitled to full faith and credit enforcement under the Uniform Child Custody Jurisdiction Act and/or the federal Parental Kidnaping Prevention Act. ___ b. Custody is established as an operation of law. I am the birth mother of the minor child(ren) who was (were) born out of wedlock and there is no final judgment or order awarding custody of the following minor child(ren): {list name(s) of the child(ren) or write "all"} _____________________________ _______________________________________________________________________ _______________________________________________________________________ ___ Paternity has not been established. A certified copy of the minor child(ren)'s birth certificate is attached and has not been amended. ___ Paternity has been established. A certified copy of the final judgment of paternity, which shows no award of custody was made, is attached. This custody order has not been changed and is still in effect. ___ c. Other: _____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this motion. 6. Facts relating to the minor child(ren)'s current situation. [√ all that apply] ___ a. The person named in paragraph 2 wrongfully removed or wrongfully detained the minor child(ren) from my custody on {date} ____________ as follows: ______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. ___ b. I believe that the minor child(ren) is (are) in immediate danger of harm or removal from this court's jurisdiction while with the person named in paragraph 2 based on the following: _____________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. The current location of the minor child(ren) is: ( ) unknown ( ) believed to be at the following address(es) with the following people {list both the address and the people you believe will be there}: _____ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 7. Advance notice of this motion to the individual named in paragraph 2 should not be required because: ______________________________________________ _______________________________________________________________________ _______________________________________________________________________ *242 _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 8. If needed, I can be contacted for notice of an emergency or expedited hearing at the following addresses/locations: Name of Contact Person: _______________________________________________ Address: ______________________________________________________________ Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} ___________________________________________________ _______________________________________________________________________ Name of Contact Person: _______________________________________________ Address: ______________________________________________________________ Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} ___________________________________________________ _______________________________________________________________________ 9. Attorneys' Fees, Costs, and Suit Monies. [√ if applies] ___ I have filed this motion because of wrongful acts of the person listed in paragraph two above. I request that this Court award reasonable attorney's fees, costs, and suit monies as applicable or authorized under Florida law, the UCCJA, and other legal authorities. WHEREFORE, I request an Emergency Order to Pick-Up Minor Child(ren), without advance notice, directing all sheriffs of the State of Florida or other authorized law enforcement officers in this state or any other state to pick up the previously named minor child(ren) and deliver them to my physical custody. I understand that I am swearing or affirming under oath to the truthfulness of the claims made above and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF _____________________ Sworn to or affirmed and signed before me on ___________ by ______________. __________________________________ NOTARY PUBLIC—STATE OF FLORIDA __________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced _______________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, *243 {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ___________________________________________________________________________ Form 12.945(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER TO PICK-UP MINOR CHILD(REN) An Emergency Verified Motion for Child Pick-Up Order has been filed by ( ) Petitioner ( ) Respondent, alleging facts which under existing law are determined to be sufficient to authorize taking into custody the minor child(ren) named below. Based on this motion, this Court makes the following findings, notices, and conclusions: Jurisdiction. This Court has jurisdiction over issues surrounding the minor child(ren) listed below based on the following: [√ all that apply] ___ a. This Court exercised and continues to exercise original jurisdiction over the minor children listed below under the Uniform Child Custody Jurisdiction Act (UCCJA), specifically, section 61.1308, Florida Statutes. ___ b. A certified out-of-state custody decree has been presented to this Court with a request for full faith and credit recognition and enforcement under the Parental Kidnaping Prevention Act, 28 U.S.C. § 1738A. This Court has jurisdiction to enforce this decree under the UCCJA, specifically section 61.1328, Florida Statutes. ___ c. By operation of Florida law governing the primary custody rights of children born of out wedlock, this Court has jurisdiction over the child(ren) listed below because this (these) child(ren) was (were) born in the State of Florida and no prior court action involving the minor child(ren) has addressed a putative father's rights to custody or other parental rights. See sections 742.031 and 744.301, Florida Statutes. ___ d. Pursuant to the UCCJA, specifically section 61.133, Florida Statutes, this Court has jurisdiction to modify a custody decree of another state and has consulted with the Court who took initial jurisdiction over the minor child(ren) to determine this authority. ___ e. Other: ___________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Notice of Hearing. Because this Order to Pick-Up Minor Child(ren) has been issued without prior notice to the non-movant {name} ______________________________________, all *244 parties involved in this matter are informed that they are scheduled to appear and testify at a hearing regarding this matter on {date} ________________, at ___.m., at which time the Court will consider whether the Court should issue a further order in this case, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {name} _______ at {room name/number, location, address, city} _______________________________, Florida. If a party does not appear, this order may be continued in force, extended, or dismissed, and/or additional orders may be issued, including the imposition of court costs. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________________________, {address} ___________________________________________, {telephone} _________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. ORDER This Court ORDERS AND DIRECTS any and all sheriffs of the State of Florida (or any other authorized law enforcement officer in this state or in any other state) to immediately take into custody the minor child(ren) identified below from anyone who has possession and: ___ 1. Place the minor child(ren) in the physical custody of {name} _______ {Social Security No.} _______________, who ( ) may ( ) may not remove the minor child(ren) from the jurisdiction of this Court. OR ___ 2. Accompany the minor child(ren) to the undersigned judge, if the minor child(ren) is (are) picked up during court hours, for immediate hearing on the issue of custody. It is the intention of this Court that the nonmoving party, minor child(ren), and movant appear immediately upon service of this order before the undersigned judge, if available, or duty judge to conduct a hearing as to which party is entitled to lawful custody of the minor child(ren) at issue. It is not the intention of the court to turn over the child(ren) to the movant on an ex parte basis. Neither party should be permitted to remove the child(ren) from the jurisdiction of this Court pending a hearing. If unable to accomplish the above, the sheriff/officer shall take the child(ren) into custody and place them with the Department of Children and Families of the State of Florida pending an expedited hearing herein. OR ___ 3. Place the minor child(ren) in the physical custody of {agency} _____, who shall contact the undersigned judge for an expedited hearing. The sheriff/officer shall not delay the execution of this court order for any reason or permit the situation to arise where the nonmoving party is allowed to remove the child(ren) from the jurisdiction of this court. 4. NEITHER PARTY OR ANYONE AT THEIR DIRECTION, EXCEPT PURSUANT TO THIS ORDER, MAY REMOVE THE CHILD(REN) FROM THE JURISDICTION OF THIS COURT PENDING FURTHER HEARING. SHOULD THE NONMOVING PARTY IN ANY WAY VILATE THE MANDATES OF THIS ORDER IN THE PRESENCE OF THE LAW ENFORCEMENT OFFICER, THIS OFFICER IS TO IMMDIATELY ARREST AND INCARCERATE THE OFFENDING PARTY UNTIL SUCH TIME AS THE OFFENDING PARTY MAY BE BROUGHT BEFORE THIS COURT FOR FURTHER PROCEEDINGS. *245 All sheriffs of the State of Florida are authorized and ORDERED to serve (and/or execute) and enforce this order in the daytime or in the nighttime and any day of the week, except as limited by this order above. Except as limited by the above, if necessary, the sheriff/officer is authorized to take all reasonable, necessary, and appropriate measures to effectuate this order. The sheriff/officer shall not delay the execution of this order for any reason or permit the situation to rise where the child(ren) is (are) removed from the jurisdiction of this Court before execution of this order. The minor child(ren) is (are) identified as follows: Name Sex Birth date Race Physical Description ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Current location/address of minor child(ren) or of party believed to have possession of the minor child(ren): __________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ORDERED on {date} ___________, at {time} ___________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.946(a), MOTION FOR CIVIL CONTEMPT/ENFORCMENT When should this form be used? You may use this form to ask the court to enforce a prior court order or final judgment. What should I do next? To initiate a civil contempt/enforcement proceeding against a party who is not complying with a prior court order, you must file a motion with the court explaining what the party has failed to do. This form should be typed or printed in black ink. After completing this form, you should sign it before a notary public. You should then file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. A copy of this form must be mailed or hand delivered to any other party(ies) in your case. The court will then set a hearing. You should check with the clerk of court, judicial assistant, or family law intake staff for information on the local procedure for scheduling a hearing. Once you know the time and date of the hearing, you will need to complete Notice of Hearing (General), Florida Family Law Form 12.923, or, if applicable, Notice of Hearing (Child Support Enforcement Hearing Officer), Florida Family Law Form 12.921, or Order of Referral to General Master, Florida Family Law Form 12.920(b), which will specify a time and place for a hearing on the issue. A copy of this form must be mailed or hand delivered to the other party. At the hearing, as in any other civil proceeding, you, as the moving party, will have the burden of proving the other party has not obeyed a prior court order. Once noncompliance *246 is established, the other party will have an opportunity to show an inability to comply with the prior court order. If he or she is unable to do so, the judge may find the other party to be in contempt. If so, the judge may order appropriate sanctions to compel compliance by the other party, including jail, payment of attorneys' fees, suit money, or costs, and coercive or compensatory fines, and may order any other relief permitted by law. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. See also section 61.14, Florida Statutes. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION FOR CIVIL CONTEMPT/ENFORCEMENT ( ) Petitioner ( ) Respondent requests that the Court enter an order of civil contempt/enforcement against ( ) Petitioner ( ) Respondent in this case because: 1. A final judgment or order {title of final judgment or order} ____________ in this case was entered on {date} __________, by {court, city, and state} ______________________________________________________________________ ______________________________________________________________________ [] Check here if the judgment or order is not from this Court and attach a copy. 2. This order of the Court required the other party in this case to do or not do the following: {Explain what the other party was ordered to do or not do.} _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] Check here if additional pages are attached. 3. The other party in this case has willfully failed to comply with this order of the Court: {Explain what the other party has or has not done.} ____________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ *247 _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] Check here if additional pages are attached. 4. I respectfully request that the Court issue an order holding the above-named person in civil contempt, if appropriate, and/or providing the following relief: ___ a. enforcing the prior order or judgment; ___ b. awarding a monetary judgment; ___ c. if a monetary judgment was included in the prior order, issuing a writ of execution or garnishment or other appropriate process; ___ d. awarding prejudgment interest; ___ e. requiring the other party to pay costs in connection with this motion; ___ f. compelling compliance with the prior judgment or order of the Court; ___ g. if the other party is found to be in civil contempt, ordering a compensatory fine; ___ h. if the other party is found to be in civil contempt, ordering a coercive fine; ___ i. if the other party is found to be in civil contempt, ordering incarceration of the other party; ___ j. issuing a writ of possession for real property, writ for possession of personal property, or other appropriate writ; ___ k. awarding make-up visitation with minor child(ren) as follows {explain} ________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________; ___ l. awarding other relief {explain}: _____________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made above and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on _______________ by ____________. *248 __________________________________ NOTARY PUBLIC—STATE OF FLORIDA __________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced _________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.947(a), MOTION FOR TEMPORARY SUPPORT WITH DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form may be used by: (1) the respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); temporary custody of a minor child(ren); temporary child support; and other relief. OR (2) the petitioner in a pending action for support unconnected with a dissolution. For you to use this form, a petition for support unconnected with a dissolution of marriage must have already been filed. You should use this form to ask the court to award temporary spousal support (alimony) and/or temporary child support. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition for dissolution of marriage was filed and keep a copy for your records. What should I do next? A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. Words in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure. Special notes ... If you use paragraph 1.c. of this form to ask the court to enter a temporary injunction, the court may require you to post a bond. With this form you must also file the following, if not already filed: *249 • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), if you are asking the court to determine temporary custody of minor child(ren). • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days if not filed at the time of the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), if you are asking that temporary child support be ordered. (If you do not know the other party's income, you may file this worksheet as soon as a copy of his or her financial affidavit has been served on you.) Temporary Order ... These family law forms contain a Temporary Order for Support with Dependent or Minor Child(ren), Florida Family Law Form 12.947(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing. Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. ___________________________________________________________________________ IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. MOTION FOR TEMPORARY SUPPORT WITH DEPENDENT OR MINOR CHILD(REN) The ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support: [√ or complete all that apply] 1. Assets and Liabilities. ___ a. Award temporary exclusive use and possession of the marital home. {address} ___________________________________________________________ _____________________________________________________________________ The Court should do this because: ___________________________________ _____________________________________________________________________ _____________________________________________________________________ ___ b. Award temporary use and possession of marital assets. {Specify} ______ _____________________________________________________________________ _____________________________________________________________________ *250 The Court should do this because: _____________________________________________________________________ _____________________________________________________________________ ___ c. Enter a temporary injunction prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {Explain} ________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ The Court should do this because: ___________________________________ _____________________________________________________________________ _____________________________________________________________________ ___ d. Require temporary payment of specific marital debts. {Explain} _____ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ The Court should do this because: ___________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Child(ren). ___ a. Enter a temporary custody order for the parties' minor child(ren). It is in the best interests of the child(ren) that the primary residential parent be ( ) Petitioner ( ) Respondent ( ) undesignated ( ) rotating because: _____________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ___ b. Enter a temporary injunction prohibiting the parties from permanently removing the child(ren) from the jurisdiction of the Court. The Court should do this because: ____________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3. Support. ___ a. Award temporary child support of $ __________ per month. ___ b. Award temporary spousal support/alimony of $ __________ per month. The Court should do this because: ___________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Attorney's fees and costs. ___ a. Award temporary attorney's fees of $ ________. ___ b. Award temporary costs of $ ________. The Court should do this because: ___________________________________ _____________________________________________________________________ _____________________________________________________________________ 5. Other Relief. {specify} _____________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 6. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this motion or has been filed with the Court. 7. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932, is filed with this motion or has already been filed with the Court. *251 8. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this motion or has already been filed with the Court. I request that the Court hold a hearing on this matter and grant the relief specifically requested and any other relief this Court may deem just and proper. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Other party or his/her attorney: Name: _________________________________ Address: ______________________________ City, State, Zip: _____________________ Fax Number: ___________________________ Dated: ________________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ________________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. ___________________________________________________________________________ Form 12.947(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY ORDER OF SUPPORT WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a hearing on a Motion for Temporary Support with Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony, makes these findings of fact and ORDERS as follows: The Court has jurisdiction over the subject matter and the parties. SECTION I. MARITAL ASSETS AND LIABILITIES *252 A. Injunction. 1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital assets without the written permission of the other party or a court order. If checked here ( ), the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay all ordinary and usual expenses. 2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 3. Violation of this injunction may constitute criminal contempt of court. 4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $________________ with the clerk of this Court. B. Temporary Use of Assets. 1. The assets listed below are temporarily determined to be marital assets. Each party shall temporarily have the use of, as his/her own, the assets awarded in this section, and the other party shall temporarily have no further use of said assets. Any personal property not listed below shall be for the use of party currently in possession of that item(s), and he or she may not dispose of that item(s) without the written permission of the other party or a court order. ___________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Wife Shall Husband Have Shall Have Temporary Temporary Use Use ___________________________________________________________________________ Automobiles ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Furniture & furnishings in home ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Furniture & Furnishings elsewhere ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Jewelry ___________________________________________________________________________ Business interests ___________________________________________________________________________ ___________________________________________________________________________ Other Assets ___________________________________________________________________________ C. Temporary Responsibility for Liabilities/Debts. 1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his or her own the marital liabilities indicated below and *253 shall keep said payments current. The other party shall temporarily have no further responsibility for the payment of these debts. ___________________________________________________________________________ LIABILITIES: DESCRIPTION Current Wife Husband OF DEBT(S) Amount Shall Shall Owed Pay Pay ___________________________________________________________________________ Mortgages on real estate: (home) $ $ $ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Charge/credit card accounts ___________________________________________________________________________ ___________________________________________________________________________ Auto loan ___________________________________________________________________________ Auto loan ___________________________________________________________________________ Bank/Credit Union loans ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Money owed (not evidenced by a note) ___________________________________________________________________________ ___________________________________________________________________________ Other ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [√ all that apply] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: {address} _____________________ ______________________________________________________________________ {date or event} ______________________________________________________ ______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent may make a visit to the premises described in the paragraph above for the purpose of obtaining his or her clothing and items of personal health and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to the person granted temporary exclusive use and possession of the dwelling and at the earliest convenience of both parties. ___ 3. Other: ____________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ SECTION III. TEMPORARY CUSTODY OF AND VISITATION WITH DPENDENT OR MINOR CHILD(REN) 1. Jurisdiction. The Court has jurisdiction to determine temporary custody of and visitation with the parties' minor child(ren) listed in paragraph 2 below. 2. The parties' dependent or minor child(ren) is (are): Name Birth date ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ *254 3. Temporary Parental Responsibility for the Minor Child(ren). [√ one only] ___ a. The parties shall have temporary shared parental responsibility for the parties' minor child(ren). ( ) Mother ( ) Father shall have temporary primary residential responsibility of the minor child(ren) and the other parent shall have temporary secondary residential responsibility, as set forth in paragraph 4 below. OR The temporary primary residential parent shall be ( ) undesignated ( ) rotating with time sharing for the ( ) Mother ( ) Father as set forth in paragraph 4 below. ___ b. ( ) Mother ( ) Father shall have temporary sole parental responsibility for the parties' minor child(ren). Temporary shared parental responsibility would be detrimental the child(ren) at this time because: __________________ ______________________________________________________________________ ______________________________________________________________________ The other parent shall have temporary visitation with the parties' minor child(ren) as set forth in paragraph 4 below. 4. Temporary Secondary Residential Responsibility, Temporary Visitation, or Temporary Time Sharing with Minor Child(ren). The parent granted temporary secondary residential responsibility, visitation, or time sharing shall have: [√ one only] ___ a. reasonable visitation or time sharing with the parties' minor child(ren) after reasonable notice and as agreed to by the parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to set a specific schedule. ___ b. the following specified visitation or time sharing with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: {specify days and times} _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. no contact with the parties' minor child(ren) until further order of the Court, due to the existing conditions that are detrimental to the welfare of the minor child(ren). {explain} ___________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. Limitations on Temporary Parental Responsibility, Visitation, and Time Sharing. Neither parent shall take the child(ren) from the custody of the other parent or any child care provider or other person entrusted by the other parent with the care of the child(ren) without the agreement of the other party during the other party's time of temporary parental responsibility or temporary visitation. The above reasonable (paragraph 4.a. above) or specified (paragraph 4.b. above) temporary visitation shall be: [√ if applies] ___ a. supervised by a responsible adult who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {name} ____. *255 ___ b. at a supervised visitation center located at: {address} ___________ _____________________________________________________________________, subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) Mother ( ) Father ( ) Both. 6. Communication Arrangements for Temporary Secondary Parenting, Visitation, and Time Sharing with Child(ren). [√ if applies] ___ The parties' communications to arrange visitation or time sharing and discuss issues relating to the child(ren) (if temporary shared parenting, time sharing or visitation is provided in paragraph 3 above) are restricted as follows: ( ) telephone, ( ) fax, e-mail, or letter, ( ) A responsible person shall coordinate the visitation or time sharing arrangements of the minor child(ren). If the parties cannot agree, the responsible person shall be: {name} ________ ( ) other conditions for arrangements or discussions: {explain} ______ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as scheduled and as agreed to by the parties. The following conditions, if checked below, shall also apply. [√ all that apply] ___ a. The parties shall temporarily exchange the child(ren) at the following location(s): __________________________________________________________ _______________________________________________________________________ ___ b. The parent granted temporary secondary parenting, visitation, or time sharing shall not get out of the vehicle, and the other parent shall not approach the vehicle, during the time the child(ren) are exchanged. ___ c. A responsible person shall conduct all exchanges of the child(ren). The parent granted temporary secondary parenting, temporary visitation, or time sharing shall not be present during the exchange. If the parties' cannot agree, the responsible person shall be: {name} _______________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: ______ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ 8. Injunction Prohibiting Removing the Child(ren). The Court hereby temporarily prohibits and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor child(ren) from the State of Florida without a court order or the written consent of the other party. ___ 9. Other Temporary Provisions Relating to the Minor Child(ren). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ SECTION IV. TEMPORARY ALIMONY 1. ( ) The Court denies the request(s) for temporary alimony. OR *256 ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent, hereinafter Obligor, has/had the present ability to pay temporary alimony as follows: [√ all that apply] ___ a. Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the amount of $____________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ___________________________________________________ beginning {date} _______________. This temporary periodic alimony shall continue until modified by court order, the death of either party, or until, {date/ event} _______________________________________________________________, whichever occurs first. ___ b. Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of $________. This amount shall be paid as follows: _______ _______________________________________________________________________ _______________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the amount of $______________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ___________________________________________________ _______________________________________________________________________ beginning {date} _______________. This temporary rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} _________________________________________________________, whichever occurs first. The temporary rehabilitative plan presented demonstrated the following: ________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. Retroactive. Obligor shall pay retroactive alimony in the amount of $ ________________ for the period of {date} ____________ through {date} _______________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for awarding/denying temporary alimony are as follows: ___ a. length of the marriage of the party receiving temporary alimony: ____________ years; ___ b. age of party receiving temporary alimony: _________; ___ c. health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor ( ) other __________________________________________________ ___ d. other factors ________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ [] Check here if additional pages are attached. 3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary retroactive alimony of $ ______________, as of {date} ____________. This amount shall be paid in the amount of $ __________ per month, payable in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ___________________ _______________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay health insurance premiums for the other party not to exceed $ _____________ per month. Further, ( ) Petitioner ( ) Respondent shall pay *257 any uninsured medical costs for the other party not exceed $ ________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support). To secure the temporary alimony obligations set forth in this order, the Obligor shall temporarily maintain life insurance coverage on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as reasonably available. This temporary insurance shall be in the amount of at least $ __________ and shall remain in effect until this temporary obligation for alimony terminates. 5. Other provisions relating to temporary alimony: __________________ _________________________________________________________________________ _________________________________________________________________________ SECTION V. TEMPORARY CHILD SUPPORT 1. The Court finds that there is a need for temporary child support and that the ( ) Mother ( ) Father has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $ ________. The Father's net monthly income is $ _________. Monthly child care costs are $ ________________. Monthly health/dental insurance costs are $_____________. 2. Amount. The ( ) Mother ( ) Father (hereinafter Obligor) shall be obligated to pay temporary child support in the amount of $ ____________ per month payable ( ) in accordance with Obligor's payroll cycle, and in any event at least once a month ( ) {explain} ___________________________________________________ _______________________________________________________________________ beginning {date} ________________________, and continuing until further court order or until {date/event} ____________________________________, {explain} ____________________________________________________________. If the temporary child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: __________ _______________________________________________________________________ _______________________________________________________________________ 3. Retroactive Child Support. [√ if applies] ___ ( ) Mother ( ) Father shall pay to the other party the temporary retroactive child support of $ ______________, as of {date} ____________. This amount shall be paid in the amount of $ ______________ per month, payable in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ___________________________________________ _____________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to temporarily maintain ( ) health ( ) dental insurance coverage for the parties minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey cards showing coverage to the other party. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary uninsured medical costs for the minor child(ren) shall temporarily be assessed as follows: ( ) Shared equally by both parents. *258 ( ) Prorated according to the child support guideline percentages. ( ) Other {explain}: _________________________________________________ ______________________________________________________________________ As to these uninsured medical expenses, the party who incurs the expense shall submit request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance (to secure payment of support). To secure the temporary child support obligations in this order, ( ) Petitioner ( ) Respondent ( ) Each party shall temporarily maintain life insurance coverage, in an amount of at least $____________,, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as the sole irrevocable beneficiary(ies)( ) primary residential parent as the sole irrevocable beneficiary as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the Court orders otherwise or until {date/event} ______________________________________________________________________ ______________________________________________________________________ 6. IRS Income Tax Deduction(s). The party granted temporary primary residential responsibility or temporary sole parental responsibility of the minor child(ren) shall have the benefit of any tax deductions for the child(ren), OR if checked here, ( ) assignment of any tax deduction for the child(ren) shall be as follows: _____________________________________________________________ ______________________________________________________________________ 7. Other provisions relating to temporary child support: _________________ SECTION VI. METHOD OF PAYMENT. Obligor shall pay any temporary court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay temporary court-ordered support directly to the Central Governmental Depository in {name} ___________________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that temporary support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this temporary support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $ ______________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} _______ ______________________________________________________________________ ______________________________________________________________________ *259 AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $ ______ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of temporary payment: _____________ _______________________________________________________________________ _______________________________________________________________________ SECTION VII. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit money is (are) denied because _________________________ _______________________________________________________________________ ___ 2. The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $ ______________ in temporary attorney fees, and $_____________ in costs. The Court further finds that the temporary attorney fees awarded are based on the reasonable rate of $ ________ per hour and _______________________________________________________________________ reasonable hours. Other provisions relating to temporary attorney fees, costs, and suit money are as follows: ________________________________________ _______________________________________________________________________ _______________________________________________________________________ SECTION VIII. OTHER PROVISIONS. Other Provisions: __________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ORDERED on {date} __________, at {time} __________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _______________________________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.948(a), MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN) When should this form be used? This form may be used by: (1) the respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); and other relief. OR (2) the petitioner in a pending action for support unconnected with a dissolution. For you to use this form, a petition for support unconnected with a dissolution of marriage must have already been filed. You should *260 use this form to ask the court to award temporary spousal support (alimony). This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition for dissolution of marriage was filed and keep a copy for your records. What should I do next? A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. Words in "bold underline" in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure. Special notes ... If you use paragraph I.e. of this form to ask the court to enter a temporary injunction, the court may require you to post a bond. With this form you must also file the following, if not already filed: • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days if not filed at the time of the petition.) • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. Temporary Order ... These family law forms contain a Temporary Order for Support with No Dependent or Minor Child(ren), Florida Family Law Form 12.948(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing. Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. *261 MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN) ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support: [√ or complete all that apply] 1. Assets and Liabilities. ___ a. Award temporary exclusive use and possession of the marital home. {address} ____________________________________________________________ ______________________________________________________________________ The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ b. Award temporary use and possession of marital assets. {Specify} ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ c. Enter a temporary injunction prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {Explain} _____ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ d. Require Temporary payment of specific marital debts. {Explain} ____ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ 2. Support. Award temporary spousal support/alimony of $_____________ per month. The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ 3. Attorney's fees and costs. ___ a. Award temporary attorney's fees of $________. ___ b. Award temporary costs of $________. The Court should do this because: ____________________________________ ______________________________________________________________________ ______________________________________________________________________ 4. Other Relief. {specify} ______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 5. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932, is filed with this motion or has already been filed with the Court. *262 6. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this motion or has already been filed with the Court. I request that the Court hold a hearing on this matter and grant the relief specifically requested and any other relief this Court may deem just and proper. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________. Other party or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ __________________________________ Signature of Party Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, located at {street} __________________, {city} ______________, {state} __________, {phone} _________________, helped {name} _____________, who is the [√ one only] ___ petitioner or ___ respondent, fill out this form. Form 12.945(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a hearing on a on a Motion for Temporary Support with No Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony, makes these findings of fact and ORDERS as follows: The Court has jurisdiction over the subject matter and the parties. SECTION I. MARITAL ASSETS AND LIABILITIES A. Injunction. *263 1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital assets without the written permission of the other party or a court order. If cheeked here ( ), the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay all ordinary and usual expenses. 2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 3. Violation of this injunction may constitute criminal contempt of court. 4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $________________ with the clerk of this Court. B. Temporary Use of Assets. 1. The assets listed below are temporarily determined to be marital assets. Each party shall temporarily have the use of, as his/her own, the assets awarded in this section, and the other party shall temporarily have no further use of said assets. Any personal property not listed below shall be for the use of party currently in possession of that item(s), and he or she may not dispose of that item(s) without the written permission of the other party or a court order. ___________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Wife Shall Husband Have Shall Have Temporary Temporary Use Use ___________________________________________________________________________ Automobiles ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Furniture & furnishings in home ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Furniture & Furnishings elsewhere ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Jewelry ___________________________________________________________________________ Business interests ___________________________________________________________________________ ___________________________________________________________________________ Other Assets ___________________________________________________________________________ C. Temporary Responsibility for Liabilities/Debts. 1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his or her own the marital liabilities indicated below and shall keep said payments current. The other party shall temporarily have no further responsibility for the payment of these debts. *264 ___________________________________________________________________________ LIABILITIES: DESCRIPTION Current Wife Husband OF DEBT(S) Amount Shall Shall Owed Pay Pay ___________________________________________________________________________ Mortgages on real estate: (home) $ $ $ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Charge/credit card accounts ___________________________________________________________________________ ___________________________________________________________________________ Auto loan ___________________________________________________________________________ Auto loan ___________________________________________________________________________ Bank/Credit Union loans ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Money owed (not evidenced by a note) ___________________________________________________________________________ ___________________________________________________________________________ Other ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [√ all that apply] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: {address} _____________________ ______________________________________________________________________ {date or event} _____________________________________________ ______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent may make a visit to the premises described in the paragraph above for the purpose of obtaining his or her clothing and items of personal health and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to the person granted temporary exclusive use and possession of the dwelling and at the earliest convenience of both parties. ___ 3. Other: ____________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ SECTION III. TEMPORARY ALIMONY 1. ( ) The Court denies the request(s) for temporary alimony. OR ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent, hereinafter Obligor, has/had the present ability to pay, temporary alimony as follows: [√ all that apply] ___ a. Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the amount of $_____________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ___________________________________________________ whichever occurs first. ___ b. Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of $__________. This amount shall be paid as follows: ____ _______________________________________________________________________ _______________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the amount of $_______________ per month, payable ( ) in accordance *265 with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ___________________________________________________ _______________________________________________________________________ beginning {date} ________________. This temporary rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} __________________________________________________________ whichever occurs first. The temporary rehabilitative plan presented demonstrated the following: ________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. Retroactive. Obligor shall pay retroactive alimony in the amount of $______________ for the period of {date} _____________ through {date} ______________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for awarding/denying temporary alimony are as follows: ___ a. length of the marriage of the party receiving temporary alimony: ________ years; ___ b. age of party receiving temporary alimony: ________; ___ c. health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor ( ) other __________________________________________________; ___ d. other factors _________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ [] Check here if additional pages are attached. 3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary retroactive alimony of $______________, as of {date} _____________. This amount shall be paid in the amount of $__________ per month, payable in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ___________________ _______________________________________________________________________ beginning {date} ___________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay health insurance premiums for the other party not to exceed $________ per month. Further ( ) Petitioner ( ) Respondent shall pay any uninsured medical costs for the other party not exceed $_____________ per year. AS to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support). To secure the temporary alimony obligations set forth in this order, the Obligor shall temporarily maintain life insurance coverage on his/her life naming the obligee as the sole irrevocable beneficiary, so long as reasonably available. This temporary insurance shall be in the amount of at least $_and shall remain in effect until this temporary obligation for alimony terminates. 3. Other provisions relating to temporary alimony: _______________________ _______________________________________________________________________ _______________________________________________________________________ SECTION IV. METHOD OF PAYMENT. *266 Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. obligor shall pay temporary court-ordered support directly to the Central Governmental Depository in {name} ______________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests that temporary support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this temporary support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payment directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $_____________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: there are no minor child(ren) common to the parties AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $____________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of temporary payment: _____________ _______________________________________________________________________ _______________________________________________________________________ SECTION V. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit money is (are) denied because _______________________, ___ 2. The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $__________ in temporary attorney fees, and $__________ in costs, the Court further finds that the temporary attorney fees awarded are based on the reasonable rate of $________ per hour and ____ reasonable hours. Other provisions relating to temporary attorney fees, costs, and suit money are as follows:_________________________________________ _______________________________________________________________________ _______________________________________________________________________ SECTION VI. OTHER PROVISIONS. Other Provisions: _________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ORDERED on {date} __________, at {time} ___________. *267 __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _______________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(a), AFFIDVIT AND MOTION FOR WATVER OF FEES FOR PETITION FOR INJUNTION FOR PROTECTION When should this form be used? If you need to file a petition for an injunction for protection against domestic violence or repeat violence and you do not have enough money to pay filing fees to the clerk of the circuit court or service fees to the sheriff, you may use this form to request that the fees be waived. Later, the court will decide who, if anyone, should pay those fees. This form should be typed or printed in black ink. You should complete the first section of this form, and sign it in front of a notary public or the clerk. You should then file the original of this form with your petition for injunction for protection. You should keep a copy for your records. If have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do next? A copy of this form must be mailed, faxed and mailed, or hand delivered to the respondent in your case. Special notes ... With this form you will also need to file the following: • Family Law Financial Affidavit, Florida Family Law Form 12.901(d) or (e). IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR INJUNCTION FOR PROTECTION I, {full legal name of petitioner} _____________________________________, certify that I do not have enough money to pay filing fees to the Clerk of the Circuit Court or service fees to the sheriff or other authorized law enforcement agency and ask that, as allowed by section 741.30(2)(a) or section 784.046(3)(b), florida Statutes, the fees be waived subject to a later order of the Court about the payment of those fees. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ *268 __________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. __________________________________ NOTARY PUBLIC—DEPUTY CLERK __________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _______________________________________ CLERK'S CERTIFICATE AS TO AFFIDAVIT AND MOTION FOR WAIVER OF FEES I, ____________________________________, as Clerk of the Circuit Court, do hereby certify that I received and filed the above without payment of fees necessary to process the petition and serve the injunction, subject to a subsequent order of the court relative to the payment of such fees. CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(b), PETITION FOR INJUNCTION FOR PROTETION AGAINST DOMESTIC VILENCE When should this form be used? If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a protective order prohibiting domestic violence. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to petitioner by any of petitioner's family or household members who are residing in the same single dwelling unit with petitioner. The domestic violence laws only apply to your situation if the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren), whether or not you have ever been married or ever lived together. If the respondent is not one of the above, you should look at Petition for Injunction for Protection Against Repeat Violence, Florida Family Law Form 12.980(g), to determine if your situation will qualify for an injunction for protection against repeat violence. If you are under the age of eighteen and you have never been married or had the disabilities of nonage removed by a court, then one of your parents or your legal guardian must sign this petition with you. *269 This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it in front of a notary public or the clerk of the circuit court in the county were you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that you are a victim of domestic violence or that an imminent danger of domestic violence exists, the judge will sign an immediate Temporary Injunction for Protection Against Domestic Violence, Florida Family Law Form 12.980(d). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued "ex parte." This means that the judge has considered only the information presented by one side—YOU. The temporary injunction gives a date that you should appear in court for a hearing. At that hearing, you will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Domestic Violence, Florida Family Law Form 12.980(e), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no imminent danger of domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Family Law Form 12.980(h); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic violence forms and can give you information about local domestic violence victim assistance programs, shelters, and other related services. You may also call the Domestic Violence Hotline at 1-800-500-1119. For further information, see chapter 741, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure. Special notes ... With this form you may also need to file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), must be completed and filed if you are asking the court to determine issues of temporary *270 custody or visitation with regards to a minor child. • Notice of Social Security Number, Florida Family Law Form 12.901(j), must be completed and filed if you are asking the court to determine issues of temporary child support. • Family Law Financial Affidavit, Florida Family Law Form 12.901(d) or (e), must be completed and filed if you are seeking temporary alimony or temporary child support. Additionally, if you fear that disclosing your address to the respondent would put you in danger, you should complete Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i), and file it with the clerk of the circuit court and write "confidential" in the space provided on the petition. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE I, {full legal name} ______________________________________, being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed.. However, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for confidential Filing of Address, Florida Family Law Form 12.980(f), and write ""confidential in the space provided on this form for your address and telephone number.) 1. Petitioner currently lives at: {street address} _______________________ { city, state and zip code} ___________________________________________ Telephone Number: {area code and number} ______________________________ 2. Filing Fees [√ one only] ___ a. Petitioner is paying the filing fee and sheriffs or other authorized law enforcement agency's service fees. ___ b. Petitioner does not have enough money to pay the filing fee or service fees and is filing an Affidavit and Motion for Waiver of Fees, Florida Family Law Form 12.980(a), and a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Petitioner asks that he or she not have to pay the fees necessary to proces the petition and serve the injunction and other motions or orders needed to enforce the injunction, subject to later order(s) of the court about the payment of such fees. 3. petitioner's attorney's name, address, and telephone number is: _______ ______________________________________________________________________. (if you do not have an attorney, write ""none.") *271 SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at: {street address, city, state, and zip code} _______________________________________________________________________ ______________________________________________________________________. Respondent's Driver's License number is: {if known} _________. 2. Respondent is: [√ one only] ___ a. the spouse of Petitioner. Date of Marriage: _______________________ ___ b. the former spouse of Petitioner. Date of Marriage: ________________________________ Date of Divorce: ________________________________ ___ c. related by blood or marriage to Petitioner. Specify relationship: _________________________________________________ ___ d. a person who is or was living in one home with Petitioner, as if a family. ___ e. a person with whom Petitioner has a child in common, even if Petitioner and Respondent never were married or living together. 3. Petitioner has known Respondent since {date}__________________________. 4. Respondent's last known place of employment: __________________________ Employment address: ___________________________________________________ Working hours: ________________________________________________________ 5. Physical description of Respondent: Race: ___ Sex: Male ___ Female ___ Date of Birth: _____________________ Height: ______ Weight: ______ Eye Color: ______ Hair Color: ___________ Distinguishing marks or scars: ________________________________________ Vehicle: (make/model) ____________ Color: ____ Tag Number: ______ 6. Other names Respondent goes by (aliases or nicknames): ________________ 7. Respondent's attorney's name, address, and telephone number is: _______ _______________________________________________________________________ (If you do not know whether Respondent has an attorney, write ""unknown." If Respondent does not have an attorney, write ""none.") SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence against Respondent in this or any other court? ___ Yes ___ No If yes, what happened in that case? (include case number, if known) ________________________________________________________________ _______________________________________________________________________ 2. Has Respondent ever received or tried to get an injunction for protection against domestic violence against Petitioner? ___ Yes ___ No If yes, what happened in that case? (include case number, if known) _______________________________________________________________ _______________________________________________________________________ 3. Describe any other court case that is either going on now or that happened in the past, including a dissolution of marriage, paternity action, or child support enforcement action, between Petitioner and Respondent {include city, state, and case number, if known}: ___________________________________________ _______________________________________________________________________ *272 4. Petitioner is the victim of an act of domestic violence or has reasonable cause to believe that he or she is in imminent danger of becoming the victim of an act of domestic violence. Below is a brief description of the latest act of violence or threat of violence that causes Petitioner to honestly fear imminent domestic violence by Respondent. (Use additional sheets if necessary.) On {date} ______________, at {location} ______________________________, the Respondent ________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] check here if you are attaching additional pages to continue these facts. 5. Additional Information [√ all that apply] ___ a. Other acts or threats of domestic violence as described on attached sheet. ___ b. this or other acts of domestic violence have been previously reported to { person or agency}: __________________________________________________ ___ c. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): ___________________________________________________ ___ d. Respondent has a drug problem. ___ e. Respondent has an alcohol problem. ___ f. Respondent has a history of mental health problems. If checked, answer the following, if known. Has Respondent ever been the subject of a Baker Act proceeding? ( ) Yes ( ) No Is Respondent supposed to take medication for mental health problems? ( ) Yes ( ) No If yes, is Respondent currently taking his/her medication? ( ) Yes ( ) No SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME (Complete this section only if you want the Court to grant you temporary exclusive use and possession of the home that you share with the respondent.) 1. Petitioner claims the following about the home that Petitioner and Respondent share or that Petitioner left because of domestic violence: [√ all that apply] ___ a. Petitioner needs the exclusive use and possession of the home that the parties share at {street address} ____________________________________, {city, state, zip code} ______________________________________________. ___ b. Petitioner cannot get another safe place to live because: __________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. If kept out of the home, Respondent has the money to get other housing or may live without money at {street address} ___________________________, {city, state, zip code} ______________________________________________. *273 2. The home is: [√ one only] ___ a. owned or rented by Petitioner and Respondent jointly. ___ b. solely owned or rented by Petitioner. ___ c. solely owned or rented by Respondent. SECTION V. TEMPORARY CUSTODY OF MINOR CHILD(REN) (Complete this section only if you are seeking temporary custody of any minor child. You must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren). If you are asking the court to determine issues of temporary custody with regards to a minor child, you must also complete and file a Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f)). Note: If the paternity of the minor child(ren) listed below has not been established through either marriage or court order, the Court may deny temporary custody, visitation, and/or support. 1. Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor child(ren) whose name(s) and age(s) is (are) listed below. Name Place of Birth Birth date Sex _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. The minor child(ren) whom Petitioner is seeking temporary custody of: [√ one only] ___ a. saw the domestic violence described in this petition happen. ___ b. were at the place where the domestic violence happened but did not see it. ___ c. were not there when the domestic violence happened this time but have seen previous acts of domestic violence by Respondent. ___ d. have not witnessed domestic violence by Respondent. 3. name any other minor child(ren) who were there when the domestic violence happened. Include child(ren)'s name, age, sex, and parents' names. ___ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 4. Visitation [√ all that apply] ___ a. Petitioner requests that the Court order reasonable visitation by Respondent with the minor child(ren), as follows: ________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ b. Petitioner requests that the Court order supervised exchange of the minor child(ren) or exchange through a responsible person designated by the Court. The following person is suggested as a responsible person for purposes of such exchange. Explain: ___________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. Petitioner requests that the Court limit visitation by Respondent with the minor child(ren). Explain: ___________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ d. Petitioner requests that the Court prohibit visitation by Respondent with the minor child(ren) because petitioner genuinely fears that Respondent *274 imminently will abuse, remove, or hide the minor child(ren) from Petitioner. Explain: ______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ SECTION VI. TEMPORARY SUPPORT (Complete this section only if you are seeking financial support from the respondent. You must also complete and file a Financial Affidavit, Florida Family Law Form 12.901(d) or (e), and Notice of Social Security Number, Florida Family Law Form 12.901(j), if you are seeking child support). [√ all that apply] ___ 1. Petitioner claims a need for the money he or she is asking the Court to make Respondent pay, and Respondent has the ability to pay that money. ___ 2. Petitioner requests that the Court order Respondent to pay the following temporary alimony to Petitioner. (Petitioner must be married to Respondent to ask for temporary alimony.) Temporary Alimony Requested $________ every ( ) week ( ) other week ( ) month. ___ 3. petitioner requests that the Court order Respondent to pay the following temporary child support to Petitioner. (The respondent must be the natural parent, adoptive parent, or guardian by court order of the minor child(ren) for the court to order the respondent to pay child support.) Temporary child support is requested in the amount of $________ every ( ) week ( ) other week ( ) month. SECTION VII. INJUNCTION (this section summarizes what you are asking the Court to include in the injunction. This section must be completed.) 1. Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against domestic violence that will be in place from now until the scheduled hearing in this matter. 2. Petitioner asks the Court to enter, after a hearing has been held on this petition, a final judgment on injunction prohibiting Respondent from committing any acts of domestic violence against Petitioner and: a. prohibiting Respondent form going to or within 500 feet of any place the Petitioner lives; b. prohibiting Respondent form going to or within 500 feet of the Petitioner's place(s) of employment or school; the address of Petitioner's place(s) of employment or school is: ______________________________________________ _______________________________________________________________________ c. prohibiting Respondent from contacting Petitioner by mail, by telephone, through another person, or in any other manner; [√ all that apply] ___ d. prohibiting Respondent form going to or within 500 feet of the following place(s) Petitioner or Petitioner's minor child(ren) must go often {include address}: _____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ e. granting Petitioner temporary exclusive use and possession of the home Petitioner and Respondent share; ___ f. granting Petitioner temporary exclusive custody of the parties' minor child(ren); ___ g. establishing visitation rights with the parties' minor child(ren); ___ h. granting temporary alimony for Petitioner. ___ i. granting temporary child support for the minor child(ren); ___ j. ordering Respondent to participate in treatment, intervention, and/or counseling services; *275 ___ k. referring Petitioner to a certified domestic violence center; and any other terms the Court deems necessary for the protection of Petitioner and/or Petitioner's child(ren), including injunctions or directives to law enforcement agencies, as provided in section 741.30, Florida Statutes. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH RESPODENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I RESPONDENT APPEAR AT THE HEARING. I HAVE READ EVERY STATEMENT MADE IN THIS PETITION, AND EACH STATEMENT IS TRUE AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE UNDER PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES. _________ (initials) Dated: _______________________________ __________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ______________ by ___________. __________________________________ NOTARY PUBLIC—DEPUTY CLERK __________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ___ Form 12.980(c)(1) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER SETTING HEARING ON THE PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION *276 The Petition for Injunction for Protection Against Domestic Violence filed under section 741.30, Florida Statutes, or Repeat Violence under section 784.046, Florida Statutes, has been reviewed. This Court has jurisdiction of the parties and of the subject matter. A Temporary Injunction for Protection Against Domestic or Repeat Violence, pending the hearing scheduled below, is NOT being entered at this time but an injunction may be entered after the hearing, depending on the findings made by the Court at that time. FINDINGS The Court finds that the facts, as stated in the Petition alone and without a hearing on the matter, do not demonstrate that Petitioner is a victim of domestic or repeat violence or that Petitioner has reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic violence. Therefore, there is not a sufficient factual basis upon which the court can enter a Temporary Injunction for Protection Against Domestic or Repeat Violence prior to a hearing. A hearing is scheduled on the Petition for Injunction for Protection Against Domestic or Repeat Violence in section II of this Order. Petitioner may amend or supplement the Petition at any time to state further reasons why a Temporary Injunction should be ordered which would be in effect until the hearing scheduled below. NOTICE OF HEARING Petitioner and Respondent are ordered to appear and testify at a hearing on the Petition for Injunction for Protection Against Domestic or Repeat Violence on {date} ___________________________________________________________________, at ___ a.m./p.m. at {location} ___________________________________________. at which time the Court will consider whether a Final Judgment of Injunction for Protection Against Domestic or Repeat Violence should be entered. If entered, the injunction will remain in effect until a fixed date set by the Court or until modified or dissolved by the Court. At the hearing, the Court will determine whether other things should be ordered, including who should pay the filing fees and costs. If Petitioner and/or Respondent do not appear, orders may be entered, including the imposition of court costs or an injunction. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________________________, {address} _____________________, {telephone} ____________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. Nothing in this order limits Petitioner's rights to dismiss the petition. ORDERED on __________________________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner: ___ by hand delivery in open Court ___by U.S. mail Respondent: ___ forwarded to sheriff for service Other: ______________________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ____________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT *277 (SEAL) By: ______________________________ Deputy Clerk Form 12.980(c)(2) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER DENYING PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE OR ( ) REPEAT VIOLENCE The Court has reviewed the Petition for Injunction for Protection Against Domestic or Repeat Violence filed in this cause and finds that the Petitioner has failed to comply with one or more statutory requirements applicable to that petition including the following: ___ 1. Petitioner has failed to allege in a petition directed to domestic violence that Respondent is a member of Petitioner's family or resides in the same dwelling unit with Petitioner. ___ 2. Petitioner has used a petition form other than that which is approved by the Court and the form used lacks the statutorily required components. ___ 3. Petitioner has failed to complete a mandatory portion of the petition. ___ 4. Petitioner has failed to sign the petition. ___ 5. Petitioner has failed to allege facts sufficient to support the entry of an injunction for protection against domestic or repeat violence because: _____ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ___ 6. Other: ___________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ It is therefore, ORDERED AND ADJUDGED that the Petition is denied without prejudice to amend or supplement the petition to cure the above stated defects. ORDERED ON _________________. __________________________________ CIRCUIT JUDGE COPIES TO: Petitioner: ___ by hand delivery in open Court ___by U.S. mail *278 I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of _________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk Form 12.980(d) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter under the laws of Florida. "IT IS INTENDED THAT THIS PROTECTION ORDER MEET THE RQUIREMENTS OF 18 U.S.C. § 2265 AND THEREFORE INTENDED THAT IT BE ACCORDED FULL FAITH AND CREDIT BY THE COURT OF ANOTHER STATE OR INDIAN TRIBE AND ENFORCED AS IF IT WERE THE ORDER OF THE ENFORCING STATE OR OF THE INDIAN TRIBE." NOTICE OF HEARING Because this Temporary Injunction for Protection Against Domestic Violence has been issued without prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date} ________________, at __________ a.m./p.m., when the Court will consider whether the Court should issue an Injunction for Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {name} ___________, at {room name/number, location, address, city} _______________ _________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________________________, {address} ___________________________________________, {telephone} _______, *279 within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771. FINDINGS The statements made under oath by Petitioner make it appear that section 741.30, Florida Statutes, applies to the parties. It also appears that Petitioner is a victim of domestic violence by Respondent, and/or Petitioner has reasonable cause to believe he/she is in imminent danger of becoming a victim of domestic violence by Respondent, and that irreparable harm and injury will probably occur in the form of violence to Petitioner or persons lawfully with Petitioner unless this injunction is issued without notice. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may subject Respondent to criminal prosecution, including the imposition of a fine, jail, or both, as provided by Florida Statutes. In addition, it is a federal criminal felony offense to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262. The criminal penalty for violating this section is incarceration of up to life imprisonment, depending on the nature of the violation. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members who are residing in the same single dwelling unit with Petitioner. 2. No Contact. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ___ or place where Petitioner attends school {list address of school} ____; _______________________________________________________________________ or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _______________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [Initial if applies; Write N/A if not applicable] *280 ___ Petitioner and Respondent are employed by the same employer, work at the same physical location, or attend the same school. Accordingly, the following restrictions shall apply: _____________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] ___ a. Respondent shall not use or possess a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ______________ County Sheriffs Department until further order of the court. ___ c. Other directives relating to firearms and ammunition: ______________ _______________________________________________________________________ _______________________________________________________________________ NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTESTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIRARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8). 4. Additional order necessary to protect Petitioner from domestic violence: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial all that apply; write N/A if does not apply] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ________________________________ _______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may make a single visit to the premises described in the paragraph above for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the home from which these items are to be retrieved shall accompany ( ) Petitioner ( ) Respondent to the home and must stand by while he/she takes his/her personal items. The law enforcement agency shall not be responsible for storing or transporting any property. GOING TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER IS A VIOLTION OF THIS INJUNCTION. 3. Other: ________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ *281 _______________________________________________________________________ _______________________________________________________________________ TEMPORARY SUPPORT Temporary support, if requested by Petitioner in the Petition for Injunction for Protection Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on the matter. TEMPORARY CUSTODY OF MINOR CHILD(REN) 1. Jurisdiction. Jurisdiction to determine custody of any minor child(ren) listed in paragraph 2 below is proper under the Uniform Child Custody Jurisdiction Act (UCCJA). 2. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below: Name Birth date _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to custodial parent. The noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care provider or other person entrusted by the custodial parent with the care of the child(ren). 3. Type of Contract/Visitation with Minor Child(ren). The noncustodial parent shall have: [Initial if applies; write N/A if does not apply] ___ a. no contact with the parties minor child(ren) until further order of the Court ___ b. the following specified visitation with the parties' minor child(ren), subject to any limitations set out below: {specify days and times} ____________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ___ c. Neither party shall remove the minor child(ren) from the State of Florida, which is the jurisdiction of this Court, prior to the hearing on this temporary injunction. Violation of this custody order may constitute a felony of the third degree under sections 787.03 and 787.04, Florida Statutes. 4. Other Additional Provisions Relating to the Minor Child(ren). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Fforida Family Law Rule 12.610.) *282 DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION 1. The Sheriff of _____________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. 2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest for any violation of its provisions which constitutes a criminal act under section 741.31, Florida Statutes. 3. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. 4. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence. 5. This case ( ) does ( ) does not involve issues of custody, and/or visitation. As such, this injunction ( ) does ( ) does not incorporate a page pertaining to those issues. ORDERED on ___________________________ __________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of _____________ County Petitioner (or his or her attorney): ___ by U.S. Mail ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order-see below.) Respondent: ___ forwarded to sheriff for service ___ State Attorney's Office ___ Other: _______________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk *283 Form 12.980(e) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Domestic Violence under section 741.30, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. "IT IS INTENDED THAT THIS PROTECTION ORDER MEET THE RQUIREMENTS OF 18 U.S.C. § 2265 AND THEREFORE INTENDED THAT IT BE ACCORDED FULL FAITH AND CREDIT BY THE COURT OF ANOTHER STATE OR INDIAN TRIBE AND ENFORCED AS IF IT WERE THE ORDER OF THE ENFORCING STATE OR OF THE INDIAN TRIBE." HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Domestic Violence in this case should be ( ) issued ( ) modified ( ) extended. The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's ( ) Respondent's Counsel Counsel FINDINGS On {date} ___________________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of domestic violence and/or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent. INJUNCTION AND TERMS This injunction shall be in full force and effect until _________________, or until further order of the Court. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction at any time. *284 Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. In addition, it is a federal criminal felony offense to cross state lines or enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 U.S.C. § 2262. The criminal penalty for violating this section is incarceration of up to life imprisonment, depending on the nature of the violation. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to Petitioner or any of Petitioner's family or household members who is residing in the same single dwelling unit with Petitioner. 2. No Contact. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ______________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ___ _______________________________________________________________________ or place where Petitioner attends school {list address of school} ____; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _______________________________ _______________________________________________________________________ [Initial if applies; Write N/A if not applicable] ___ Petitioner and Respondent are employed by the same employer, work at the same physical location, or attend the same school. Accordingly, the following restrictions shall apply: _____________________________________________ 3. Firearms. [Initial if applies; Write N/A if not applicable] ___ a. Respondent shall not use or possess a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _________________ County Sheriffs Department. ___ c. Other directives relating to firearms and ammunition: ______________ _______________________________________________________________________ _______________________________________________________________________ NOTE: RESPONDENT IS ADVISED THAT, REGARDLESS OF THE TERMS OF THIS INJUNCTION, IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNTION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMERCE WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. § 922(g)(8). 4. Evaluation/Counseling. *285 [Initial all that apply; write N/A if does not apply] a. The Court finds that Respondent has: ___ i. willfully violated the ex parte injunction; ___ ii. been convicted of, had adjudication withheld on, or pled nolo contendere to a crime involving violence or a threat of violence; and/or ___ iii. in this state or any other state, had at any time a prior injunction for protection entered against the respondent after a hearing with notice. Note: If respondent meets any of the above enumerated criteria, the Court must order the Respondent to attend a batterers' intervention program unless it makes written factual findings stating why such a program would not be appropriate. See § 741.30(6)(d), Florida Statutes. b. Within 10 days of the date of this injunction, Respondent shall enroll in and thereafter without delay complete the following, and Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within 30 days of the date of this injunction: ___ i. A certified batterers' intervention program from a list of programs to be provided by the Court or any entity designated by the court. Respondent shall also successfully complete any substance abuse or mental health evaluation that the assessing program counselor deems necessary as a predicate to completion of the batterers' intervention program. ___ ii. A substance abuse evaluation at: ____________________________ or a similarly qualified facility and any substance abuse treatment recommended by that evaluation. ___ iii. A mental health evaluation by a licensed mental health professional at: _____________________________________________________________ or any other similarly qualified facility and any mental health treatment recommended by that evaluation. ___ iv. Other: ______________________________________________________ ___ c. Although Respondent meets the statutory mandate of attendance at a batterers' intervention program, the Court makes the following written findings as to why the condition of batterers' intervention program would be inappropriate: _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ d. Petitioner is referred to a certified domestic violence center and is provided with a list of certified domestic violence centers in this circuit, which Petitioner may contact. 5. Court Costs. Pursuant to section 741.30(2)(a), Florida Statutes, filing fees to the Clerk of the Circuit Court and service fees to the sheriff are waived, subject to subsequent order of the Court; OR costs in the amount of $_____ for the filing fee, plus $_____ for the sheriffs fee, for a total of $_____ are taxed against ( ) Petitioner ( ) Respondent ( ) Other (explain) _________________, for which sum let execution issue. This amount shall be paid to the {county} _____________ Clerk of the Circuit Court, within 30 days of the date of this injunction. If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to Petitioner, upon payment by Respondent. 6. Other provisions necessary to protect Petitioner from domestic violence: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ *286 TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME [Initial if applies; Write N/A if not applicable] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: _______________________________ ______________________________________________________________________ ___ 2. ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premised described above on _____________, at __________ a.m./p.m., accompanied by a law enforcement officer only, for the purpose of obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction over the premises shall go with ( ) Petitioner ( ) Respondent to the home and must stand by while he/she takes his/her personal items. The law enforcement agency shall not be responsible for storing or transporting any property. GOING TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER IS A VIOLATION OF THIS INJUNCTION. ___ 3. The following other personal possessions may also be removed from the premises at this time: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ___ 4. Other: ___________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ TEMPORARY CUSTODY OF AND VISITATION WITH MINOR CHILD(REN) 1. Jurisdiction. Jurisdiction to determine custody of and visitation with any minor child(ren) listed in paragraph 2 below is proper under the Uniform Child Custody Jurisdiction Act (UCCJA). 2. Temporary Custody of Minor Child(ren). ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below: Name Birth date _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Law enforcement officers shall use any and all reasonable and necessary force to physically deliver the minor child(ren) listed above to custodial parent. The noncustodial parent shall not take the child(ren) from the custody of custodial parent or any child care provider or other person entrusted by the custodial parent with the care of the child(ren). 3. Type of Contact/Visitation with Minor Child(ren). The noncustodial parent shall have: [Initial one only] ___ a. no contact with the parties minor child(ren) until further order of the Court. ___ b. the following specified visitation with the parties' minor child(ren), subject to any limitations set out below: {specify days and times} ____________ _______________________________________________________________________ *287 _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 4. Limitations on Visitation. The above specified visitation shall be: [Initial all that apply; write N/A if does not apply] ___ a. unsupervised. ___ b. supervised by the following specified responsible adult: ___________ ___ c. at a supervised visitation center located at: ______________________ _______________________________________________________________________ and shall be subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) custodial parent ( ) noncustodial parent ( ) both: _________________________________________ _______________________________________________________________________ 5. Arrangements for Contact/Visitation with Minor Child(ren). [Initial all that apply; write N/A if does not apply] ___ a. A responsible person shall coordinate the visitation arrangements of the minor chikl(ren). If specified, the responsible person shall be: {name} _________________ ___ b. Other conditions for visitation arrangements as follows: ___________ _______________________________________________________________________ _______________________________________________________________________ 6. Exchange of Minor Child(ren). If the exchange does not take place at school or day care, then: [Initial all that apply; write N/A if does not apply] ___ a. The parties shall exchange the child(ren) at the following location(s): __ _______________________________________________________________________ _______________________________________________________________________ ___ b. A responsible person shall conduct all exchanges of the child(ren). The noncustodial parent shall not be present during the exchange. If specified, the responsible person shall be: {name} ___________________________________ ___ c. Other conditions for visitation exchange as follows: _______________ _______________________________________________________________________ _______________________________________________________________________ 7. Other Additional Provisions Relating to the Minor Child(ren). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ TEMPORARY SUPPORT 1. Temporary Alimony. ___ a. The court finds that there is a need for temporary alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay temporary alimony to ( ) Petitioner ( ) Respondent *288 (hereinafter Obligee in the amount of $______________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ______________________________________ _______________________________________________________________________ beginning {date} ________________. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until the Obligee dies, until this injunction expires, or until {date} ______________, whichever occurs first. ___ b. ( ) Petitioner ( ) Respondent shall be required to maintain health insurance coverage for the other party. Any uncovered medical costs for the party awarded alimony shall be assessed as follows: _________________________ _______________________________________________________________________ ___ c. Other provisions relating to alimony: _______________________________________________________________________ _______________________________________________________________________ 2. Temporary Child Support. ___ a. The Court finds that there is a need for temporary child support and that the noncustodial parent (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by ( ) Petitioner ( ) Respondent are correct OR the Court makes the following findings: The Petitioner's net monthly income is $____________, (Child Support Guidelines ______%). The Respondent's net monthly income is $______________, (Child Support Guidelines ______%). Monthly child care costs are $____________, Monthly health/dental insurance costs are __________ $____________. ___ b. Amount. Obligor shall pay temporary child support in the amount of $____________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: _______________________________________________________________________ _______________________________________________________________________ beginning {date} ________________, and continuing until further order of the court, or until {date/event} _________________________________________, {explain} _____________________________________________________________ If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: ____________________ _______________________________________________________________________ ___ c. ( ) Petitioner ( ) Respondent shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren) so long as reasonably available. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ___ d. Any reasonable and necessary uninsured medical costs for the minor child(ren) shall be assessed as follows: ______________________________ _______________________________________________________________________ ___ e. Other provisions relating to child support: ________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Method of Payment. [Initial one only] ___ a. Obligor shall pay any temporary child support/alimony ordered through income deduction, and such support shall be paid to the central governmental depository in _____________ County. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until child supporValimony payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice, Obligor is responsible for making timely payments directly to the central governmental depository. *289 ___ b. Temporary child support/alimony shall be paid through the central governmental depository in the office of the {name of county} _________________ County Clerk of Circuit Court. The Obligor shall also pay the central governmental depository service charge. Income deduction is not in the best interests of the child(ren) because: __________________ _______________________________________________________________________ _______________________________________________________________________ OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION 1. This injunction is valid in all counties of State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest for any violation of its provisions, except those regarding child support and/or alimony, which constitutes a criminal act under section 741.31, Florida Statutes. When inconsistent with this order, any subsequent court order issued under Chapter 61, Florida Statutes, shall take precedence over this order on all matters relating to property division, alimony, child custody, or child support. 2. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. 3. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation, or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence. 4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction. 5. The temporary injunction, if any, entered in this case is dissolved. 6. This case ( ) does ( ) does not involve issues of support, custody, and/or visitation. As such, this injunction ( ) does ( ) does not incorporate pages pertaining to those issues. ORDERED on _______________________ __________________________________ CIRCUIT JUDGE COPIES TO: *290 Sheriff of ______________ County Petitioner (or his or her attorney): ___ by U.S. Mail ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order—see below.) Respondent (or his or her attorney): ___ forwarded to sheriff for service ___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order—see below.) ___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of a certified copy of this injunction.) ___ State Attorney's Office ___ Batterer's intervention program (if ordered) ___ Domestic Relations Depository, Clerk of Circuit Court (if ordered) ___ Department of Revenue ___ Other: _______________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______. County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} ____________________________, acknowledge receipt of a certified copy of this Injunction for Protection. __________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent} ____________________________, acknowledge receipt of a certified copy of this Injunction for Protection. __________________________________ Respondent Form 12.980(f) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and *291 __________________________________, Respondent. ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( )REPEAT VIOLENCE [√ all that apply] ___ Petitioner failed to appear at the hearing scheduled in this cause. ___ Petitioner appeared at the hearing but desires to voluntarily dismiss this action. ___ The evidence presented is insufficient under Florida law (section 741.30 or 784.046, Florida Statutes) to allow the Court to issue an injunction for protection against domestic or repeat violence. Accordingly, the case is dismissed without prejudice. ___ Petitioner shall pay filing fees to the Clerk of the Circuit Court for a total of $____________, for which sum let execution issue. This amount shall be paid to the {county} _____________________________________________________ Clerk of the Circuit Court, within 30 days of the date of this order. ORDERED on ___________________________ __________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of C___________ County Petitioner ___ by U.S. Mail ___ by hand delivery in open court Respondent ___ by U.S. Mail ___ by hand delivery in open court ___ State Attorney's Office ___ Other: _______________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(g), PETITION FOR INJUNCTION FOR PROTETION AGAINST REPEAT VILENCE When should this form be used? If you or a member of your immediate family are a victim of repeat violence, you can use this form to ask the court for a protective order prohibiting repeat violence. Repeat violence means that two incidents of violence have been committed against you or a member of your immediate family by another person, one of which must have been within 6 months of filing this petition. Repeat violence includes assault, battery, sexual battery, or stalking. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. If the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your *292 child(ren), whether or not you have ever been married or ever lived together, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Family Law Form 12.980(b), rather than this form. If you are under the age of eighteen and have never been married or had the disabilities of nonage removed by a court, one of your parents or your legal guardian must sign this petition with you. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it the presence of a notary or in front of the clerk of the circuit court in the county were you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that you or a member of your immediate family are a victim of repeat violence and that an immediate and present danger of repeat violence to you or that family exists, the judge will sign a Temporary Injunction for Protection Against Repeat Violence, Florida Family Law Form 12.980(l). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. The temporary injunction is issued "ex parte." This means that the judge has considered only the information presented by one side—YOU. Section I of the temporary injunction gives a date that you should appear in court for a hearing. You will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue a Final Judgment of Injunction for Protection Against Repeat Violence, Florida Family Law Form 12.980(m), which will remain in effect for a specific time period or until modified or dissolved by the court. If you and/or the respondent do not appear, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied on the grounds that it appears to the court that no immediate and present danger of repeat violence exists, the court will set a full hearing on your petition. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection, Florida Family Law Form 12.980(h); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary forms. For further information, see section 784.046, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure. *293 IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE I, {full legal name} ______________________________________, being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed.) 1. Petitioner currently lives at: {address, city, state, zip code}________ _______________________________________________________________________ 2. Filing Fees [√ one only] ___ a. Petitioner is paying the filing fee and sheriffs (or other authorized law enforcement agency's) service fees. ___ b. Petitioner does not have enough money to pay the filing fee or service fees and is filing an Affidavit and Motion for Waiver of Fees, Florida Family Law Form 12.980(a), and a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Petitioner asks that he/she not have to pay the fees necessary to process the petition and serve the injunction and any motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the payment of such fees. 3. Petitioner's attorney's name, address, and telephone number is: _______ _______________________________________________________________________ (If you do not have an attorney, write "none.") SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at: {address, city, state, and zip code} ___ ______________________________________________________________________. Respondent's Driver's License number is: {if known} __________________. 2. Petitioner has known Respondent since {date} _________________________. 3. Respondent's last known place of employment: __________________________ Employment address: ___________________________________________________ Working hours: ________________________________________________________ 4. Physical description of Respondent: Race: ______ Sex: Male ___ Female ____ Date of Birth: _________________ Height: ______ Weight: ______ Eye Color: ______ Hair Color: ___________ Distinguishing marks and/or scars: ____________________________________ *294 Vehicle: (make/model) _________________ Color: ________ Tag Number: ______ 5. Other names Respondent goes by (aliases or nicknames): _________________ 6. Respondent's attorney's name, address, and telephone number is: ________ _______________________________________________________________________. (If you do not know whether Respondent has an attorney, write "unknown." If Respondent does not have an attorney, write "none.") SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Has Petitioner ever received or tried to get an injunction for protection against repeat violence against Respondent in this or any other court? ___ Yes ___ No If yes, what happened in that case? {include case number, if known} _________________________________________________________________ ________________________________________________________________________ 2. Has Respondent ever received or tried to get a repeat violence injunction for protection against Petitioner? ___ Yes ___ No If yes, what happened in that case? (include city, state, and case number, if known) _________________________________________________ ________________________________________________________________________ 3. Describe any other court case that is either going on now or that happened in the past between Petitioner and Respondent (include case number, if known): ________________________________________________________________________ ________________________________________________________________________ 4. Respondent has directed at least two incidents of "violence," meaning assault, battery, sexual battery, or stalking against Petitioner or a member of Petitioner's immediate family. One of these two incidents of "violence" has occurred within 6 months of the date of filing of this petition. The most recent incident (including date and location) is described below. On {date} __________________________, at {location} __________, Respondent _____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. 5. Other prior incidents (including dates and location) are described below: On {date} __________________________, at {location} _____________________, Respondent _____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ *295 ________________________________________________________________________ ________________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. 6. Petitioner genuinely fears repeat violence by Respondent. Explain: ___ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. Additional Information [√ all that apply] ___ a. Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): _____________________________________________ _______________________________________________________________________ ___ b. This or prior acts of repeat violence have been previously reported to: { person or agency} __________________________________________________. SECTION IV. INJUNCTION (This section must be completed.) 1. Petitioner asks the Court to enter an injunction prohibiting Respondent from committing any acts of violence against Petitioner and: a. prohibiting Respondent from going to or within 500 feet of any place Petitioner lives; b. prohibiting respondent from going to or within 500 feet of Petitioner's place(s) of employment or the school that Petitioner attends; the address of Petitioner's place(s) of employment and/or school is __________________ ______________________________________________________________________; c. prohibiting Respondent from contacting Petitioner by mail, by e-mail, in writing, through another person, or in any other manner; d. ordering Respondent not to use or possess any guns or firearms; [√ all that apply] ___ e. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's immediate family must go to often: ____ _______________________________________________________________________ _____________________________________________________________; and any other terms the Court deems necessary for the safety of Petitioner and Petitioner's immediate family. I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH THE RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST APPEAR AT THE HEARING. I UNDERSTAND THAT I AM SWEARING OR AFFIRMING UNDER OATH TO THE TRUTHFULNESS OF THE CLAIMS MADE IN THIS PETITION AND THAT THE PUNISHMENT FOR KNOWINGLY MAKING A FALSE STATEMENT INCLUDES FINES AND/OR IMPRISONMENT. Dated: _______________________________ __________________________________ Signature of Petitioner Printed Name: ____________________ Address: _________________________ City, State, Zip: ________________ Telephone Number: ________________ Fax Number: ______________________ *296 STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. __________________________________ NOTARY PUBLIC—DEPUTY CLERK __________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(h), SUPPLMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION When should this form be used? You may use this form if your Petition for Injunction for Protection Against Domestic Violence, Florida Family Law Form 12.980(b), or your Petition for Injunction for Protection Against Repeat Violence, Florida Family Law Form 12.980(g), was denied by the judge. You should use this supplemental affidavit to add facts or clarify the facts you wrote in your original petition. For a domestic violence case, you should include FACTS that establish that you have been a victim of violence or are in imminent danger of becoming a victim of violence from the respondent. For a repeat violence case, you should include FACTS that establish that you or a member of your immediate family have or has been a victim of at least two prior incidents of violence, that one of those incidents occurred within the last six months and that there is an immediate and present risk of danger to you or a member of your.immediate family. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with the clerk in the county where the petition was filed and keep a copy for your records. What should I do next? After you complete this supplemental affidavit, the clerk will attach it to your original petition and all the documents will be submitted to the judge as your "Amended Petition." IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE *297 I, {full legal name} ______________________________________, being sworn, certify that the following statements are true: 1. On {date} __________________________________, at {place and address} ____ _______________________________________________________________________ Respondent said or did the following things that hurt me or a member of my immediate family and made me afraid for my or my family member's safety: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. 2. On {date} __________________________________, at {place and address}_____ _______________________________________________________________________ the following event(s) took place: ____________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. 3. ___ Check here if you are attaching copies of medical records for treatment you may have received for injuries referred to in your petition or in this supplemental affidavit, or copies of any police or sheriff reports concerning incidents of violence involving you and Respondent. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this supplemental affidavits and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ __________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF __________________ Sworn to or affirmed and signed before me on ____________ by _________, __________________________________ NOTARY PUBLIC—DEPUTY CLERK *298 __________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(i), PETITIOER'S REQUEST FOR CONFIDETIAL FILING OF ADDRESS When should this form be used? If you are the petitioner in a petition for injunction for protection against domestic violence action and you fear that disclosing your address to the respondent would put you in danger, you should complete this form and file it with the clerk of the circuit court. You cannot use this form in a petition for injunction for protection against repeat violence action. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and keep a copy for your records. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ __________________________________, Petitioner, and __________________________________, Respondent. PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, {full legal name} ___________________________________, Petitioner in the above injunction for protection against domestic violence action, request that the Court maintain and hold as confidential, the following address: Address____________________________________________________________________ ___________________________________________________________________________ City__________________________ State__________________________ Zip _____ ________________________________ Telephone (area code and number) This request is being made for the purpose of keeping the location of my residence unknown to Respondent for safety reasons pursuant to section 741:30, Florida Statutes. Dated: _______________________________ __________________________________ Signature of petitioner CLERK'S CERTIFICATE AS TO PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, ___________________________________, as Clerk of the Circuit Court, do hereby certify that I received and filed the above and will keep the above address confidential, subsequent to further order of the Court relative to such confidentiality. *299 CLERK OF THE CIRCUIT COURT (SEAL) By: ______________________________ Deputy Clerk INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.980(j), SUPLEMENTAL PETITION FOR ETENSION OF INJUNCTION FOR PROTECTION AGAINST DOMETIC VIOLENCE OR REPEAT VILENCE When should this form be used? If you are the petitioner on a previously entered injunction for protection against domestic violence or repeat violence and that injunction will soon expire, you may use this form to request that the court extend the injunction. You must file a petition for extension BEFORE the previously entered order expires. This form should be typed or printed in black ink. After completing this form, you should sign it before a notary public or the clerk of the circuit court. You should then file the original with the clerk in the county where the petition was filed and keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do next? For your case to proceed, you will need to set a hearing on your petition. You must properly notify the other party of the petition and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. You will need to use personal service to deliver a copy of your petition and Notice of Hearing to the respondent. You will need to appear at the hearing on your petition. After the hearing, if the judge grants your petition, he or she will prepare an Order Extending Injunction for Protection Against Domestic Violence of Repeat Violence, Florida Family Law Form 12.980(n). After the judge signs the order, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the previously entered injunction AND a certified copy of the order extending that injunction with you at all times. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic or repeat violence forms and will answer any question that you may have. Special notes ... With this form you may also file the following: • Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(l), if your petition is for protection against domestic violence and you wish to keep your address confidential. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ________________________ Division: ________________________ *300 __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL PETITION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( )REPEAT VIOLENCE I, {full legal name} ______________________________________, being sworn, certify that the following statements are true: SECTION 1. PETITIONER (This section is about you. It must be completed. However, if this is a domestic violence case and you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address. Florida Family Law Form 12.980(i), and write "confidential" in the space provided on this form for your address and telephone number.) 1. Petitioner currently lives at: {street address} _______________________ {city, state and zip code} ____________________________________________ Telephone Number: {area code and number} ______________________________ 2. Filing Fee [√ one only] ___ a. Petitioner is paying the filing fee and sheriffs (or other authorized law enforcement agency's) services fees. ___ b. Petitioner does not have enough money to pay the filing fee or service fees and files an Affidavit and Motion for Waiver of Fees, Florida Family Law Form 12.980(a), and a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Petitioner asks that he/she not have to pay the fees necessary to process the petition and serve the injunction and any motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the payment of such fees. 3. Petitioner's attorney's name, address and telephone number is: ________ _______________________________________________________________________ (If you do not have an attorney, write "none.") SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) New information about Respondent, since the current injunction was issued: (If known, write Respondent's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney's name.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ SECTION III. CASE HISTORY AND REASON FOR SEEKING EXTENSION OF INJUNCTION 1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to extend in this petition). *301 ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to modify or extend an injunction for protection in this or any other court. ___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Describe any other court cases (including city, state, and case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Petitioner requests that the previously entered injunction for protection against domestic violence or repeat violence be extended for the following specific reasons: {State why you wish the injunction to remain in effect.} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. 5. Petitioner genuinely fears the continued threat of violence by Respondent. SECTION IV. REQUESTED RELIEF 1. Petitioner understands that the Court will hold a hearing on this petition and that he or she must appear at the hearing. 2. Petitioner asks the Court to enter an order in this case that extends the previously entered injunction for a period of ( ) _________________ or ( ) until modified or dissolved by the court. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this supplemental petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Respondent STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ *302 NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced _______________ INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.980(k), SUPPLMENTAL PETITION FOR MODIFCATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE When should this form be used? This form may be used if you are a party to a previously entered injunction for protection against domestic violence or repeat violence and you want the court to modify the terms of the injunction. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or the clerk of the circuit court. You should then file the original with the clerk in the county where the original petition was filed and keep a copy for your records. You must file a petition for modification before the previously entered order expires. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do next? For your case to proceed, you will need to set a hearing on your petition. You must properly notify the other party of the petition and hearing. You should check with the clerk of court for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. You will need to use personal service to deliver a copy of your petition and the Notice of Hearing to the respondent. You will need to appear at a hearing on your petition for modification of injunction. After the hearing, if the judge grants your supplemental petition, he or she will prepare a new injunction for protection that contains the modifications. After the judge signs the new injunction, the clerk will provide you with the necessary copies. Make sure that you keep a certified copy of the new injunction with you at all times! Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" are defined in in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic or repeat violence forms and will answer any question that you may have. Special notes ... If the injunction you are seeking to modify is for domestic violence and you want the court to modify alimony, custody of a minor child(ren), or child support, you must establish that there has been a substantial change in circumstance(s) that requires this (these) modification(s). Be sure that you make these substantial change(s) clear in your supplemental petition. With this form you may also file the following: • Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i), if your petition is for domestic violence and you wish to keep your address confidential. • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), must be completed and attached if the modification(s) you are seeking involve temporary custody of any minor child(ren). *303 • Financial Affidavit, Florida Family Law Form 12.901(d) or (e), must be completed and attached if the modification) you are seeking involves temporary alimony or temporary child support. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ __________________________________, Petitioner, and __________________________________, Respondent. SUPPLEMENTAL PETITION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( )REPEAT VIOLENCE I, {full legal name} __________________________________________, being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed. However, if this is a domestic violence case and you fear that disclosing your address to the respondent would put you in danger, you should complete and file Petitioner's Request for Confidential Filing of Address, Florida Family Law Form 12.980(i), and write "confidential" in the space provided on this form for your address and telephone number.) 1. Petitioner currently lives at: {street address} _________________________________ {city, state and zip code} __________________________________________________ Telephone Number: {area code and number} ____________________________________ 2. Filing Fees [√ one only] ___ a. Petitioner is paying the filing fee and sheriffs (or other authorized law enforcement agency's) service fees. ___ b. Petitioner does not have enough money to pay the filing fee or service fees and files an Affidavit and Motion for Waiver of Fees, Florida Family Law Form 12.980(a), and a Financial Affidavit, Florida Family Law Form 12.901(d) or (e). Petitioner asks that he/she not have to pay the fees necessary to process the petition and serve the injunction and any motions or orders needed to enforce the injunction, subject to later order(s) of the Court about the payment of such fees. 3. Petitioner's attorney's name, address and telephone number is: _____________ ___________________________________________________________________________. (If you do not have an attorney, write "none.") SECTION II. NEW INFORMATION New information since the previous injunction was issued: (If known, write Respondent's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney's name.) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ *304 __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION III. CASE HISTORY AND REASON FOR SEEKING MODIFICTION OF INJUNCTION 1. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to get an injunction for protection in this or any other court (other than the injunction you are asking to modify in this petition). _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. Describe any attempts since the date of the current injunction by either Petitioner or Respondent to modify or extend an injunction for protection in this or any other court. ___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Describe any other court cases (including case numbers, if known) since the date of the current injunction between Petitioner and Respondent, including any cases involving the parties' minor child(ren), divorce, juvenile dependency, guardianship, or other civil or criminal cases. ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Petitioner requests that the previously entered injunction for protection against domestic violence or repeat violence be modified for the following specific reasons: {State why you wish the injunction to be changed.} __ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [] Check here if you are attaching additional pages to continue these facts. SECTION IV. REQUESTED RELIEF 1. Petitioner understands that the court will hold a hearing on this petition and that he or she must appear at the hearing. 2. Petitioner asks the Court to enter an order in this case, that modifies the previously entered injunction in the following ways: {State how you wish the injunction to be changed.} _____________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *305 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this supplemental petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Party STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—DEPUTY CLERK ________________________________________ [Print, type, or stamp commissioned name of notary clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________ Form 12.980(l) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ __________________________________, Petitioner, and __________________________________, Respondent. TEMPORARY INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter under the laws of Florida. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered. SECTION I. NOTICE OF HEARING Because this Temporary Injunction for Protection Against Repeat Violence has been issued without notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear and testify at a hearing regarding this matter on {date}__________, at __________ a.m./p.m., when the Court will consider whether the Court should enter an Injunction for Protection Against Repeat Violence, which shall remain in effect until modified or dissolved by the Court, and whether other things should be ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable {name} __________________________________, at {room name/number, location, address, city} ________________________________ __________________________________________________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction *306 may be continued in force, extended, or dismissed, and/or additional orders may be granted, including the imposition of court costs. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} ___________________________________, {address} __________________________________________, {telephone} ____________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771. SECTION II. FINDINGS The statements made under oath by Petitioner make it appear that section 784.046, Florida Statutes, applies to the parties, that Petitioner is a victim of repeat violence and that an immediate and present danger exists to Petitioner or to a member of Petitioner's immediate family. SECTION III. TEMPORARY INJUNCTION AND TERMS This injunction shall be effective until the hearing set above and in no event for longer than 15 days, unless extended by court order. This injunction is valid and enforceable in all counties of the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any party violating this injunction may be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, battery, sexual battery, or stalking. 2. No Contact. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} ___________________________________________________________________ ____________________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} _____ _________________________________________________________________________ or place where Petitioner attends school {list address of school} _________________________________________________________________________ _________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _______________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [Initial if applies; Write N/A if not applicable] ___ Petitioner and Respondent are employed by the same employer, work at the same physical location, or attend the same school. Accordingly, the following restrictions shall apply: __________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *307 3. Firearms. [Initial all that apply; write N/A if does not apply] ___ a. Respondent shall not use or possess a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in Respondent's possession to the ____________________ County Sheriffs Department. ___ c. Other directives relating to firearms and ammunition: ___________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Additional order(s) necessary to protect Petitioner from repeat violence: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN EFORCING THIS INJUNCTION 1. The Sheriff of ___________ County, or any other authorized law enforcement officer, is ordered to serve this temporary injunction upon Respondent as soon as possible after its issuance. 2. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest for any violation of its provisions, which constitutes a criminal act under section 784.047, Florida Statutes. 3. Should any Florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. 4. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute *308 such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence. ORDERED on ___________________________ _________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of _____________ County Petitioner ___ by U.S. Mail ___ by hand delivery Respondent: ___ forwarded to sheriff for service ___ Other: _______________________________________________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: _________________________________ Deputy Clerk Form 12.980(c)(2) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ __________________________________, Petitioner, and __________________________________, Respondent. FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE (AFTER NOTICE) The Petition for Injunction for Protection Against Repeat Violence under section 784.046, Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. The term "Petitioner" as used in this injunction includes the person on whose behalf this injunction is entered. SECTION I. HEARING This cause came before the Court for a hearing to determine whether an Injunction for Protection Against Repeat Violence in this case should be ( ) issued ( ) modified ( ) extended. The hearing was attended by ( ) Petitioner ( ) Respondent ( ) Petitioner's Counsel. ( ) Respondent's Counsel SECTION II. FINDINGS *309 On {date} _________________________________, a notice of this hearing was served on Respondent together with a copy of Petitioner's petition to this Court and the temporary injunction, if issued. Service was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of repeat violence. SECTION III. INJUNCTION AND TERMS This injunction shall be in full force and effect until {date} ____________, or until further order of the Court. This injunction is valid throughout all counties in the State of Florida. The terms of this injunction may not be changed by either party alone or by both parties together. Only the Court may modify the terms of this injunction. Either party may ask the Court to change or end this injunction. Any party violating this injunction shall be subject to civil or indirect criminal contempt proceedings, including the imposition of a fine or imprisonment, and also may be charged with a crime punishable by a fine, jail, or both, as provided by Florida Statutes. ORDERED and ADJUDGED: 1. Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any acts of violence against Petitioner, including assault, battery, sexual battery, or stalking. 2. No Contact. Unless otherwise provided herein, Respondent shall have no contact with Petitioner. Respondent shall not directly or indirectly contact Petitioner in person, by mail, e-mail, fax, telephone, through another person, or in any other manner. Unless otherwise provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner's current residence {list address} _________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {list address of current employment} ______ or place where Petitioner attends school {list address of school} _______ ___________________________________________________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ____________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [Initial if applies; Write N/A if not applicable] ___ Petitioner and Respondent are employed by the same employer, work at the same physical location, or attend the same school. Accordingly, the following restrictions shall apply: __________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Firearms. [Initial all that apply; write N/A if does not apply] ___ a. Respondent shall not use or possess a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ____________________________ County Sheriffs Department. ___ c. Other directives relating to firearms and ammunition: ___________________ ____________________________________________________________________________ ____________________________________________________________________________ *310 4. Court Costs. Pursuant to section 784.046(3)(b), Florida Statutes, filing fees to the Clerk of the Circuit Court and the service fees to the sheriff are waived, subject to subsequent order of the court; OR costs in the amount of $______ for the filing fee, plus $______ for the sheriffs fee, for a total of $______ are taxed against ( ) Petitioner ( ) Respondent ( ) Other {explain} ______________, for which sum let execution issue. This amount shall be paid to the office of the {name of county} ____________________ Clerk of the Circuit Court, within 30 days of the date of this injunction. If Respondent is directed to pay filing fees or service fees and Petitioner has previously paid said fees, the clerk shall refund same to Petitioner, upon payment by Respondent. 5. Additional order(s) necessary to protect Petitioner from repeat violence: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. OTHER SPECIAL PROVISIONS (This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida Family Law Rule 12.610.) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION V. DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION 1. This injunction is valid in all counties of the State of Florida. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest for any violation of its provision, which constitutes a criminal act under section 784.047, Florida Statutes. 2. Should any florida law enforcement officer having jurisdiction have probable cause to believe that Respondent has knowingly violated this injunction, the officer may arrest Respondent, confine him/her in the county jail without bail, and shall bring him/her before the Initial Appearance Judge on the next regular court day so that Respondent can be dealt with according to law. The arresting agent shall notify the State Attorney's Office immediately after arrest. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. 3. If Respondent violates the terms of this injunction and there has not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which the violation occurred and complete an affidavit in support of the violation or Petitioner may contact the State Attorney's office for assistance in filing an action for indirect civil contempt or indirect criminal contempt. Upon receiving such a report, the State Attorney is hereby appointed to prosecute *311 such violations by indirect criminal contempt proceedings, or the State Attorney may decide to file a criminal charge, if warranted by the evidence. 4. Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be bound by all matters occurring at the hearing and on the face of this injunction. 5. The temporary injunction, if any, entered in this case is dissolved. ORDERED on ________________________________________________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of ____________________ County Petitioner (or his or her attorney): ___ by U.S. Mail ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order—see below) Respondent (or his or her attorney): ___ forwarded to sheriff for service ___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order— see below) ___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction) ___ State Attorney's Office ___ Other: ________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ____________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ____________________________________ Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} ____________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _________________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent} _______________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _________________________________________ Respondent *312 Form 12.980(n) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ __________________________________, Petitioner, and __________________________________, Respondent. ORDER EXTENDING INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE THIS CAUSE came before the Court on {date} _____________, upon Petitioner's action for an extension of injunction for protection and it appearing to the Court as follows: ___ Ex parte. The claims in the petition for extension of injunction for protection make it appear to the Court that there is an immediate and present danger of domestic and repeat violence, as required under section 741.30 or section 784.046, Florida Statutes, the previously entered injunction is extended until {date} _______________, A full hearing on the petition is scheduled for {date} ______________ at __________ a.m./p.m. in ______________________________, To be completed if this order was entered after an ex parte hearing: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact {name} _______________, {address} __________________________________, {telephone} __________________, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. ___ After notice and hearing. Respondent was served with a copy of the temporary extension, if applicable, and a notice of this hearing within the time required by Florida law and was afforded an opportunity to be heard. The notice and opportunity to be heard were sufficient to protect Respondent's right to due process. The following persons attended the hearing: ( ) Petitioner ( ) Respondent. After hearing the testimony of each party present and of any witnesses, or upon consent of Respondent, the Court finds that Petitioner is a victim of domestic or repeat violence or reasonably fears that he/she will become a victim of violence from Respondent. The previously entered injunction is extended until {date} ________________, or until further order of the Court. ORDERED on ________________________________________________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Sheriff of ____________________ County Petitioner (or his or her attorney): ___ by U.S. Mail *313 ___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the original order—see below) Respondent (or his or her attorney): ___ forwarded to sheriff for service ___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the original order— see below) ___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails or refuses to acknowledge the receipt of certified copy of this injunction) ___ State Attorney's Office ___ Other: ________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ____________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: ____________________________________ Deputy Clerk ACKNOWLEDGMENT I, {Name of Petitioner} ____________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _________________________________________ Petitioner ACKNOWLEDGMENT I, {Name of Respondent} _______________________________, acknowledge receipt of a certified copy of this Injunction for Protection. _________________________________________ Respondent INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(a)(1), JOINT PETITION FOR ADOPTION BY STEPPARENT When should this form be used? This form should be used when a stepparent is adopting his or her spouse`s biological child. Both the stepparent and his or her spouse must sign this petition. In addition, you must obtain the written consent of the other birth parent or notify him or her of this proceeding. You must also obtain the written consent of the child, if he or she is 12 years of age or older. This form should be typed or printed in black ink. The name to be given to the child(ren) after the adoption should be used in the heading of the petition. The stepparent is the petitioner, because he or she is the one who is asking the court for legal action. After completing this form, you and your spouse must sign it before a notary public. You should then file the original and 1 copy with the clerk of the circuit court in the county where either you or the child live and keep a copy for your records. *314 What should I do next? For your case to proceed, you must have the written consent of the other birth parent or properly notify him or her of the petition and hearing. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. For more information about personal and constructive service, you should refer the "General Instructions for Pro Se Litigants" found at the beginning of these forms and the instructions to Florida Family Law Forms 12.910(a) and 12.913(a) and (b). However, the law regarding constructive service is very complex and you may wish to consult an attorney regarding that issue. The court may choose not to require consent to an adoption in some circumstances. For more information about situations where consent may not be required, see section 63.072, Florida Statutes. When you have filed all of the required forms and met the requirements for consent as outlined above, you are ready to set a hearing on your petition. You should check with the clerk of court, family law intake staff or the judicial assistant to set a final hearing. Notice of Hearing (General), Florida Family Law Form 12.923, along with a copy of the petition, must be mailed or hand delivered to all of the following: • anyone from whom consent is required if they did not give consent, or if they gave consent but later withdrew it. • any grandparent who already has court-ordered visitation rights. • a birth father whose consent is not required, by order of the court. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. See chapter 63, Florida Statutes, and Florida Family Law Rule 12.200(a)(2) for further information. Special notes ... With this petition you must file the following: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Stepparent Adoption: Consent of Adoptee, Florida Family Law Form 12.981(b), if the child to be adopted is 12 years of age or older. • Stepparent Adoption: Consent and Waiver by Parent, Florida Family Law Form 12.981(c)(1), if obtainable. • Certified copy of noncustodial birth parent's death certificate, if that parent is deceased • Certified copy of child's birth certificate. These family law forms contain a Final Judgment of Stepparent Adoption, Florida Family Law Form 12.981(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment form with you to the hearing. If so, you should type or print the heading, including the circuit, county case number, division, and the child(ren)'s names, and leave the rest blank for the judge to complete at your hearing. You should decide how many certified copies of the final judgment you will need and be prepared to obtain them after the hearing. There is a charge for certified copies, and the clerk can tell you how much. The file will be sealed after the final hearing, and then it will take an order from a judge to open the file and obtain a copy of the final judgment. AS AN ADOPTIVE STEPPARENT, YOU MAY BE LIABLE FOR CHILD SUPORT IN THE EVENT OF A LATER DIVORCE AND COULD BE LIABLE IN LITIGATION FOR THE ACTIONS OF THE ADOPTEE(S). THIS ADOPTION MAY ALSO AFFECT THE ADOPTEE'S INHERITANCE. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last *315 page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). JOINT PETITION FOR ADOPTION BY STEPPARENT Petitioner, {full legal name} ________________________________________, being sworn, joined by the birth ( ) mother ( ) father, {full legal name} __________, being sworn, files this joint petition for adoption of the above-named minor child(ren), under chapter 63, Florida Statutes. 1. This is an action for adoption of a minor child(ren) by his/her (their) stepparent. 2. I desire to adopt the following child(ren): Child's Current Name Birth date Birthplace a. ________________________________________________________________________ b. ________________________________________________________________________ c. ________________________________________________________________________ d. ________________________________________________________________________ e. ________________________________________________________________________ f. ________________________________________________________________________ A certified copy of the birth certificate(s) of the child(ren) to be adopted is (are) attached. 3. The child(ren) has (have) resided in my care and custody since {date} ___________. I wish to adopt the child(ren) because I would like to establish legally the parent-child relationship already existing between the child(ren) and me. Since the above date, I have been able to provide adequately for the material needs of the child(ren) and am able to continue doing so in the future, as well as to provide for the child(ren)'s mental and emotional well-being. My facilities and resources are as described here: a. Facilities: {describe residence} __________________________________ ____________________________________________________________________________ ____________________________________________________________________________ b. Resources: {describe employment, income and other financial resources} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. I am ____ years old, and have resided at {street address}, __________________ {city} ___________________, {county} ___________________ Florida for ___ years. 5. I married the birth ( ) father or ( ) mother of the child(ren) on {date} __________, in {city} ________________ {county} __________, Florida. The following are the dates and places of my divorces, if any: *316 Date of Divorce Place of Divorce a. ____ __________________________________________________________________ b. ____ __________________________________________________________________ 6. The adoptee's name(s) shall be: a. ________________________________________________________________________ b. ________________________________________________________________________ c. ________________________________________________________________________ d. ________________________________________________________________________ e. ________________________________________________________________________ f. ________________________________________________________________________ 7. A completed Uniform Child Custody Jurisdiction Affidavit (UCCJA), Florida Family Law Form 12.901(f), is filed with this petition. 8. The adoptee's birth father is: _________________________ _______________ Father's Name Birth date ____________________________________________________________________________ Address 9. The adoptee's birth mother is: _________________________ ____________ Mother's Name Birth date _________________________________________________________________________ Address 10. A description and estimate of the value of any property of the adoptee is as follows: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 11. Notice. If you already have given any notice to the birth parent(s) of this adoption, explain: ____________________________________________________________________________ ____________________________________________________________________________ 12. Consent. [√ all that apply] ___ a. The following are the names and addresses of persons whose consent to the adoption is required, but who have not consented: Name Address 1. ________________________________________________________________________ 2. ________________________________________________________________________ ___ b. The consent of the birth father is not required because: (√ one only] ___ 1. The minor child(ren) is (are) not the birth father's because the child(ren) was (were) previously adopted by someone else. ___ 2. The mother and father were never married, and the minor child(ren) has (have) not been established by court proceeding or valid acknowledgment of paternity to be his child(ren). ___ 3. To my knowledge, the birth father has not signed a voluntary statement of paternity in the presence of competent witnesses and has not filed such a statement with the Bureau of Vital Statistics. ___ 4. The birth father has not provided the child(ren) with support in a repetitive and customary manner. ___ 5. The birth father did not provide the mother, during her pregnancy, with emotional and financial support. ___ c. The consent of the birth parent should be excused for the following reason: *317 [√ one only] ___ 1. The birth parent has deserted the child(ren) without providing a means of his/her identification or has abandoned the child(ren). ___ 2. The birth parent's parental rights have been terminated by a court order. A copy of the order is attached. ___ 3. The birth parent has been declared incapacitated by a court order, and restoration of capacity is medically improbable. A copy of the order is attached. ___ 4. The legal guardian or lawful custodian of the ehild(ren), other than a parent, has failed to respond in writing to a request for consent for a period of 60 days, or his/her reasons for withholding consent are unreasonable. ___ 5. The former spouse's or birth parent's consent should be excused because of prolonged, unexplained absence, unavailability, incapacity, or another circumstance constituting unreasonable withholding of consent. Explain: _____________________________________________________________ ______________________________________________________________________ ___ d. The minor child(ren) is (are) 12 years of age or over, and his or her (their) consent is (are) attached. ___ e. The noncustodial birth parent died on {date } __________, in _________ County, {state} ____________. A certified copy of the death certificate is attached. WHEREFORE, I request that this Court enter a Final Judgment of Adoption of the minor child(ren) by Petitioner Stepparent and change the name of the adoptee(s). I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Stepparent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. *318 Dated: _______________________________ _________________________________________ Signature of birty ( ) mother ( ) father Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(a)(2), PETTION FOR ADOPTION OF ADULT BY STEPPARENT When should this form be used? This form should be used when a stepparent is adopting his or her spouse's adult child. You must obtain the written consent of the adult child to be adopted, as well as the written consent of his or her birth parents and spouse (if married). This form should be typed or printed in black ink. The name to be given to the adoptee after the adoption should be used in the heading of the petition. The stepparent is the petitioner, because he or she is the one who is asking the court for legal action. You must have your signature witnessed by a notary public. After completing this form, you should file the original with the clerk of the circuit court in the county where either you or the adoptee live and keep a copy for your records. What should I do next? For your case to proceed, you must have the written consent of the adoptee, his or her spouse if married, and the birth parents or properly notify each of them of the petition and hearing. If you know where they live, you must use personal service. If you absolutely do not know where they live, you may use constructive service. For more information about personal and constructive service, you should refer th "General Instructions for Pro Se Litigants" found at the beginning of these forms and the instructions to Florida Family Law Forms 12.910(a) and 12.913(a) and (b). However, the law regarding constructive service is very complex and you may wish to consult an attorney regarding that issue. The court may choose not to require consent to an adoption in some circumstances. For more information about situations where consent may not be required, see section 63.072, Florida Statutes. When you have filed all of the required forms and met the requirements for consent as *319 outlined above, you are ready to set a hearing on your petition. You should check with the clerk of court, family law intake staff, or judicial assistant to set a final hearing, and notify the other party(ies) using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. See chapter 63, Florida Statutes, and Florida Family Law Rule 12.200(a)(2) for further information. Special notes ... With this petition you must file the following: • Stepparent Adoption: Consent of Adoptee, Florida Family Law Form 12.981(b) • Stepparent Adoption: Consent of Adult Adoptee's Spouse, Florida Family Law Form 12.981(c)(2) • Stepparent Adoption: Consent of Adult Adoptee's Birth Parents, Florida Family Law Form 12.981(c)(3), if obtainable • Certified copy of Adoptee's Birth Parents' death certificates, if deceased. THIS ADOPTION MAY AFFECT THE ADOPTEE'S INHERITANCE. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). PETITION FOR ADOPTION OF ADULT BY STEPPARENT Petitioner, {full legal name} ________________________________________, files this petition for adoption of the above-named adult, pursuant to chapter 63, Florida Statutes, and states: 1. This is an action for adoption of an adult by the adult's stepparent, Petitioner. 2. I desire to adopt {adult's full legal name} ____________________________, who was born on {date} ______________, at {city, county and state} ______ ___________________________________________________________________________. 3. I desire to adopt the adult because: _______________________________________ ____________________________________________________________________________ ___________________________________________________________________________. 4. I am ___ years old, and I have resided at {address} ____________________, Florida for ___ years. *320 5. The adoptee's name shall be: ______________________________________________. 6. The adoptee's birth parents are: ___________________________________ _______________________________________ Father's Name Birth date ___________________________________ _______________________________________ Address ___________________________________ _______________________________________ Mother's Name Birth date ___________________________________ _______________________________________ Address 7. Notice. Notice to the birth parents was made by: ________________________ 8. Consent. [√ all that apply] ___ a. The consent of the adoptee is attached. ___ b. The adoptee is married to {full legal name of adoptee's spouse} ___ ___________________, and the consent of the spouse is attached. ___ c. The adoptee is not married. ___ d. The consent of ( ) _________________________, the birth mother, and ( ) _____________________________, the birth father, of the adult is (are) attached to this petition. ___ e. The birth ( ) mother ( ) father are absent, or do not consent to the adoption, and proof of service of process of this petition on the birth ( ) mother ( ) father is attached. ___ f. The birth ( ) mother ( ) father is (are) deceased. A certified copy of the death certificate(s) is (are) attached. WHEREFORE, I request that this Court enter a Final Judgment of Adoption of the adult by Petitioner Stepparent and change the name of the adoptee. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Party Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] *321 ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(b), STEPPAENT ADOPTION: CONSENT OF ADOPTEE When should this form be used? This form must be completed and signed by the person being adopted, the adoptee, if he or she is over 12 years of age. It must be signed in the presence of a notary public and two witnesses other than the notary public. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the adoption petition is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the people identified in the instructions for Joint Petition for Stepparent Adoption, Florida Family Law Form 12.981(a). Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). STEPPARENT ADOPTION: CONSENT OF ADOPTEE 1. I, {full legal name} _____________________________, being over the age of 12, consent to my adoption by {name} ____________________, to be his/her legal child and heir at law. 2. I consent to my name being legally changed to {specify} ________________. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment. *322 Dated: _______________________________ _________________________________________ Signature of Adoptee Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(c)(1), STEPARENT ADOPTION: CONSENT AND WAIVER BY PARENT When should this form be used? This form is to be completed and signed by the birth parent who is giving up all rights to and custody of the child to be adopted. It must be signed in the presence of a notary public and two witnesses other than the notary. You should file this form with the petition for adoption. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the people identified in the instructions for Joint Petition for Stepparent Adoption, Florida Family Law Form 12.981(a). Special Notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ *323 IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT 1. I, {full legal name} ________________________________________________, am the [√ one only] ( ) father or ( ) mother of the above-named child(ren), who was (were) born on {date} _________________, at {City, county, and state} _____________________________________________________. I relinquish all rights to and custody of this (these) minor child(ren), {name(s)} ________________, and consent to the adoption by Petitioner, {name} _________ ___________________________________ with full knowledge of the legal effect of the stepparent adoption. 2. I understand my legal rights as a parent, and I understand that I do not have to sign this consent and release of my parental rights. I acknowledge that this consent is being given knowingly, freely, and voluntarily. I further acknowledge that my consent is not given under fraud or duress. I understand that there is no "grace period" in Florida during which I may revoke my consent. I understand that, in signing this consent, I am permanently and forever giving up all my parental rights to and interest in this (these) child(ren). I voluntarily, permanently relinquish all my parental rights to this (these) child(ren). 3. I understand pursuant to section 63.182, Florida Statutes, that: "After one year of the entry of judgment of adoption, any irregularity or procedural defect in the proceedings is cured, and the validity of the judgment of adoption shall not be subject to direct collateral attack because of any irregularity or procedural defect. Any defect or irregularity of, or objection to, a consent that could have been cured had it been made during the proceedings shall not be questioned after the time for taking an appeal has expired." 4. I consent, release, and give up permanently, of my own free will, my parental rights to this (these) child(ren), for the purpose of adoption. 5. I waive any further notice of this adoption proceeding. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and waiver and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Parent ______________________________________ Printed Name: ___________________________ Signature of Parent Address: ________________________________ Printed Address: _____________________ City, State, Zip: _______________________ Business Address: ____________________ Telephone Number: _______________________ Home Address: ________________________ Fax Number: _____________________________ Social Security No: __________________ ______________________________________ Signature of Parent Printed Address: _____________________ Business Address: ____________________ *324 Home Address: ________________________ Social Security No: __________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(c)(2), STEPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S SPOUSE When should this form be used? This form must be completed by the spouse of an adult who is being adopted. This form should be typed or printed in black ink. After completing this form, the spouse of the adoptee should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition for adoption of an adult was filed and keep a copy for your records. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ______________________________ Division: ______________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S SPOUSE *325 1. I, {full legal name} ___________________________________________________, am the ( ) wife ( ) husband of {full legal name} ___________________, who Petitioner, {full legal name} ________________________________________ wishes to adopt. 2. I consent to the adoption of my spouse by Petitioner. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Parent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(c)(3), STEPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S BIRTH PAENTS When should this form be used? This form must be completed by the birth parents of an adult who is being adopted. This form should be typed or printed in black ink. After completing this form, the birth parents of the adoptee should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA *326 Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S BIRTH PARENT(S) 1. I/We, {full legal name(s)} __________________________________________ and ___________________________________________, are the birth ( ) mother ( ) father of {full legal name} ____________________________________________, who is 18 or more years old, and who Petitioner, {full legal name} ____________________________ wishes to adopt. 2. I/We consent to the adoption by Petitioner. 3. I/We waive any further notice of this adoption proceed. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Birth Mother Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Birth of Father Printed Name: ___________________________ Address: ________________________________ *327 City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ _________________________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(d), STEPPAENT ADOPTION AFFIDAVIT OF DILIGENT SEARCH When should this form be used? This form is to be used in a Joint Petition for Adoption by Stepparent, Florida Family Law Form 12.981(a)(1), to obtain constructive service (also called service by publication) in a stepparent adoption case. This form includes a checklist of places you can look for information on the location of the birth parent. While you do not have to look in all of these places, the court must believe that you have made a very serious effort to get information about the birth parent's location and that you have followed up any information you received. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and keep a copy for your records. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see rule 12.070, Florida Family Law Rules of Procedure and rule 1.070, Florida Rules of Civil Procedure. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ *328 Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). STEPPARENT ADOPTION: AFFIDAVIT OF DILIGENT SEARCH I, {full legal name} ___________________________________________, being sworn, certify that the following information is true: 1. I am married to the child(ren)'s birth ( ) mother ( ) father, {name} ___. 2. The last known address of the child(ren)'s other birth parent {name} __________________, as of {date} ____________________, was: ____________________________________________________________________________ Address City State Zip ______________________________ ________________________________ Telephone No. Fax No. His/her last known employment, as of {date} ___________________, was: ____________________________________________________________________________ Name of Employer ____________________________________________________________________________ Address City State Zip ______________________________ ________________________________ Telephone No. Fax No. 3. The other birth parent is over the age of 18. 4. The other birth parent's address or location is now known and cannot be determined, although I have made a reasonable effort to locate him/her through the following: [√ all that apply] ___ United States Post Office inquiry through Freedom of Information Act for current address or any relocations. ___ Last known employment of the other birth parent, including name and address of employer. You should also ask for any addresses to which W-2 Forms were mailed, and, if a pension or profit-sharing plan exists, then to what address any pension or plan payment is to be mailed. ___ Unions from which the other birth parent may have worked or that governed particular trade or craft. ___ regulatory agencies, including professional or occupational licensing. ___ names and addresses of relatives and contacts with those relatives and inquiry as to the other birth parent' last known address. You are to follow up any leads of any addresses where the other birth parent may have moved. Relatives include, but are not limited to: parents, brothers, sisters, aunts, uncles, cousins, nieces, nephews grandparents, great-grandparents, former inlaws, stepparents, stepchildren. ___ Information about the other birth parent's possible death and, if dead, the date and location. ___ Telephone listings in the last known locations of the other birth parent's residence. ___ Internet at http://www.switchboard.com or other Internet people finder, or the public library checked for ___ Law enforcement arrest and/or criminal records in the last known residential area of the other birth parent. ___ Highway Patrol records in the state of the other birth parent's last known address. *329 ___ Department of Motor Vehicle records in the state of the other birth parent's last known address. ___ Department of Corrections records in the state of other other birth parent's last known address. ___ Title IV-D (child support enforcement) agency records in the state of the other birth parent's last known address. ___ Hospitals in the last known area of the other birth parent's residence. ___ Utility companies, which include water, sewer, cable TV, and electric in the last known area of the other birth parent's residence. ___ Letters to the Armed Forces of the U.S. and their response as to whether or not there is any information about the other birth parent. (See Florida Family Law Form 12.912(a), Memorandum for Certificate of Military Service.) ___ Tax Assessor's and Tax Collector's Office in the area where the other birth parent last resided. ___ Other: {explain} _____________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. _____________________________________ NOTARY PUBLIC—STATE OF FLORIDA _____________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. *330 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.981(e), PETITION FOR ADOPTION INFORMATION When should this form be used? This form is used to request release of relevant medical or social information on an adoptee. You cannot use this form to find out the identity of birth parent(s). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the adoption took place and keep a copy for your records. Special Notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ______________________________ Division: ______________________________ IN RE: THE ADOPTION OF _____________________________________, {use name to be given to child(ren)} Adoptee(s). PETITION FOR ADOPTION INFORMATION 1. I, {full legal name} __________________, am interested in this matter as: [√ one only] ___ adult adoptee (over 18). ___ adoptive parent. ___ adult birth sibling. ___ other: {specify} _____________________________________________________. 2. The adoptee(s), {name(s)} __________________________________________________ was (were) born on {date} _________________________________________________. 3. I request nonidentifying information as to family medical history and social history of the adoptee(s) as follows: [√ all that apply] ___ If available, to be furnished to adoptive parents before finalization of the adoption. ___ If available, to be furnished to adoptee upon request after adoptee reaches majority. 4. The reason I am requesting disclosure of this information is: ___________ _________________________________________________________________________ _________________________________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Party Printed Name: ___________________________ *331 Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. Form 12.981(f) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, Adoptee(s). ORDER RELEASING ADOPTION INFORMATION This case came before the Court upon the Petition for Adoption Information, and the Court being fully advised in the premises, it is ORDERED: ___ 1. The Petitioner shall receive ___ a. nonidentifying information as to: _________________________________. ___ b. identifying information as to: ____________________________________. ___ c. all records relating to the adoption proceedings. ___ 2. The petition is denied in whole or in part because: ____________________. ORDERED on __________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: *332 Petitioner (or his or her attorney) Respondent (or his or her attorney) Form 12.981(g) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE ADOPTION OF _____________________________________, Adoptee(s). FINAL JUDGMENT OF STEPPARENT ADOPTION This matter came before the Court on the Petition for Stepparent Adoption filed in this action, and having heard testimony and considered the evidence, the Court finds that: 1. The Court has jurisdiction over the subject matter of the Petition for Adoption. 2. The Court has jurisdiction over the minor child(ren), {name(s)} ________, Petitioner, {name} _____________________________________________________, and the birth parent to whom Petitioner is married, {name} __________________________________, in that they are residents of ______________________________ County, Florida. Further, the child(ren) and Petitioner have significant connections with the State of Florida. 3. There is no pending litigation regarding the child(ren), in Florida or any other state, nor is there any other person not a party to these proceedings who has, or claims to have, physical custody or visitation rights to the minor child(ren). 4. The best interests of this (these) child(ren) would be served and promoted by this adoption, and Petitioner desires the permanent responsibility of a parent in this adoption. 5. The consent of the birth ( ) mother ( ) father who is not married to Petitioner is: [√ only one] __ attached to the petition. ___ not required because he/she is deceased. ___ waived because: [√ all that apply] ___ the parent has deserted the child(ren) without affording a means of identification. ___ the parent has abandoned the child(ren) and has not visited, supported, contacted, or communicated with the child(ren). ___ the parent has been judicially declared mentally incapacitated, and restoration of capacity is medically improbable. ___ the legal guardian or lawful custodian of the adoptee(s), other than the birth parent, has failed to respond in writing to a request for consent for 60 days, or the Court has examined the written reasons for withholding consent and has found the withholding of consent to be unreasonable. ___ other: {specify} *333 6. The best interests of the child(ren) will be promoted by this adoption. 7. The minor child(ren) is (are) suitable for adoption by Petitioner. NOW, THEREFORE, IT IS ORDERED that: 1. The minor child(ren) presently known as {name(s)} _______________________ is (are) declared to be the legal child(ren) of Petitioner, {name} _____, and is (are) given the name(s) of _______________________________________________, by which minor child(ren) shall hereafter be known. 2. The minor child(ren) shall be the child(ren) and legal heir(s) at law of Petitioner, {name} _____________________________________________________, and shall be entitled to all rights and privileges, and subject to all obligations, of children born of Petitioner. 3. All legal relations between the adoptee(s) and the noncustodial parent, and between the adoptee(s) and the relatives of that birth parent, are terminated by this adoption, as are all parental rights and responsibilities of that birth parent. 4. This Final Judgment of Adoption creates a relationship between the adoptee(s) and Petitioner and all relatives of Petitioner that would have existed if the adoptee(s) was (were) a blood descendant of the Petitioner, born within wedlock, entitled to all rights and privileges thereof, and subject to all obligations of a child being born to Petitioner. ORDERED on ________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA FAILY LAW FORM 12.982(a), PETITION FOR CHANGE OF NAME (ADULT) When should this form be used? This form should be used when an adult wants the court to change his or her name. This form is not to be used in connection with a divorce action. If you want a change of name because of a dissolution of marriage that is not yet final, the change of name should be done as part of that case. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? Next, you must obtain a hearing date for the court to consider your request. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the final hearing. Included in these forms is a Final Judgment of Change of Name (Adult), Florida Family Law Form 12.982(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant, to see if you need to bring a final judgment form with you. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. *334 If the judge grants your petition, he or she will sign this order. This officially changes your name. The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you how much those charges are. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see section 68.07, Florida Statutes. Special notes ... The heading of the form calls for the name of the petitioner. Your current name should go there, as you are the one who is asking the court for something. The judicial circuit, case number, and division may be obtained from the clerk of court's office when you file the petition. It may be helpful to compile a list of all of the people and/or places that will need a copy of your final judgment. This list may include the driver's license office, social security office, banks, schools, etc. A list will help you know how maiiy copies of your order you should get from the clerk of court after your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner. PETITION FOR CHANGE OF NAME (ADULT) I, {full legal name} ___________________________________________ being sworn, certify that the following information is true: 1. My complete present name is: ____________________________________________________________________________ I request that my name be changed to: ____________________________________________________________________________ 2. I live in _____________________ County, Florida, at {street address} ____ ____________________________________________________________________________ 3. I was born on {date} ____________, in {city} __________________, {county} _____________, {state} _______________, {country} __________________________. 4. My father's full legal name: _______________________________________________ My mother's full legal name: _______________________________________________ My mother's maiden name: ___________________________________________________ 5. I have lived in the following places since birth: Dates (to/from) Address ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ *335 ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ ________/_______ ____________________________________________________ [] Check here if you are continuing these facts on an attached page. 6. Family [√ all that apply] ___ a. I am not married. ___ b. I am married. My spouse's full legal name is: _________________________ ___ c. I do not have child(ren). ___ d. The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ [] Check here is you are continuing these facts on an attached page. 7. Former names [√ all that apply] ___ My name has never been changed by a court. ___ My name previously was changed by court order from ______________________ to _______________________________ on {date} ________________________, by {court, city, and state} ____________________. ___ A copy of the court order is attached. ___ My name previously was changed by marriage from ________________________________ to __________________________________ on {date} _______________________, in {city, county, and state} ___________. A copy of the marriage certificate is attached. ___ I have never been known or called by any other name. ___ I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} ____________________________________________________________________________ ____________________________________________________________________________ 8. Occupation My occupation is: _________________________________________________________. I am employed at: {company and address} ________________________________ ____________________________________________________________________________ During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer's address ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ ________/_______ _______________________________________________________ [] Check here if you are continuing these facts on an attached page. 9. Business [√ one only] ___ I do not own and operate a business. *336 ___ I own and operate a business. The name of the business is: _______________. The street address is: ____________________________________________________. My position with the business is: _________________________________________. I have been involved with the business since: {date} ___________________. 10. Profession [√ one only] ___ I am not in a profession. ___ I am in a profession. My profession is: ___________________________________ I have practiced this profession: Dates (to/from) Place and address ________/_______ _____________________________________________________ ________/_______ _____________________________________________________ ________/_______ _____________________________________________________ ________/_______ _____________________________________________________ ________/_______ _____________________________________________________ []Check here if you are continuing these facts on an attached page. 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School _________ ______________ _________________________________________________ _________ ______________ _________________________________________________ _________ ______________ _________________________________________________ [] Check here if you are continuing these facts on an attached page. 12. Felony Convictions [√ one only] ___ I have never been convicted of a felony. ___ I was convicted of a felony on {date} _______________________________, in {city} _______________________, {county} ______________________, {state} _______________________. [] Check here if you have been convicted of additional felonies, and explain on an attached page. 13. Bankruptcy [√ one only] ___ I was adjudicated bankrupt on {date} __________________________, in {city} ___________________, {county} _________________________, {state} [] Check here if you have filed additional bankruptcies, and explain on an attached page. 14. Creditor(s)' Judgments [√ one only] ___ I have never had a money judgment entered against me by a creditor. ___ The following creditor(s) money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case number √ if Paid ____ ______ ________ _________________________________________ [] ____ ______ ________ _________________________________________ [] ____ ______ ________ _________________________________________ [] ____ ______ ________ _________________________________________ [] [] Check here if these facts are continued on an attached page. 15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. *337 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner. FINAL JUDGMENT OF CHANGE OF NAME (ADULT) This cause came before the Court on {date}___, for a hearing on Petition for Change of Name (Adult) under section 68.07, Florida Statutes, and it appearing to the Court that: 1. Petitioner is a bona fide resident of _____________ County, Florida; 2. Petitioner's request is not for any ulterior or illegal purposes; and *338 3. granting this petition will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise; it is ORDERED that Petitioner's present name, ______________________, is changed to _______________________________________, by which Petitioner shall hereafter be known. ORDERED ON ________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.982(c), PETITION FOR CHANGE OF NAME (MINOR CHILD) When should this form be used? This form should be used when parents want the court to change the name of their minor child(ren). For the purposes of this proceeding, a person under the age of 18 is a minor. This form is not to be used in connection with an adoption or paternity action. If you want a change of name for your child(ren) because of an adoption or paternity action that is not yet final, the change of name should be done as part of that case. This form should be typed or printed in black ink. The primary petition should only be completed for one child. If you wish to change the names of more than one child, you should complete and file a Supplemental Form for Petition for Change of Name (Minor Child) for each child. The supplemental form is an attachment to the petition. Be sure that the bottom of each page of each supplemental form is initialed by the petitioner(s). After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? If both parents agree to the change of name and live in the county where the change of name is sought, you may both file as petitioners. In this situation, service is not necessary, and you need only to set a hearing. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. If only one parent is a resident of the county where the change of name(s) is sought or only one parent asks for the child(ren)'s name(s) to be changed, the other parent must be notified and his or her consent obtained, if possible. If the other parent consents to the change of name, a Consent for Change of Name (Minor Child), Florida Family Law Form 12.982(d), should be filed. If the other parent does not consent to the change of name, you may still have a hearing on the petition if you have properly notified the other parent about your petition and the hearing. If you know where he or she lives, you must use personal service. If you absolutely do not know where he or she lives, you may use constructive service. For more information about personal and constructive service, you should refer the "General Instructions for Pro Se Litigants" found at the beginning of these forms and the instructions to Florida Family Law Forms 12.910(a) and 12.913(a) and (b). However, the law regarding constructive service is very complex and you may wish to consult an attorney regarding that issue. Next, you must obtain a final hearing date for the court to consider your request. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You *339 may be required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Minor Child), Florida Family Law Form 12.982(e), which may be used when a judge grants a change of name for a minor child(ren). If you attend the hearing, you should take the final judgment with you. You should complete the top part of the form, including the circuit, county, case number, division, and the name(s) of the petitioners) and leave the rest blank for the judge to complete. It should be typed or printed in black ink. If the judge grants your petition, he or she will sign this order. This officially changes your child(ren)'s name(s). The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you how much those charges are. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see section 68.07, Florida Statutes. Special notes ... The heading of the form calls for the name(s) of the petitioner (s). This is the parent(s) who is (are) requesting the change of their child(ren)'s name(s). The judicial circuit, case number, and division may be obtained from the clerk of court's office when you file the petition. It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment. This list may include the driver's license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner/Father, _____________________________________, Petitioner/Mother. PETITION FOR CHANGE OF NAME (MINOR CHILD) I/We, {full legal name(s)} ___________________________________________, being sworn, certify that the following information is true: I am/We are the birth or legal parent(s) of the minor child(ren) named in this petition. [√ only one] ___ a. There is only one minor child named in this petition. ___ b. There are {enter number of children} ______ children named in this petition. The information on the first child is entered below. I/we have attached the completed supplemental forms for each other child. *340 THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 : 1. Minor child's complete present name is: _________________________________________________________________________ I/We request that this minor child's name be changed to: _________________________________________________________________________ 2. The minor child lives in ____________ County, Florida, at {street address} _________________________________________________________________________ 3. The minor child was born on {date} _________________, in {city, county, state, country} _________________________________________________________________ 4. The minor child's father's full legal name: ________________________________ The minor child's mother full legal name: __________________________________ The minor child's mother's maiden name: ____________________________________ 5. The minor child has lived in the following places since birth: Dates (to/from) Address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ [] Check here if you are continuing these facts on an attached page. 6. [√ one only] ___ The minor child is not married. ___ The minor child is married to: {full legal name} _______________________. 7. [√ one only] ___ The minor child has no children. ___ The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of birth} __________________________________________________. 8. Former names [√ all that apply] ___ The minor child's name has never been changed by a court. ___ The minor child's name previously was changed by court order from _______ ____________________ to _____________________ on {date} ________________. by {court, city, and state} ____________________________________________. A copy of the court order is attached. ___ The minor child's name previously was changed by marriage from __________ to ____________________ on {date} ______________________________________, in {city, county, and state} ___________________________________________. A copy of the marriage certificate is attached. ___ The minor child has never been known or called by any other name. ___ The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: __________________________________________________ ____________________________________________________________________________ 10. Felony Convictions. *341 [√ one only] ___ The minor child has never been convicted of a felony. ___ The minor child was convicted of a felony on {date} ___________, in {city} ____________________________________________________________________________ {county} _______________, {state} ________. 11. Money Judgments. [√ one only] ___ The minor child has never been adjudicated bankrupt, and no money judgment has ever been entered against him or her. ___ The following money judgment(s) has been entered against him or her: Date Amount Creditor Court entering judgment and case √ if Paid number ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S): 12. Petitioner(s) live in ________________ County, Florida, at {street address} ________________________________________________________________________. 13. I/We have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 14. My/our civil rights have never been suspended, or, if ever suspended, they have been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Petitioner/Father Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Petitioner/Mother *342 Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ____________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. Form 12.982(c), Supp. SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME MINOR CHILD) Case No.: ______________________________ THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # _____: 1. Minor child's complete present name is: _________________________________________________________________________ I/We request that minor child's name be changed to: _________________________________________________________________________ 2. The minor child lives in ________ County, Florida, at {street address} ___________________________________________________________________________. 3. The minor child was born on {date} ______________________, in {city, county, state, country} _________________________________________. 4. The minor child's father's full legal name: ________________________________ The minor child's mother's full legal name: ________________________________ The minor child's mother's maiden name: ____________________________________ 5. The minor child has lived in the following places since Dates (to/from) Address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ *343 ________/_________ ________________________________________________ ________/_________ ________________________________________________ [] Check here if you are continuing these facts on an attached page. 6. [√ one only] ___ The minor child is not married. ___ The minor child is married to: {full legal name} _______________________. 7. [√ one only] ___ The minor child has no children. ___ The minor child is the parent of the following child(ren): {enter name(s) and date(s) of birth} _______________________________________________________ 8. Former Names [√ all that apply] ___ The minor child's name has never been changed by a court. ___ The minor child's name previously was changed by court order from _______ _____________________ to ____________________ on {date} ________________, by {court, city, and state} ____________________________________________. A copy of the court order is attached. PETITIONER(S) MUST INITIAL HERE ______ ___ The minor child's name previously was changed by marriage from ___ ____________________ to _____________________ on {date} ________________, in {city, county, and state} ___________________________________________. A copy of the marriage certificate is attached. ___ The minor child has never been known or called by any other name. ___ The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} ________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: __________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 10. Felony Convictions. [√ one only] ___ The minor child has never been convicted of a felony. ___ The minor child was convicted of a felony on {date} ____________, in {city} ____________________________________________________________________________ {county} ______________________, {state} __________. 11. Money Judgments. [√ one only] ___ The minor child has never been adjucated bankrupt, and no money judgment has ever been entered against him or her. ___ the following money judgments) has (have) been entered against him or her: Date Amount Creditor Court entering judgment and case √ if Paid number ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] PETITIONER(S) MUST INITIAL HERE ______ *344 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.982(d), CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN)) When should this form be used? This form should be used when one parent consents to the other parent's petition to change the name of their minor child(ren). A parent who is not a petitioner in the case but is consenting to the change of name should complete this form and sign it in front of a notary public. This form should be typed or printed in black ink. After this form is signed and notarized, it should be filed with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. This form should be attached to the Petition for Change of Name (Minor Child), Florida Family Law Form 12.982(c), if obtained prior to the filing of the petition. Otherwise, it may be filed separately after it has been completed. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information see section 68.07, Florida Statutes, and the instructions for Petition for Change of Name (Minor Child), Florida Family Law Form 12.982(c), or Petition for Change of Name (Family), Florida Family Law Form 12.982(f). Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner. CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN)) I, {full legal name} __________________________________________, being sworn, certify that the following information is true: I am the birth or legal ( ) father ( ) mother of the minor child(ren) named in this case, and I give consent for the following name changes: Minor child(ren)'s complete present Minor child(ren)'s name(s) to be name(s): changed to: (1) _______________________________ (1) _______________________________ (2) _______________________________ (2) _______________________________ (3) _______________________________ (3) _______________________________ (4) _______________________________ (4) _______________________________ (5) _______________________________ (5) _______________________________ (6) _______________________________ (6) _______________________________ *345 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________________ _________________________________________ Signature of Consenting Parent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ________________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner, or ___ consenting parent, fill out this form. Form 12.982(e) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner/Father, _____________________________________, Petitioner/Mother. FINAL JUDGMENT OF CHANGE OF NAME (MINOR CHILD(REN)) This cause came before the Court on {date} _____________, for a hearing on Petition for Change of Name under section 68.07, Florida Statutes, and it appearing to the Court that: 1. Petitioners) is (are) a bona fide resident(s) of _____________ County, Florida: 2. ___ Petitioners are the parents of the minor child(ren) named in the petition; *346 3. ___ Petitioner is the parent of the ininor child(ren) named in the petition, and the other parent has been properly notified and has either consented or failed to respond; ___ Other: _______________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Petitioner's request is not for any ulterior or illegal purpose; and 4. granting this petition will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise; it is ORDERED that the minor child(ren)'s present name(s) be changed to (1) _______________________________ (1) _______________________________ (2) _______________________________ (2) _______________________________ (3) _______________________________ (3) _______________________________ (4) _______________________________ (4) _______________________________ (5) _______________________________ (5) _______________________________ (6) _______________________________ (6) _______________________________ by which minor child(ren) shall hereafter be known. ORDERED ON__________________________. _________________________________________ CIRCUIT JUDGE INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.982(f), PETITION FOR CHANGE OF NAME (FAMILY) When should this form be used? This form should be used when a family wants the court to change its name. This form is not to be used in connection with a divorce, paternity, or adoption action. If you want a change of name because of a dissolution of marriage, paternity, or adoption action that is not yet final, the change of name should be done as part of that ease. This form should be typed or printed in black ink. The petition should only be completed for one adult. If you wish to change the name(s) of another adult and/or child(ren), you should complete and file a Supplemental Form for Petition for Change of Name (Family) for each additional family member and file the supplemental form(s) as an attachment to the petition. Be sure that the bottom of each child's supplemental form is initialed. After completing this form, it should be signed before a notary public. You should then file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? If any of the children for whom you are requesting this change of name are not the legal children of both adults filing this petition, you must obtain the consent of the legal parent(s). A parent not named as a petitioner in this action may consent by submitting a Consent for Change of Name (Minor Child), Florida Family Law Form 12.982(d). If the other parent does not consent to the change of name, you may still have a hearing on the petition if you have properly notified the other parent about your petition and the hearing. If you know where he or she lives, you must use personal service. If you absolutely do not know where he or she lives, you may use constructive service. For more information about personal and constructive service, you should refer the "General Instructions for Pro Se Litigants" found at the beginning of these forms and the instructions *347 to Florida Family Law Forms 12.910(a) and 12.913(a) and (b). The law on constructive service is very complex and you may wish to consult an attorney regarding constructive service. Next, you must obtain a final hearing date for the court to consider your request. You should ask the clerk of court, family law intake staff, or judicial assistant about the local procedure for setting a hearing. You may be required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Family), Florida Family Law Form 12.982(g), which may be used when a judge grants a change of name for a family. If you attend the hearing, you should take the final judgment form with you. You should complete the top part of this form, including the circuit, county, case number, division, the name(s) of the petitioners) and leave the rest blank for the judge to complete. It should be typed or printed in black ink. If the judge grants your petition, he or she will sign this order. This officially changes your family's name. The clerk can provide you with certified copies of the signed order. There will be charges for the certified copies, and the clerk can tell you how much those charges are. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. For further information, see section 68.07, Florida Statutes. Special Notes ... The heading of the form calls for the name(s) of the petitioner (s). This is the parent(s) who are requesting the change of their family's name(s). The judicial circuit, case number, and division may be obtained from the clerk of court's office when you file the petition. It may be helpful to compile a list of all of the people and places that will need a copy of the final judgment. This list may include the driver's license office, social security office, banks, schools, etc. A list will help you know how many copies of your order you should get from the clerk of court after your hearing. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF _____________________________________, Petitioner/Father, _____________________________________, Petitioner/Mother. PETITION FOR CHANGE OF NAME (FAMILY) I/We, {full legal name(s)} ___________________________________________, being sworn, certify that the following information is true: *348 There are {enter number} __________ adults named in this petition. A supplemental form is attached for each adult not set out below. There are {enter number} __________ children named in this petition. I am/We are the birth or legal parents of the minor child(ren) named in this petition. I/We have attached a completed supplemental form for each minor child. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER ( ) HUSBAND ( ) WIFE: 1. My complete present name is: I request that my name be changed to: _________________________________________________________________________ 2. I live in _______________ County, Florida, at {street address} __________ _________________________________________________________________________ 3. I was born on {date} ________________, in {city} ______________, {county} __________, {state} ________________, {country} ________________________________. 4. My father's full legal name: _______________________________________________ My mother's full legal name: _______________________________________________ My mother's maiden name: ___________________________________________________ 5. I have lived in the following places since birth: Dates (to/from) Address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ 6. Family [√ all that apply] ___ a. I am not married. ___ b. I am married. My spouse's full legal name is: _________________________. ___ c. I do not have child(ren). ___ d. The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): Name {last, first, middle initial} Age Address, City, State ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ ____________________________________ _____ _______________________________ [] Check here if you are continuing these facts on an attached page. 7. Former names [√ all that apply] ___ My name has never been changed by a court. ___ My name previously was changed by court order from ________________________. to ___________________ on {date} by {court, city, and state} ____________________________________________. A copy of the court order is attached. *349 ___ My name previously was changed by marriage from _________________________ to ___________________ on {date} _______________________________________, in {city, county, and state} ___________________________________________. A copy of the marriage certificate is attached. ___ I have never been known or called by any other name. ___ I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 8. Occupation My occupation is: _______________________________________________________ I am employed at: {company and address} _________________________________ During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer's address ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ [] Check here if you are continuing these facts on an attached page. 9. Business [√ one only] ___ I do not own and operate a business. ___ I own and operate a business. The name of the business is: _____________ The street address is: __________________________________________________ My position with the business is: _______________________________________ I have been involved with the business since: {date} ___________________. 10. Profession [√ one only] ___ I am not in a profession. ___ I am in a profession. My profession is: _______________________________. I have practiced this profession: Dates (to/from) Place and address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ [] Check here if you are continuing these facts on an attached page. 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School _______________ _______________ __________________________________________ _______________ _______________ __________________________________________ _______________ _______________ __________________________________________ [] Cheek here if you are continuing these facts on an attached page. 12. Felony Convictions *350 [√ one only] ___ I have not been convicted of a felony. ___ I was convicted of a felony on {date} ____________, in {city} _________________________________________________________________, {county} _______________________, {state} __________. [] Check here if you have been convicted of additional felonies, and explain on an attached page. 13. Bankruptcy [√ one only] ___ I have never been adjudicated bankrupt. ___ I was adjudicated bankrupt on {date} _____________, in {city} __________, {city} _________________________________________________________________, {county} _______________________, {state} __________. [] Check here if you have had additional bankruptcies, and explain on an attached page. 14. Creditor(s)' Judgments [√ one only] ___ I have never had a money judgment entered against me by a creditor. ___ The following creditor(s)' money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case √ if Paid number ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] [] Cheek here if you are continuing these facts on an attached page. 15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ _________________________________________ Signature of Petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by _____________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known *351 ___ Produced identification Type of identification produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} _________________________, {city} ___________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. Form 12.982(f), Supp. ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) Case No.: _____________________________________________________________________ THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER ( ) HUSBAND ( ) WIFE: 1. My complete present name is: _________________________________________________________________________ I request that my name be changed to: _________________________________________________________________________ 2. I live in _____________________ County, Florida, at {street address} ____ _________________________________________________________________________. 3. I was born on {date} ____________, in {city} __________________, {county} _________________________, {state} __________, {country} __________. 4. My father's full legal name: _______________________________________________ My mother's full legal name: _______________________________________________ My mother's maiden name: ___________________________________________________ 5. I have lived in the following places since birth: Dates (to/from) Address ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ ________/_________ _______________________________________________ [] Check here if you are continuing these facts on an attached page. 6. Family [√ all that apply] ___ a. I am not married. ___ b. I am married. My spouse's full legal name is: __________________________ ___ c. I do not have child(ren). ___ d. The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including those over 18, must be listed): ___________________________________ ____ _________________________________ ___________________________________ ____ _________________________________ *352 ___________________________________ ____ _________________________________ ___________________________________ ____ _________________________________ ___________________________________ ____ _________________________________ [] Check here if you are continuing these facts on an attached page. 7. Former names [√ all that apply] ___ My name has never been changed by a court. ___ My name previously was changed by court order from ______________________ to ___________________ on {date} ________________________________________ by {court, city, and state} ____________________________________________. A copy of the court order is attached. ___ My name previously was changed by marriage from _________________________ to ___________________ on {date} ________________________________________ in {city, county, and state} ___________________________________________. A copy of the marriage certificate is attached. ___ I have never been known or called by any other name. ___ I have been known or called by the following other name(s): {list name(s) and explain where you were known or called by such name(s)} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 8. Occupation My occupation is: __________________________________________________________. I am employed at: {company and address} ___________________________ ____________________________________________________________________________. During the past 5 years, I have had the following jobs: Dates (to/from) Employer and employer's address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ [] Check here if you are continuing these facts on an attached page. 9. Business [√ one only] ___ I do not own and operate a business. ___ I own and operate a business. The name of the business is: ____________. The street address is: _________________________________________________. My position with the business is: ______________________________________. I have been involved with the business since: {date} ___________________. 10. Profession [√ one only] ___ I am not in a profession. ___ I am in a profession. My profession is: _______________________________. I have practiced this profession: Dates (to/from) Place and address ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ ________/_________ _____________________________________________ [] Check here if you are continuing these facts on an attached page. *353 11. Education I have graduated from the following school(s): Degree Date of Received Graduation School _________ ______________ ______________________________________________ _________ ______________ ______________________________________________ _________ ______________ ______________________________________________ [] Check here if you are continuing these facts on an attached page. 12. Felony Convictions [√ one only] ___ I have not been convicted of a felony. ___ I was conviction of a felony on {date} ____________, in {city} _________, {county} _________________________, {state} __________. [] Check here if you have been convicted of additional felonies, and explain on an attached page. 13. Bankruptcy [√ one only] ___ I have never been adjudicated bankrupt. ___ I was adjudicated bankrupt on {date } _________, in {city } ______, {county} _________________________, {state} __________. [] Check here if you have additional bankruptcies, and explain on an attached page. 14. Creditor(s)' Judgments [√ one only] ___ I have never had a money judgment entered against me by a creditor. ___ The following creditor(s)' money judgment(s) have been entered against me: Date Amount Creditor Court entering judgment and case √ Paid number ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] [] Cheek here if you are continuing these facts on an attached page. 15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise. 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ _________________________________________ Signature of Petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ *354 Sworn to or affirmed and signed before me on ________ by _____________________. _____________________________________ NOTARY PUBLIC—STATE OF FLORIDA _____________________________________ _____________________________________ [Print, type, or stamp commissioned name of notary.] IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. CHILD SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) Case No.: ______________________________ THE FOLLOWING INFORMATION IS TRUE ABOUT THE MINOR CHILD # ______: 1. Minor child's complete present name is: ____________________________________________________________________________ I/We request that this minor child's name be changed to: ____________________________________________________________________________ 2. The minor child lives in __________ County, Florida, at {street address} ___ ____________________________________________________________________________ 3. The minor child was born on __________, in {city, county, state, country} ____________________________________________________________________________ 4. The minor child's father's full legal name: ________________________________ The minor child's mother full legal name: __________________________________ The minor child's mother's maiden name: ____________________________________ 5. The minor child has lived in the following places since birth: Dates (to/from) Address ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ ________/_________ ________________________________________________ [] Check here if you are continuing these facts on an attached page. 6. [√ one only] ___ The minor child is not married. ___ The minor child is married to: {full legal name} _______________________. 7. [√ one only] *355 ___ The minor child has no children. ___ The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of birth} __________________________________________________________ _____________________________________________________________________________________. 8. Former names [√ all that apply] ___ The minor child's name has never been changed by court order. ___ The minor child's name previously was changed by court order from _______ __________ to _____________________ on {date} __________________________ by {court, city, and state} ____________________________________________. A copy of the court order is attached. PETITIONER(S) MUST INITIAL HERE ______ ___ The minor child's name previously was changed by marriage from __________ __________ to _____________________ on {date} __________________________, in {city, county, and state} ___________________________________________. ___ The minor child has never been known or called by any other name. ___ The minor child has been known or called by the following other name(s): {list name(s) and explain where child was known or called by such name(s)} ____________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 9. The minor child is not employed in an occupation or profession, does not own and operate a business, and has received no educational degrees. If the minor child has a job, explain: __________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 10. Felony Convictions. [√ one only] ___ The minor child has never been convicted of a felony. ___ The minor child was convicted of a felony on {date} ___________, in {city} _________________________________________________________________________, {county} _______________, {state} ________. 11. Money Judgments. [√ one only] ___ The minor child has never been adjudicated bankrupt, and no money judgment has ever been entered against him or her. ___ The following money judgment(s) has been entered against him or her: Date Amount Creditor Court entering judgment and case √ if Paid number ____ ______ ________ ________________________________ [] ____ ______ ________ ________________________________ [] PETITIONER(S) MUST INITIAL HERE ______ Form 12.982(g) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ IN RE: THE NAME CHANGE OF *356 _____________________________________ Petitioner/Father, _____________________________________ Petitioner/Mother. FINAL JUDGMENT OF CHANGE OF NAME (FAMILY) This cause came before the Court on {date} __________________, for a hearing on Petition for Change of Name under section 68.07, Florida Statutes, and it appearing to the Court that: 1. Petitioners are bona fide residents of _________________ County, Florida. 2. ___ Petitioners are the parents of the minor child(ren) named in the petition; ___ Petitioner is the parent of the minor child(ren) named in the petition, and the other parent has been properly notified and has either consented or failed to respond; ___ Other: ________________________________________________________________ _______________________________________________________________________; 3. Petitioner's request is not for any ulterior or illegal purpose and; 4. granting this petition will not in any manner invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or otherwise; it is ORDERED that the present name(s) be changed to (1) _______________________________ (1) _______________________________ (2) _______________________________ (2) _______________________________ (3) _______________________________ (3) _______________________________ (4) _______________________________ (4) _______________________________ (5) _______________________________ (5) _______________________________ (6) _______________________________ (6) _______________________________ by which they shall hereafter be known. ORDERED ON__________________________. _________________________________________ CIRCUIT JUDGE INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(a), PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF When should this form be used? This form should be used by a birth mother or father to ask the court to establish paternity, custody, visitation, and/or child support of a minor child or children. This means that you are trying to legally establish who is the father of the child(ren). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. What should I do next? For your case to proceed, you must properly notify the respondent of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. However, if constructive service is used, the court may only grant limited relief. You should seek legal advice *357 on constructive service in a paternity case. For more information see chapter 49, Florida Statutes, or you may contact Child Support Enforcement at the Florida Department of Revenue if you need assistance with your case. If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways: DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure, completed the scientific paternity testing, if necessary, and filed all of the required papers. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Family Law Form 12.983(d). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes. Special notes ... More than one child of the same alleged father may be listed on a single petition. However, if you are filing a paternity action involving more than one possible father, a separate petition must be filed for each alleged father. If the respondent files an answer denying that the person named in the petition is the child(ren)'s father, one of you should file a Motion for Scientific Paternity Testing, Florida Family Law Form 12.983(e). This is used to ask the court to order a scientific test to determine who is the child(ren)'s father. If the father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be checked on page 2, section 9a on this form. If the paternity of a child who was conceived or born during a marriage is at issue, the court may appoint a guardian ad litem to assist the court in this matter and to protect the rights of child. With this petition, you must file the following and provide a copy to the other party: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days if not filed with the petition.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days, if not filed with the petition, unless you and the other party *358 have agreed not to exchange these documents.) • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.) • Affidavit of Indigency, Florida Family Law Form 12.901(c), if you are requesting that filing fees be waived. Child Custody ... The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor or dependent child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) are being served. For more information, you may consult sections 61.401-61.405, Florida Statutes. Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary residence • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No Contact Many circuits require that parents of a minor or dependent child(ren) who are involved in divorce or paternity actions attend a parenting course and/or mediation before being allowed to schedule a final hearing. You should check with your local clerk of court's office, family law intake staff, or judicial assistant for more information on the parenting course and mediation requirements in your area. Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for one or more children, you should request child support in your petition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Final Judgments ... These family law forms contain a Final Judgment of Paternity, Florida Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last *359 page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF Petitioner, {full legal name} ________________________________________, being sworn, certifies that the following information is true: This is an action for paternity and to determine custody, parental responsibility, and child support under chapter 742, Florida Statutes. SECTION I. 1. Petitioner is the ( ) mother ( ) father of the following minor child(ren): NAME Place of Birth Birth date Sex (1) ___________________________ ____________________ ______________ _______ (2) ___________________________ ____________________ ______________ _______ (3) ___________________________ ____________________ ______________ _______ (4) ___________________________ ____________________ ______________ _______ (5) ___________________________ ____________________ ______________ _______ (6) ___________________________ ____________________ ______________ _______ 2. Petitioner currently lives at: {street address, city, state} ____________ _________________________________________________________________________. 3. Respondent currently lives at: {street address, city, state} ____________ _________________________________________________________________________. 4. Both parties are over the age of 18, and neither is, nor has been within a 30-day period immediately prior to this date, a person in the military service of the United States as defined by the Amended Sailors' and Soldiers' Civil Relief Act of 1940. 5. Neither Petitioner nor Respondent is mentally incapacitated. 6. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, G Florida Family Law Form 12.901(f), is filed with this petition. 7. A completed Notice of Social Security Number, Florida Family Law Form 12.901, is filed with this petition. 8. A completed Financial Affidavit, Florida Family Law form 12.901(d) or (e), is, or will be, filed. 9. Paternity Facts. *360 [√ one only] ___ a. Paternity has previously been established as a matter of law. ___ b. The parties engaged in sexual intercourse with each other in the month(s) of {list month(s) and year(s)} ____________________________________________, at {city and state} ____________________________________________________. As a result of the sexual intercourse, ( ) Petitioner ( ) Respondent conceived and gave birth to the minor child(ren) named in paragraph 1.( ) Petitioner ( ) Respondent is the natural father of the minor child(ren). The mother ( ) was ( ) was not married at the time of the conception and/or birth of the minor child(ren) named in paragraph 1. If the mother was married, the name and address of her husband at the time of conception and/or birth is: _______ ____________________________________________________________________________. SECTION II. CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain} _______________________________________________________________ _________________________________________________________________________. 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [√ one only] ___ a. shared by both Father and Mother. ___ b. awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: _________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________. 3. Primary Residential Parent (Custody). It is in the best interests of the child(ren) that the primary residential parent be ( ) Father ( ) Mother ( ) undesignated ( ) rotating because __________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________. 4. Visitation or Time Sharing. Petitioner requests that the Court order [√ all that apply] ___ a. no visitation. ___ b. limited visitation. ___ c. supervised visitation. ___ d. supervised or third-party exchange of child(ren). ___ e. visitation or time sharing as determined by the Court. ___ f. a visitation or time sharing schedule as follows: Explain the requested visitation or time sharing schedule: _______________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Explain why this schedule is in the best interests of the child(ren): ____________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Has the above visitation or time sharing schedule been agreed to by the parties? ( ) yes ( ) no 5. The minor child(ren) should *361 [√ only one] ___ a. retain his/her (their) present name(s) ___ b. receive a change of name as follows: present name(s) be changed to (1) _________________________________ (1) ________________________________ (2) _________________________________ (2) ________________________________ (3) _________________________________ (3) ________________________________ (4) _________________________________ (4) ________________________________ (5) _________________________________ (5) ________________________________ (6) _________________________________ (6) ________________________________ SECTION III. CHILD SUPPORT [√ all that apply] ___ 1. Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), is, or will be, filed. Such support should be ordered retroactive to [√ one only] ___ a. the date of birth of the child. ___ b. the date of the filing of this petition. ___ c. other: {date} ___________________________. {Explain} ____________ ______________________________________________________________________. ___ 2. Petitioner requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Petitioner understands that a Motion to Deviate from Child Support Guidelines, Florida Family Law Form 12.943, must be completed before the Court will consider this request. ___ 3. Petitioner requests that medical/dental insurance coverage for the minor child(ren) be provided by: [√ one only] ___ a. Father. ___ b. Mother. ___ 4. Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid by: [√ one only] ___ a. Father. ___ b. Mother. ___ c. Father and Mother each pay one-half. ___ d. Father and Mother each pay according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). ___ e. Other {explain}: _______________________________________________ ______________________________________________________________________. ___________________________________________________________________. ___ 5. Petitioner requests that life insurance to secure child support be provided by: [√ one only] ___ a. Father. ___ b. Mother. ___ c. Both. ___ 6. ( ) Petitioner ( ) Respondent ( ) Both has (have) incurred medical expenses in the amount of $__________ on behalf of the minor child(ren), including hospital and other expenses incidental to the birth of the minor child(ren). There should be an appropriate allocation or apportionment of these expenses. *362 ___ 7. ( ) Petitioner ( ) Respondent ( ) Both has (have) received past public assistance for this (these) minor child(ren). PETITIONER'S REQUEST 1. Petitioner requests a hearing on this petition and understands that he or she must attend the meeting. 2. Petitioner requests that the Court enter an order that: [√ all that apply] ___ a. establishes paternity of the minor child(ren), ordering proper scientific testing, if necessary; ___ b. establishes parental responsibility, custody, and visitation of the minor child(ren); ___ c. awards child support, including medical/dental insurance coverage for the minor child(ren); ___ d. determines the appropriate allocation or apportionment of all expenses incidental to the birth of the child(ren), including hospital and medical expenses; ___ e. determines the appropriate allocation or apportionment of all other past, present, and future medical and dental expenses incurred or to be incurred on behalf of the minor child(ren); ___ f. enters an appropriate Income Deduction Notice with regard to the periodic child support and, if applicable, the medical/dental insurance coverage for the minor chnd(ren); ___ g. changes the child(ren)'s name(s): ___ h. other relief as follows: ________________________________________________ ____________________________________________________________________________ __________________________________________________________________; and grants such relief as may be appropriate and in the best interests of the minor child(ren). I understand that I am swearing and affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ ____________________________________________ Signature of Petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ________________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ____________________________ *363 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________, a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(b), ANSWER TO PETITION TO DETERMINE PTERNITY AND FOR RELATED RLIEF When should this form be used? This form should be used when you are responding to a petition to determine paternity. You may use this form to admit or deny the allegations contained in the petition. However, if you wish to ask the court for things not included in the petition, such as custody, visitation, or child support, you should file an Answer to Petition and Counterpetition to Determine Paternity and for Related Relief, Florida Family Law Form 12.983(c). This form should be typed or printed in black ink. After completing this form, you should sign this form before a notary public. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? If you deny that the person named in the petition is the child(ren)'s father, a Motion for Scientific Paternity Testing, Florida Family Law Form 12.983(e), should be filed. This is used to ask the court to order a scientific test to determine who is the child(ren)'s father. You have 20 days to file an answer to the other party's petition. A copy of this form, along with all of the other forms required with this answer, must be mailed or hand delivered to the other party in your case. After you file your answer, the case will generally proceed in one of the following two ways: UNCONTESTED ... This case is uncontested if you and the petitioner agree on all issues raised in the petition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... This case is contested if you and the other party disagree on any issues raised in the petition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes. Special notes ... With this answer, you must file the following and provide a copy to the other party: • Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f). • Notice of Social Security Number, Florida Family Law Form 12.901(j). • Financial Affidavit, Florida Family Law Form 12.901(d) or (e). (This must *364 be filed within 45 days of the service of the petition on you, if not filed at the time you file this answer.) • Certificate of Compliance with Mandatory Disclosure, Florida Family Law Form 12.932. (This must be filed within 45 days of the service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.) • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this form after the other party files his or her financial affidavit.) Many circuits require completion of a parenting course or mediation before being allowed to schedule a final hearing. You should check with your local clerk, family law intake staff, or judicial assistant for more information on the parenting course and mediation requirements in your area. Child Custody ... The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is being served. For more information, you may consult sections 61.401-61.405, Florida Statutes. Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary residence • Secondary Residential Responsibility • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for one or more children, you should request child support in your petition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Final Judgments ... These family law forms contain a Final Judgment of Paternity, Florida Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and *365 telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ __________________________________, Petitioner, and __________________________________, Respondent. ANSWER TO PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF I, {full legal name} ___________________________________________, Respondent, being sworn, certify that the following information is true: 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ___________________________________________ ________________________________________________________________________. 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those issues: {indicate section and paragraph number} _________________________________ ___________________________________________________________________________. 3. I currently an unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ____________________ ___________________________________________________________________________. 4. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family Law Form 12.901(f), is filed with this petition. 5. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this petition. 6. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Petitioner or his/her attorney: Name:_________________________________ Address:______________________________ City, State, Zip: ____________________ Fax Number: __________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and that the punishment for knowingly making a false statement includes fines and/or imprisonment. *366 Dated: _____________________ _________________________________________ Signature of Respondent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ________________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(c), ANSWER TO PETITION AND COUNTERPETTION TO DETERMINE PATERNITY AND FOR RELATED RELIEF When should this form be used? This form should be used when you are responding to a petition to determine paternity and asking the court for something different than what was in the petition, such as custody, visitation, and child support. The answer is used to admit or deny the allegations contained in the petition, and the counterpetition is used to ask for whatever you want the court to do for you. The other party has 20 days to answer your counterpetition after being served with your counterpetition. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? You have 20 days to file an answer or answer and counterpetition to the other party's petition. A copy of this form, along with all of the other forms required with this answer and counterpetition, must be mailed or hand delivered to the other party in your case. If you deny that the person named in the petition is the child(ren)'s father, a Motion for Scientific Paternity Testing, Florida Family Law Form 12.983(e), should be filed. This is used to ask the court to order a scientific test to determine who is the child(ren)'s father. After you file an answer and counterpetition, the case will then generally proceed as follows: *367 UNCONTESTED ... This case is uncontested if you and the other party agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED ... This case is contested if you and the other party disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" for some basic information. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes. Special notes ... If the child(ren)'s father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be checked on page 2, section 9a of the counterpetition part of this form. With this answer, you must file the following: • Uniform Child Custody Jurisdiction Act Affidavit, • Florida Family Law Form 12.901(f). • Notice of Social Security Number, Florida Family Law Form 12.901. • Financial Affidavit, • Florida Family Law Form 12.901(d) or (e). (This must be filed within 45 days of service of the petition on you if not filed with this answer.) • Certificate of Compliance with Mandatory Disclosure, • Florida Family Law Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed with this answer, unless you and the other party have agreed not to exchange these documents.) • Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.) Many jurisdictions may require the completion of a parenting course or mediation before a final hearing may be set. You should contact the office of your local clerk of court, family law intake staff, or the judicial assistant about requirements for parenting courses or mediation where you live. Child Custody ... The judge will decide the parenting arrangements based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor child(ren). The judge may request a parenting evaluation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is being served. For more information, you may consult section 61.401-61.405, Florida Statutes. Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further. • Shared Parental Responsibility • Sole Parental Responsibility • Rotating Custody • Primary residence • Secondary Residential Responsibility *368 • Reasonable visitation • Specified visitation • Supervised visitation • No contact Child Support ... The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. If you are requesting custody or primary residential responsibility for one or more children, you should request child support in your petition. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations. Final Judgments ... These family law forms contain a Final Judgment of Paternity, Florida Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner/Counterrespondent, and _____________________________________, Respondent/Counterpetitioner, ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF I, {full legal name} ___________________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and `paragraph number} __________________________________________ ___________________________________________________________________________. *369 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those issues: {indicate section and paragraph number} ___________________________________________ _________________________________________________________________________. 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ____________________ ___________________________________________________________________________. COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF SECTION I. PATERNITY 1. Respondent is the ( ) mother ( ) father of the following minor child(ren): NAME Place of Birth Birth date Sex (1) ___________________________ ____________________ ______________ _______ (2) ___________________________ ____________________ ______________ _______ (3) ___________________________ ____________________ ______________ _______ (4) ___________________________ ____________________ ______________ _______ (5) ___________________________ ____________________ ______________ _______ (6) ___________________________ ____________________ ______________ _______ 2. Petitioner currently lives at: {street address, city, state} ____________ ____________________________________________________________________________. 3. Respondent currently lives at: {street address, city, state} ____________ ___________________________________________________________________________. 4. Both parties are over the age of 18, and neither is, nor has been within a 30 day period immediately prior to this date, a person in the military service of the United States as defined by the Amended Sailors' and Soldiers' Civil Relief Act of 1940. 5. Neither Petitioner nor Respondent is mentally incapacitated. 6. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Family law Form 12.901(f), is filed with this counterpetition. 7. A completed Notice of Social Security Number, Florida Family Law Form 12.901(j), is filed with this counterpetition. 8. A completed Financial Affidavit, Florida Family Law Form 12.901(d) or (e), is, or will be, filed. 9. Paternity Facts. [√ one only] ___ a. Paternity has previously been established as a matter of law. ___ b. the parties engaged in sexual intercourse with each other in the month(s) of {list month(s) and year(s)} _____________________________________________, at {city and state} ____________________________________________________. As a result of the sexual intercourse, ( ) Petitioner ( ) Respondent conceived and gave birth to the minor child(ren) named in paragraph l.( ) Petitioner ( ) Respondent is the natural father of the minor child(ren). The mother ( ) was ( ) was not married at the time of the conception and/or birth of the minor child(ren) named in paragraph 1. If the mother was married, the name and address of her husband at the time of conception and/or birth is: _______ _________________________________________________________________________. SECTION II. CHILD CUSTODY, PARENTAL RESPONSIBILITY, AND VISITATION *370 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: { explain} ______________________________________________________________ ___________________________________________________________________________. 2. Parental Responsibility. It is in the child(ren)'s best interest that parental responsibility be: [√ one only] ___ a. shared by both Father and Mother. ___ b. awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________. 3. Primary Residential Parent (Custody). It is in the best interests of the child(ren) that the primary residential parent be ( ) Father ( ) Mother ( ) undesignated ( ) rotating because ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________. 4. Visitation or Time Sharing. Respondent requests that the Court order: [√ all that apply] ___ a. no visitation. ___ b. limited visitation. ___ c. supervised visitation. ___ d. supervised or third-party exchange of child(ren). ___ e. visitation or time sharing as determined by the Court. ___ f. a visitation or time sharing schedule as follows: Explain the requested visitation or time sharing schedule: ____________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Explain why this request is in the best interests of the child(ren): _______ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Has the above visitation or time sharing schedule been agreed to by the parties? ( ) yes ( ) no 5. The minor child(ren) should [√ only one] ___ a. retain his/her (their) present name(s). ___ b. receive a change of name as follows: present name(s) be changed to (1) _________________________________ (1) ________________________________ (2) _________________________________ (2) ________________________________ (3) _________________________________ (3) ________________________________ (4) _________________________________ (4) ________________________________ (5) _________________________________ (5) ________________________________ (6) _________________________________ (6) ________________________________ SECTION III. CHILD SUPPORT [√ all that apply] *371 ___ 1. Respondent requests that the court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, fj Florida Family Law Form 12.901(g), is, or will be, filed. Such support should be ordered retroactive to: [√ one only] ___ a. the date of birth of the child. ___ b. the date of the filing of this petition. ___ c. other: {date} ______________ {Explain} ________________________ ____________________________________________________________________________ ___ 2. Respondent requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Respondent understands that a Motion to Deviate form Child Support Guidelines, Florida Family Law Form 12.943, must be completed before the Court will consider this request. ___ 3. Respondent requests that medical/dental insurance coverage for the minor child(ren) be provided by: [√ one only] ___ a. Father. ___ b. Mother. ___ 4. Respondent requests that uninsured medical/dental expenses for the child(ren) be paid by: [√ one only] ___ a. Father. ___ b. Mother. ___ c. Father and Mother each pay one-half. ___ d. Father and Mother each pay according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g). ___ e. Other {explain}: ________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________. ___ 5. Respondent requests that life insurance to secure child support be provided by: [√ one only] ___ a. Father. ___ b. Mother. ___ c. Both. ___ 6. ( ) Petitioner ( ) Respondent ( ) both has (have) incurred medical expenses in the amount of $______ on behalf of the minor child(ren), including hospital and other expenses incidental to the birth of the minor child(ren). there should be an appropriate allocation or apportionment of these expenses. ___ 7. ( ) Petitioner ( ) Respondent ( ) Both has (have) received past public assistance for this (these) minor child(ren). RESPONDENT'S REQUEST 1. Respondent requests a hearing on this petition and understands that he or she must attend the hearing. 2. Respondent requests that the Court enter an order that: [√ all that apply] ___ a. establishes paternity of the minor child(ren), ordering proper scientific testing, if necessary; ___ b. establishes parental responsibility, custody, and visitation of the minor child(ren); *372 ___ c. awards child support, including medical/dental insurance coverage, for the minor child(ren); ___ d. determines the appropriate location or apportionment of all expenses incidental to the birth of the child(ren), including hospital and medical expenses; ___ e. determines the appropriate a location or apportionment of all other past, present, and future medical and dental expenses incurred or to be incurred on behalf of the minor child(ren); ___ f. enters an appropriate Income Deduction Notice with regard to the periodic child support and, if applicable, the medical/dental insurance coverage for the minor child(ren); ___ g. changes the child(ren)'s name(s); and ___ h. other relief as follows: ________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________; and grants such other relief as may be appropriate and in the best interests of the minor child(ren). I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ _________________________________________ Signature of Respondent/Counter-petitioner Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ________________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. *373 INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(d), ANSWER TO COUNTERPETITION When should this form be used? This form may be used by a petitioner to respond to the respondent`s counterpetition in a paternity case. You may use this form to admit or deny the allegations contained in the respondent's counterpetition. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. If the respondent has denied that the person named in the petition is the father of the child(ren) and requested a scientific paternity test, you must now wait until the test is complete. You should then proceed according to the instructions in Petition to Determine Paternity and for Related Relief, Florida Family Law Form 12.983(a). Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes. Special notes ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner/Counterrespondent, and _____________________________________, Respondent/Counterpetitioner, ANSWER TO COUNTERPETITION I, {full legal name} _________________________, Petitioner/Counterrespondent, being sworn, certify that the following information is true: 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ___________________________________________ ___________________________________________________________________________. 2. I disagree with petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those issues: {indicate section and paragraph number} _________________________________ ___________________________________________________________________________. *374 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ____________________ ___________________________________________________________________________. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ____________. Respondent or his/her attorney: Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ _________________________________________ Signature of Respondent/Counterrespondent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ________ by ________________________. ________________________________________ NOTARY PUBLIC—STATE OF FLORIDA ________________________________________ [Print, type, or stamp commissioned name of notary.] ___ Personally known ___ Produced identification Type of identification produced ____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the petitioner, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(e), MOTION FOR SCIENTIFIC PATERNITY TESTING When should this form be used? This form should be used when the mother or alleged father wants the court to order a scientific paternity test to determine the paternity of a minor child(ren). This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public. You should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. *375 What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case. When you have filed this motion, you are ready to set a hearing on this motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should file a Notice of Hearing (General), Florida Family Law Form 12.923, or other appropriate notice of hearing form. A copy of this motion and the Notice of Hearing must be mailed or hand delivered to the other party in your case. Where can I look for more information? Before proceeding, you should read "General Information for Pro Se Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes. Special notes ... These family law forms contain an Order on Motion for Scientific Paternity Testing, Florida Family Law Form 12.983(f), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Form 12.900, before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. MOTION FOR SCIENTIFIC PATERNITY TESTING ( ) Petitioner ( ) Respondent certifies that the following information is true: 1. At this time, other than testimony, very little or no substantial proof of paternity or nonpaternity is available in this action. 2. I request, under section 742.12, Florida Statutes, that the Court enter an order for appropriate scientific testing of the biological samples of Petitioner and Respondent and the minor child(ren) listed below, so that a determination of paternity of the minor child(ren) can be made to a reasonable degree of medical certainty: Name Birth date (1) ________________________________________________________________________ *376 (2) ________________________________________________________________________ (3) ________________________________________________________________________ (4) ________________________________________________________________________ (5) ________________________________________________________________________ (6) ________________________________________________________________________ 3. I request that the costs of the scientific testing initially be borne by ( ) Petitioner ( ) Respondent ( ) both Petitioner and Respondent. I certify that a copy of this document was [√ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _____________ ( ) Petitioner ( ) Respondent or his/her attorney: Name: ____________________________________________ Address: _________________________________________ City, State, Zip: ________________________________ Fax Number: ______________________________________ Dated: _____________________ _________________________________________ Signature of Respondent Printed Name: ___________________________ Address: ________________________________ City, State, Zip: _______________________ Telephone Number: _______________________ Fax Number: _____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________. a nonlawyer, located at {street} __________________, {city} _________, {state} __________, {phone} _________________, helped {name} _________________, who is the [√ one only] ___ petitioner, or ___ consenting parent, fill out this form. Form 12.983(f) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: ______________________________ Division: ______________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. ORDER ON MOTION FOR SCIENTIFIC PATERNITY TESTING This cause having come to be heard on {date} ____________, upon a motion/stipulation for scientific paternity testing, and the Court having been fully advised in the premises, it is therefore FOUND: 1. That the Court has jurisdiction over the parties and subject matter of this action. 2. [√ one only] ___ a. That the natural mother of the dependent child(ren) at issue was not married to any individual at the time of conception or birth of the child(ren). *377 ___ b. That the natural mother of the dependent child(ren) at issue was married to an individual other than the alleged father at the time of conception or birth of said child(ren); however, a court order has determined that said individual is not the child(ren)'s father. It is therefore ORDERED: 1. The above motion is GRANTED: 2. Petitioner, Respondent, and the minor child(ren) shall appear for the purpose of appropriate scientific paternity testing: [√ one only] ___ a. immediately. ___ b. at ___ a.m./p.m. on {date} ___at {location} _________________. ___ c. at a time and place to be specified by the Florida Department of Revenue. Appropriate scientific paternity testing on Petitioner, Respondent, and the minor child(ren) shall be in {city} ________________, Florida, with at least 30 days advance written notice. If the Florida Department of Revenue fails to notify the party(ies), the party(ies) shall contact the Florida Department of Revenue for further instructions. 3. The costs of the scientific paternity testing shall be assessed ( ) at a later date ( ) against Petitioner ( ) against Respondent ( ) Other {explain)} ______. 4. The test results, together with the opinions and conclusions of the test laboratory, shall be filed with the Court. Any objection to the test results must be made in writing and must be filed with the Court at least 10 days before the hearing. If no objection is filed, the test results shall be admitted into evidence with no further predicate. Nothing in this paragraph prohibits a party from calling an outside expert witness to refute or support the testing procedure or results or the mathematical theory on which they are based. 5. Test results are admissible in evidence and should be weighed along with other evidence of the paternity of the alleged father unless the statistical probability of paternity equals or exceeds 95 percent. A statistical probability of 95 percent or more creates a rebuttable presumption that the alleged father is the biological father of the child(ren). If the party fails to rebut the presumption of paternity, the Court may enter a summary judgment of paternity. If the test results show the alleged father cannot be the biological father, the case shall be dismissed with prejudice. 6. The Court reserves jurisdiction over the parties and the subject matter of this action to enforce the terms and provisions of this and all previous orders as well as to enter such other orders as may be just. ORDERED on ______________________. _________________________________________ CIRCUIT JUDGE Copies to: Petitioner (or his or her attorney) Respondent (or his or her attorney) ___Other:_____________________________________. I CERTIFY the foregoing is a true and correct copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ______ Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) *378 By: _____________________________________ Deputy Clerk Form 12.983(g) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF PATERNITY This cause came before the Court upon a Petition to Determine Paternity and for Related Relief, under chapter 742, Florida Statutes. The Court having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction of the subject matter and the parties. 2. Paternity. [√ one only] ( ) By operation of law, ( ) The Court finds that {full legal name} _____________________________________________________________, is the natural and biological father of the minor child(ren), listed below: The parties' dependent or minor child(ren) is: Name Birth date ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION I. CUSTODY OF AND VISITATION WITH DEPENDENT OR MINOR CHILD(REN) 1. Jurisdiction. The Court has jurisdiction to determine custody of and visitation with the parties' minor child(ren) listed in paragraph 2 above. 2. Parental Responsibility for the Minor Child(ren). [√ one only] ___ a. Not adjudicated. Since no request for relief was made in this action, parental responsibility of the minor child(ren) is governed by sections 742.031 and 744.301, Florida Statutes. ___ b. The parties shall have shared parental responsibility for the parties' minor child(ren). ( ) Mother ( ) Father shall have primary residential responsibility of the minor child(ren) and the other parent shall have secondary residential responsibility, as set forth in paragraph 3 below. Or The primary residential parent shall be ( ) undesignated ( ) rotating with time sharing for the ( ) Mother ( ) Father as set forth in paragraph 4 below. ___ c. ( ) Mother ( ) Father shall have sole parental responsibility for the parties' minor child(ren). Shared parental responsibility would be detrimental to the child(ren) at this time because: ____________________________________ *379 ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ The other parent shall have visitation with the parties' minor child(ren) as set forth in paragraph 3 below. 3. Secondary Residential Responsibility, Visitation or Time Sharing with Minor Child(ren). The parent granted secondary residential responsibility, visitation, or time sharing shall have: [√ one only] ___ a. reasonable visitation or time sharing with the parties' minor child(ren) after reasonable notice and as agreed to by the parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to set a specific schedule. ___ b. the following specified visitation or time sharing with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: {specify days and times}________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. no contact with the parties' minor child(ren) until further order of the Court, due to the existing conditions that are detrimental to the welfare of the minor child(ren) {explain} ______________________________________________ _______________________________________________________________________________ ____________________________________________________________________________ 4. Limitations on Parental Responsibility, Visitation and Time Sharing. Neither parent shall take the child(ren) from the custody of the other parent or any child care provider or other person entrusted by the other parent with the care of the child(ren) without the agreement of the other parent during the other parent's time of parental responsibility or visitation. The above reasonable (paragraph 3.a. above) or specified (paragraph 3.b. above) visitation shall be: [√ if applies] ___ a. supervised by a responsible adult who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {name} _____ _____________. ___ b. at the supervised visitation center located at: {address} __________ ____________________________________________________________________________ and shall be subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) Mother ( ) Father ( ) Both. 5. Communication Arrangements for Secondary Parenting, Visitations, and Time Sharing with Child(ren). [√ if applies] ___ The parties' communications to arrange visitation or time sharing and discuss issues relating to the child(ren) (if shared parenting or visitation is provided in paragraph 2 above) are restricted as follows: ( ) telephone, ( ) fax, e-mail, or letter, ( ) A responsible person shall coordinate the visitation or time sharing arrangements of the minor child(ren). If the parties cannot agree, the responsible person shall be: {name} _____________________________________ ( ) other conditions for arrangements or discussions: {explain} ________ ____________________________________________________________________________ *380 _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 6. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as scheduled and as agreed to by the parties. The following conditions, if checked below, shall also apply. [√ all that apply] ___ a. The parties shall exchange the child(ren) at the following location(s): ___ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___ b. The parent granted secondary parenting, visitation, or time sharing shall not get out of the vehicle, and the other parent shall not approach the vehicle, during the time the child(ren) are exchanged. ___ c. A responsible person shall conduct all exchanges of the child(ren). Neither parent shall accompany the responsible person when that person is transferring the child(ren) from one parent to the other. If the parties' cannot agree, the responsible person shall be: {name} _________________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: ______ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. Injunction Prohibiting Removing the Child(ren). The Court hereby prohibits and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor child(ren) from the ( ) State of Florida ( ) {specify} _________________________________________________________________________ _________________________________________________________________________ without a court order or the written consent of the other party. 8. Other Provisions Relating to the Minor Child(ren). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. CHILD SUPPORT 1. The Court finds that there is a need for child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net income of $_________, (Child Support Guidelines ___%). The Father's net income is $____________, (Child Support Guidelines ___%). Monthly child care costs are $__________. Monthly health/dental insurance costs are $____________. 2. Amount. The ( ) Mother ( ) Father shall be obligated to pay child support in the amount of $__________ per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _______________________________________________________________ ____________________________________________________________________________ beginning {date} ____________, and continuing until *381 ( ) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting OR one of the minor children reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting and either party files a supplemental petition to modify child support and the court enters such an order. OR ( ) {date/event} _________________________________________________, {explain} ________________________________________________________. If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: _________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [√ if applies] ___ a. There is no retroactive child support or arrearage at the time of this Final Judgment. ___ b. ( ) Petitioner ( ) Respondent ( ) both has (have) incurred medical expenses in the amount of $_________ on behalf of the minor child(ren), including hospital and other expenses incidental to the birth of the minor child(ren). Petitioner shall pay ___%, Respondent shall pay ___%, which shall be paid as follows: ( ) added to arrearage in paragraph c below ( ) other {explain} ___ c. The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of: $____________ for retroactive child support, as of {date} _________________________________. $____________ for previously ordered unpaid child support, as of {date} ___________. $____________for previously incurred medical expenses. The total of $__________ in child support arrearage shall be repaid at the rate of $___________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary uninsured medical/dental costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain} _____________________________________________________ ____________________________________________________________________________ As to these uninsured medical/dental expenses, the party who incurs the expense shall submit request for reimbursement to the other party within 30 *382 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $_________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren), as beneficiary(ies)( ) primary residential parent as the beneficiary as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes selfsupporting. 6. IRS Income Tax Exemption(s). The party granted primary residential responsibility or sole parental responsibility of the minor child(ren) shall have the benefit of any tax exemption(s) for the child(ren), OR, if checked here, ( ) assignment of any tax exemption(s) for the child(ren) shall be as follows: ____________________________________________________________________________ ____________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. METHOD OF PAYMENT. Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} ________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central Government Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} __________ ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. *383 3. Bonus/one-time payments. ( ) All ( ) $__________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. CHILD(REN)'S NAME(S) ___ a. There will be no change to the child(ren)'s name(s). ___ b. It is in the child(ren)'s best interests that the child(ren)'s present name(s) shall be changed to (1) _________________________________ (1) ________________________________ (2) _________________________________ (2) ________________________________ (3) _________________________________ (3) ________________________________ (4) _________________________________ (4) ________________________________ (5) _________________________________ (5) ________________________________ (6) _________________________________ (6) ________________________________ by which the minor child(ren) shall hereafter be known. SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $ __________ in attorney fees, and $____________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $___ per hour and ________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________ ____________________________________________________________________________ ____________________________________________________________________________ 3. The costs of the scientific paternity testing shall be assessed ( ) against Petitioner ( ) against Respondent ( ) Other {explain} __________________. SECTION VI. OTHER PROVISIONS 1. Other Provisions. _____________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on ____________________. _________________________________________ CIRCUIT JUDGE Copies to: Petitioner (or his or her attorney) Respondent (or his or her attorney) *384 Central Governmental Depository ___ Other: _____________________________________ I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the Circuit Court of ________ County, Florida, and that I have furnished copies of this order as indicated above. CLERK OF THE CIRCUIT COURT (SEAL) By: _____________________________________ Deputy Clerk Form 12.990(a) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF SIMPLIFIED DISSOLUTION OF MARRIAGE This cause came before this Court for a hearing on the parties' Petition for Simplified Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Simplified Petition for Dissolution of Marriage. 3. The parties have no minor or dependent children in common, and the wife is not pregnant. 4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. 5. Marital Settlement Agreement. [√ one only] ___ a. The parties have voluntarily entered into a Marital Settlement Agreement, and each has filed the required Financial Affidavit. Therefore, the Marital Settlement Agreement is filed as "Exhibit A" in this case and is ratified and made a part of this final judgment. The parties are ordered to obey all of its provisions. ___ b. There is no marital property or marital debts to divide, as the parties previously have divided all of their personal property. Therefore, each is awarded the personal property he or she presently has in his or her possession. Each party shall be responsible for any debts in his or her own name. 6. ( ) yes ( ) no The wife's former name of {full legal name} ______________ ______________ is restored. 7. The Court reserves jurisdiction to enforce the marital settlement agreement. *385 ORDERED on ____________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: __________________________________________ Form 12.990(b)(1) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) (UNCONTESTED) This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. 4. Marital Settlement Agreement. The parties have voluntarily entered into a Marital Settlement Agreement, and each has filed the required Financial Affidavit. Therefore, the Marital Settlement Agreement is filed as "Exhibit A" in this case and is ratified and made a part of this final judgment. The parties are ordered to obey all of its provisions. 5. The Court finds that the parties have the present ability to pay support as agreed to in the marital settlement agreement as ratified and made part of this final judgment. 6. ( ) yes ( ) no The wife's former name of {full legal name} _______________ ________is restored. 7. The Court reserves jurisdiction to modify and enforce this final judgment. ORDERED on __________________ _________________________________________ CIRCUIT JUDGE *386 COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: _______________________________ Form 12.990(b)(2) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) (UNCONTESTED) This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The parties have no minor or dependent children in common, and the wife is not pregnant. 4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. 5. Marital Settlement Agreement. The parties have voluntarily entered into a Marital Settlement Agreement, and each has filed the required Financial Affidavit. Therefore, the Marital Settlement Agreement is filed as "Exhibit A" in this case and is ratified and made a part of this final judgment. The parties are ordered to obey all of its provisions. 6. The Court finds that the parties have the present ability to pay support as agreed to in the marital settlement agreement as ratified and made part of this final judgment. 7. ( ) yes ( ) no The wife's former name of {full legal name} ______________ is restored. 8. The Court reserves jurisdiction to enforce this final judgment. ORDERED on___________________. _________________________________________ CIRCUIT JUDGE *387 COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: _______________________________ Form 12.990(b)(3) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH NO PROPERTY OR DEPENDENT OR MINOR CHILD(REN) (UNCONTESTED) This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law. 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The parties have no minor or dependent children in common, and the wife is not pregnant. 4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. 5. There is no marital property or marital debts to divide, as the parties have previously divided all of their personal property. Therefore, each is awarded the personal property he or she presently has in his or her possession. Each party shall be responsible for any debts in his or her own name. 6. ( ) yes ( ) no The wife's former name of {full legal name} _____________ _____________ is restored. 7. The Court reserves jurisdiction to enforce this judgment. ORDERED on ___________________ __________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: _______________________________ *388 Form 12.990(c)(1) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law. 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved, and the parties are restored to the status of being single. SECTION I. MARITAL ASSETS AND LIABILITIES A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated. The date of valuation of these assets and liabilities is, unless otherwise indicated: ___ a. date of filing petition for dissolution of marriage____________. ___ b. date of separation ____________________. ___ c. date of divorce trial __________________. B. Division of Assets. 1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the assets found to be nonmarital, and the other party shall have no further rights or responsibilities regarding these assets. ASSETS: DESCRIPTION OF ITEM(S) Current Fair Wife's Husband's (Describe each item as clearly as possible. Market Nonmarital Nonmarital You do not need to list account numbers) Value Property Property __________________________________________________________________________________ $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Nonmarital Assets $ $ $ __________________________________________________________________________________ *389 2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets awarded in this section, and the other party shall have no further rights or responsibilities regarding these assets. Any personal item(s) not listed below are awarded to the party currently in possession or control of the item(s). __________________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Current Husband (Describe each item as clearly as possible. Fair Market Wife Shall Shall You do not need to list account numbers.) Value Receive Receive __________________________________________________________________________________ Cash (on hand or in banks/credit unions) $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Stocks/bonds __________________________________________________________________________________ __________________________________________________________________________________ Notes __________________________________________________________________________________ Business interests __________________________________________________________________________________ __________________________________________________________________________________ Real estate: (Home) __________________________________________________________________________________ __________________________________________________________________________________ Automobiles __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Boats __________________________________________________________________________________ Furniture & furnishings __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Jewelry __________________________________________________________________________________ __________________________________________________________________________________ Life insurance (cash surrender value) __________________________________________________________________________________ Retirement Plans (Profit sharing, Pension, IRA, 401(k)s, etc.) __________________________________________________________________________________ Other assets __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ *390 __________________________________________________________________________________ Total Marital Assets $ $ $ __________________________________________________________________________________ C. Division of Liabilities/Debts. 1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party shall have no responsibilities regarding these debts. __________________________________________________________________________________ LIABILITIES: DESCRIPTION OF DEBT(S) Current Wife's Husband's (Describe each item as clearly as possible. Amount Nonmarital Nonmarital You do not need to list account numbers) Owed Liability Liability __________________________________________________________________________________ $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Nonmarital Liabilities $ $ $ __________________________________________________________________________________ 2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall hold the other party harmless and pay, as his or her own, the marital liabilities awarded below. __________________________________________________________________________________ LIABILITIES: DESCRIPTION OF DEBT(S) Current Wife Husband (Describe each item as clearly as possible. Amount Shall Shall You do not need to list account numbers) Owed Pay Pay __________________________________________________________________________________ Mortgages on real estate: (Home) $ $ $ __________________________________________________________________________________ (Other) __________________________________________________________________________________ __________________________________________________________________________________ Charge/credit card accounts __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Auto loan __________________________________________________________________________________ Auto loan __________________________________________________________________________________ Bank/Credit Union loans __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Other __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ *391 __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Marital Liabilities $ $ $ __________________________________________________________________________________ D. Contingent assets and liabilities will be divided as follows: ______________ ____________________________________________________________________________ ____________________________________________________________________________ E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not receive approximately one-half, the distribution is based on the following facts and reasoning: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME [√ all that apply] ___ 1. ( ) Petitioner ( ) Respondent, as a condition of support, shall have exclusive use and possession of the dwelling located at: _____________________________ until {date of event} ___________________________________________________ ____________________________________________________________________________. ___ 2. ( ) Petitioner ( ) Respondent may make visits to the premises described in the paragraph above for the purpose of obtaining any items awarded in this Final Judgment. These visits shall occur after notice to the person granted exclusive use and possession of the dwelling and at the earliest convenience of both parties or as ordered in paragraph 4 below. ___ 3. Upon the termination of the right of exclusive use and possession, the dwelling shall be sold and the net proceeds divided ___% to petitioner and ___% to Respondent, with the following credits and/or setoffs being allowed: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Other: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. CUSTODY OF AND VISITATION WITH DEPENDENT OR MINOR CHILD(REN) 1. Jurisdiction. The Court has jurisdiction to determine custody of and visitation with the parties' minor child(ren) listed in paragraph 2 below. 2. The parties' dependent or minor child(ren) is: Name Birth date ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *392 3. Parental Responsibility for the Minor Child(ren). [√ one only] ___ a. The parties shall have shared parental responsibility for the parties' minor child(ren). ( ) Mother ( ) Father shall have primary residential responsibility of the minor child(ren) and the other parent shall have secondary residential responsibility, as set forth in paragraph 4 below. OR The primary residential parent shall be ( ) undesignated ( ) rotating with time sharing for the ( ) Mother ( ) Father as set forth in paragraph 4 below. ___ b. ( ) Mother ( ) Father shall have sole parental responsibility for the parties' minor child(ren). Shared parental responsibility would be detrimental to the child(ren) at this time because: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ The other parent shall have visitation with the parties' minor child(ren) as set forth in paragraph 4 below: 4. Secondary Residential Responsibility, Visitation, or Time Sharing with Minor Child(ren). The parent granted secondary residential responsibility, visitation, or time sharing shall have: [√ one only] ___ a. reasonable visitation or time sharing with the parties' minor child(ren) after reasonable notice and as agreed to by the parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to set a specific schedule. ___ b. the following specified visitation or time sharing with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: {specify days and times} _________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. no contact with the parties' minor child(ren) until further order of the Court, due to the existing conditions that are detrimental to the welfare of the minor child(ren). {explain} _____________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Limitations on Parental Responsibility, Visitation, and Time Sharing. Neither parent shall take the child(ren) from the custody of the other parent or any child care provider or other person entrusted by the other parent with the care of the child(ren) without the agreement of the other parent during the other parent's time of parental responsibility or visitation. The above reasonable (paragraph 4.a. above) or specified (paragraph 4.b above) visitation shall be: [√ if applies] ___ a. supervised by a responsible adult who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {name} _____ ____________________________________________________________________________. ___ b. at the supervised visitation center located at: {address} ____________ ____________________________________________________________________________, subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) Mother ( ) Father ( ) Both. 6. Communication Arrangements for Secondary Parenting, Visitation, and Time Sharing with Child(ren). [√ if applies] ___ The parties' communications to arrange visitation or time sharing and discuss issues relating to the child(ren) (if shared parenting or visitation is provided in paragraph 3 above) are restricted as follows: ( ) telephone, ( ) fax, e-mail, or *393 letter, ( ) A responsible person shall coordinate the visitation or time sharing arrangements of the minor child(ren). If the parties cannot agree, the responsible person shall be: {name} _____________________________________ ( ) other conditions for arrangements or discussions: {explain} _________ ____________________________________________________________________________ ____________________________________________________________________________ 7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as scheduled and as agreed to by the parties. The following conditions, if checked below, shall also apply. [√ all that apply] ___ a. The parties shall exchange of the child(ren) at the following location(s): ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. ___ b. The parent granted secondary parenting, visitation, or time sharing shall not get out of the vehicle, and the other parent shall not approach the vehicle, during the time the child(ren) are exchanged. ___ c. A responsible person shall conduct all exchanges of the child(ren). Neither parent shall accompany the responsible person when that person is transferring the child(ren) from one parent to the other. If the parties' cannot agree, the responsible person shall be: {name} _________________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: ______ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ___ 8. Injunction Prohibiting Removing the Child(ren). The Court hereby prohibits and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor child(ren) from the ( ) State of Florida ( ) {specify} _________________________________________________________________________ _________________________________________________________________________ with a court order or the written consent of the other party. ___ 9. Other Provisions Relating to the Minor Child(ren). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. ALIMONY 1. ( ) The Court denies the request(s) for alimony OR ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has/had the present ability to pay, alimony as follows: [√ all that apply] ___ a. Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _________________________________________________________ ____________________________________________________________________________ beginning {date} _____________________. This alimony shall continue until *394 modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. ___ b. Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________. This amount shall be paid as follows: _______________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________________________________________________ _________________________________________________________________________ beginning {date} _____________________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ___________________________________________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ d. Retroactive. Obligor shall pay retroactive alimony in the amount of $________ for the period of {date} ___________________, through {date} _______________, which shall be paid pursuant to paragraph 3 below. ____________________________________________________________________________ 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony: a. The standard of living established during the marriage; b. The duration of the marriage. c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [] Check here if additional pages are attached. ____________________________________________________________________________ 3. Arrearage/Retroactive Alimony. [√ one only] ___ a. There is no alimony arrearage at the time of this Final Judgment. ___ b. The ( ) Petitioner ( ) Respondent shall pay to the other party the alimony arrearage of: $_________________ for retroactive alimony, as of {date} __________. $_________________ for previously ordered unpaid alimony, as of {date} ________________. The total of $__________________ in alimony arrearage shall be repaid in the amount of $___________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ________________________________________ ____________________________________________________________________________ beginning {date} ________________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $____________ per *395 month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $_______________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $_______________________ and shall remain in effect until the obligation for alimony terminates. ____________________________________________________________________________ 5. Other provisions relating to alimony: ___________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION V. CHILD SUPPORT 1. The Court finds that there is a need for child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $_________, (Child Support Guidelines _________%). The Father's net monthly income is $_________, (Child Support Guidelines __________%). Monthly child care costs are $_______. Monthly health/dental insurance costs are $__________. 2. Amount. The ( ) Mother ( ) Father shall be obligated to pay child support in the amount of $___________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: ______________________________________________________________ ____________________________________________________________________________, beginning {date}____________, and continuing until ( ) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting OR one of the minor children reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting and either party files a supplemental petition to modify child support and the court enters such an order. OR ( ) {date/event} __________________________________________________, {explain} _________________________________________________________. If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: ______________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [√ one only] ___ a. There is no child support arrearage at the time of this Final Judgment. ___ b. The ( ) Father shall pay to the other party the child support arrearage of: $________________ for retroactive child support, as of {date} _________. *396 $______________ for previously ordered unpaid child support, as of {date} ___________ The total of $___________________ in child support arrearage shall be repaid in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ________________________________________ ____________________________________________________________________________ beginning {date} ______________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary uninsured medical/dental costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain} _____________________________________________________ ____________________________________________________________________________ As to these uninsured medical/dental expenses, the party who incurs the expense shall submit request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. ___ 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $__________, on () his life ( ) her life ( ) his/Tier life naming the ( ) minor ehild(ren) as the beneficiary(ies)( ) primary residential parent as the beneficiary as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. IRS Income Tax Exemption(s). The party granted primary residential responsibility or sole parental responsibility of the minor child(ren) shall have the benefit of any tax exemption(s) for the child(ren), OR, if checked here, ( ) assignment of any tax exemption(s) for the child(ren) shall be as follows: ____________________________________________________________________________ ____________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VI. METHOD OF PAYMENT. Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} _____________________________ County, along with any depository service charge. *397 ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $_______________________, or, of not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $__________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. _________________________________________________________________________ 4. Other provisions relating to method of payment, _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VII. ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ____________________________________________________________________________ ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $____________ in attorney fees, and $___________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $____________ per hour and _____________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VIII. OTHER PROVISIONS 1. Former name. The wife's former name of {full name} ______________________ ________________________________ is restored. 2. Other Provisions. _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *398 3. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on ___________________________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Government Depository Other: _______________________________ FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) Form 12.990(c)(2) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. At least one party has been a resident of the State of Florida for more than 6 months immediately before filing the Petition for Dissolution of Marriage. 3. The parties have no minor children in common, and the wife is not pregnant. 4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the parties is dissolved and the parties are restored to the status of being single. SECTION I. MARITAL ASSETS AND LIABILITIES A. Date of Valuation of Property. The assets and liabilities listed below are divided as indicated. The date of valuation of these assets and liabilities is, unless otherwise indicated: ___ a. date of filing petition for dissolution of marriage __________. ___ b. date of separation_________________. ___ c. date of divorce trial________________. *399 B. Division of Assets. 1. The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the assets found to be nonmarital, and the other party shall have no further rights or responsibilities regarding these assets. ________________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Current Wife's Husband's (Describe each item as clearly as possible. Fair Market Nonmarital Nonmarital You do not need to list account numbers) Value Property Property __________________________________________________________________________________ $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Nonmarital Assets $ $ $ __________________________________________________________________________________ 2. The assets listed below are marital assets. Each party shall keep, as his or her own, the assets awarded in this section, and the other party shall have no further rights or responsibilities regarding these assets. Any personal item(s) not listed below are awarded to the party currently in possession or control of the item(s). ________________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Current Wife Husband (Describe each item as clearly as possible. Fair Market Shall Shall You do not need to list account numbers.) Value Receive Receive __________________________________________________________________________________ Cash (on hand or in banks/credit unions) $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Stocks/bonds __________________________________________________________________________________ __________________________________________________________________________________ Notes __________________________________________________________________________________ Business interests __________________________________________________________________________________ __________________________________________________________________________________ Real estate: (Home) __________________________________________________________________________________ __________________________________________________________________________________ Automobiles __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Boats __________________________________________________________________________________ Furniture & furnishings __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Jewelry __________________________________________________________________________________ *400 __________________________________________________________________________________ ASSETS: DESCRIPTION OF ITEM(S) Current Wife Husband (Describe each item as clearly as possible. Fair Market Shall Shall You do not need to list account numbers.) Value Receive Receive ================================================================================== Life insurance (cash surrender value) __________________________________________________________________________________ Retirement Plans (Profit sharing, Pension, IRA, 401(k)s, etc.) __________________________________________________________________________________ __________________________________________________________________________________ Other assets __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Marital Assets $ $ $ __________________________________________________________________________________ C. Division of Liabilities/Debts. 1. The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party shall have no responsibilities regarding these debts. __________________________________________________________________________________ LIABILITIES: DESCRIPTION OF DEBT(S) Current Wife's Husband's Nonmarital Nonmarital (Describe each item as clearly as possible. Amount Liability Liability You do not need to list account numbers) Owed __________________________________________________________________________________ $ $ $ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Nonmarital Liabilities $ $ $ __________________________________________________________________________________ 2. The liabilities listed below are marital liabilities and are divided as indicated. Each party shall hold the other party harmless and pay, as his or her own, the marital liabilities awarded below. __________________________________________________________________________________ LIABILITIES: DESCRIPTION OF DEBT(S) Current Wife Husband (Describe each item as clearly as possible. Amount Shall Shall You do not need to list account numbers) Owed Pay Pay __________________________________________________________________________________ Mortgages on real estate: (Home) $ $ $ __________________________________________________________________________________ (Other) __________________________________________________________________________________ *401 __________________________________________________________________________________ Charge/credit card accounts __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Auto loan __________________________________________________________________________________ Auto loan __________________________________________________________________________________ Bank/Credit Union loans __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Other __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Total Marital Liabilities $ $ $ __________________________________________________________________________________ D. Contingent assets and liabilities will be divided as follows: ______________ ____________________________________________________________________________ ____________________________________________________________________________ E. The distribution of assets and liabilities in this final judgment is equitable; if each party does not receive approximately one-half, the distribution is based on the following facts and reasoning: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME [√ all that apply] ___ 1. ( ) Petitioner ( ) Respondent, as a condition of support, shall have exclusive use and possession of the dwelling located at: _____________________________ until {date of event} ___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. ___ 2. ( ) Petitioner ( ) Respondent may make visits to the premises described in the paragraph above for the purpose of obtaining any items awarded in this Final Judgment. These visits shall occur after notice to the person granted exclusive use and possession of the dwelling and at the earliest convenience of both parties or as ordered in paragraph 4 below. ___ 3. Upon the termination of the right of exclusive use and possession, the dwelling shall be sold and the net proceeds divided ___% to petitioner and ___% to Respondent, with the following credits and/or setoffs being allowed: ______ *402 ____________________________________________________________________________ ____________________________________________________________________________ 4. Other: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. MONEY 1. ( ) The Court denies the request(s) for alimony OR ( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has/had the present ability to pay, alimony as follows: [√ all that apply] ___ a Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _________________________________________________________ ____________________________________________________________________________ beginning {date}________. This alimony shall continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. ___ b. Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $______________________________________________________________________________. ____________________________________________________________________________ This amount shall be paid as follows: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________________________________________________ beginning {date} _______________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ____________________________________________________________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ d. Retroactive. Obligor shall pay retroactive alimony in the amount of $_________ for the period of {date} ______________, through {date} ____________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony: a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *403 [] Check here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [√ one only] ___ a. There is no alimony arrearage at the time of this Final Judgment. ___ b. The ( ) Petitioner ( ) Respondent shall pay to the other party the alimony arrearage of: $________ for retroactive alimony, as of {date} ________________________. $___for previously ordered unpaid alimony, as of {date} ________________. The total of $__________ in alimony arrearage shall be repaid in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _________________________________________________________________________ _________________________________________________________________________ beginning {date} __________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $__________ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $__________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support.) To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $__________ and shall remain in effect until the obligation for alimony terminates. 5. Other provisions relating to alimony: ___________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. SECTION IV. METHOD OF PAYMENT. Obligor shall pay court-ordered alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} _____________________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.13(1)(d)3, Florida Statutes, to require payment through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the *404 Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: There are no minor child(ren) common to the parties AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All $__________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________ _________________________________________________________________________ _________________________________________________________________________ SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $________ in attorney fees, and $__________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $__________ per hour and __________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VI. OTHER PROVISIONS 1. Former Name. The wife's former name is {full name} ____________________ __________________ is restored. 2. Other provisions. _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on_____________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ Form 12.993(a) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ *405 Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. SUPPLEMENTAL FINAL JUDGMENT OF MODIFICATION OF PARENTAL RESPONSIBILITY/VISITATION This cause came before this Court on a Supplemental Petition for Modification of Parental Responsibility and Visitation. The Court, having reviewed the file, heard the testimony, and being otherwise fully advised, makes these findings of fact and reaches these conclusions of law: SECTION I. FINDINGS 1. The Court has jurisdiction over the subject matter and the parties. 2. The last order estabUshing or modifying parental responsibility or visitation was entered on {date} ____________________. 3. There has been a substantial change in circumstances of the parties since the entry of the last order, specifically: _____________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. It is the best interests of the minor child(ren) that the current parental responsibility/visitation order be changed because: ________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. CUSTODY OF AND VISITATION WITH DEPENDENT OR MINOR CHILD(REN) 1. Jurisdiction. The Court has jurisdiction to determine custody of and visitation with the parties' minor child(ren) listed in paragraph 2 below. 2. The parties' dependent or minor child(ren) are: Name Birth date ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Parental Responsibility for the Minor Child(ren). [√ one only] ___ a. The parties shall have shared parental responsibility for the parties' minor child(ren). *406 ( ) Mother ( ) Father shall have primary residential responsibility of the minor child(ren) and the other parent shall have secondary residential responsibility, as set forth in paragraph 4 below. OR The primary residential parent shall be ( ) undesignated ( ) rotating with time sharing for the ( ) Mother ( ) Father as set forth in paragraph 4 below. ___ b. ( ) Mother ( ) Father shall have sole parental responsibility for the parties' minor ehild(ren). Shared parental responsibility would be detrimental to the child(ren) at this time because: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ The other parent shall have visitation with the parties' minor child(ren) as set forth in paragraph 4 below. 4. Secondary Residential Responsibility, Visitation, or Time Sharing with Minor Child(ren). The parent granted secondary residential responsibility, visitation, or time sharing shall have: [√ one only] ___ a. reasonable visitation or time sharing with the parties' minor child(ren) after reasonable notice and as agreed to by the parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to set a specific schedule. ___ b. the following specified visitation or time sharing with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: {specify days and times} _________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. no contact with the parties' minor child(ren) until further order of the Court, due to the existing conditions that are detrimental to the welfare of the minor child(ren) {explain} ______________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Limitations on Parental Responsibility, Visitation or Time Sharing. Neither parent shall take the child(ren) from the custody of the other parent or any child care provider or other person entrusted by the other parent with the care of the child(ren) without the agreement of the other parent during the other parent's time of parental responsibility or visitation. The above reasonable (paragraph 4.a. above) or specified (paragraph 4.b. above) visitation shall be: [√ if applies] ___ a. supervised by a responsible adult who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {name} _____ ____________________________________________________________________________. ___ b. at the supervised visitation center located at: $ address $ _________, subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) Mother ( ) Father ( ) Both. 6. Communication Arrangements for Secondary Parenting, Visitation, or Time Sharing with Child(ren). [√ if applies] ___ The parties' communications to arrange visitation or time sharing and discuss issues relating to the child(ren) (if shared parenting or visitation is provided in paragraph 3 above) are restricted as follows: ( ) telephone, ( ) fax, e-mail, or letter, ( ) A responsible person shall coordinate the visitation or time sharing *407 arrangements of the minor child(ren). If the parties cannot agree, the responsible person shall be: {name} _____________________________________ ( ) other conditions for arrangements or discussions: {explain} _________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as scheduled and as agreed to by the parties. The following conditions, if checked below, shall also apply. [√ all that apply] ___ a. The parties shall exchange the child(ren) at the following location(s): __ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. ___ b. The parent granted secondary parenting, visitation, or time sharing shall not get out of the vehicle, and the other parent shall not approach the vehicle, during the time the child(ren) are exchanged. ___ c. A responsible person shall conduct all exchanges of the child(ren). Neither parent shall accompany the responsible person when that person is transferring the child(ren) from one parent to the other. If the parties cannot agree, the responsible person shall be: {name} _________________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: _________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ 8. Injunction Prohibiting Removing the Child(ren). The Court hereby prohibits and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor child(ren) from the ( ) State of Florida ( ) {specify} ____________________________________________________________________________ ____________________________________________________________________________ without a court order or the written consent of the other party. ___ 9. Other Provisions Relating to the Minor Child(ren). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. CHILD SUPPORT 1. Modification of Child Support. [√ one only] ___ a. The modification of parental responsibility or visitation entered above does not necessitate a modification of child support. The previous order or final judgment establishing or modifying child support shall remain in effect. ___ b. The Court finds that there is a need for modification of child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $__________, (Child Support Guidelines ______%). The Father's net monthly income is $__________, (Child Support Guidelines ____%). *408 Monthly child care costs are $__________. Monthly health/dental insurance costs are $_________. 2. Amount. ( ) Mother ( ) Father shall be obligated to pay child support in the amount of $____________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _______________________________________________________________ _________________________________________________________________________ beginning {date} ______________, and continuing until ( ) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting OR one of the minor children reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting and either party files a supplemental petition to modify child support and the court enters such an order. OR ( ) {date/event} __________________________________________________, {explain} _________________________________________________________. If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: _________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [√ one only] ___ a. There is no child support arrearage at the time of this Supplemental Final Judgment. ___ b. The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of: $_________ for retroactive child support, as of {date} _________________. $_________ for previously ordered unpaid child support, as of {date} ___. The total of $__________ in child support arrearage shall be repaid in the amount of $__________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date} __________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary uninsured medical/dental costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain} _____________________________________________________ ____________________________________________________________________________ As to these uninsured medical/dental expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. *409 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $_________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary(ies)( ) primary residential parent as the beneficiary as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the first of the parties' minor children reaches of age of 18 or until one of the parties' children becomes emancipated, marries, dies, otherwise becomes self-supporting, at which time the amount of life insurance shall be recomputed. 6. IRS Income Tax Exemption(s). The party granted primary residential responsibility or sole parental responsibility of the minor child(ren) shall have the benefit of any tax exemption(s) for the child(ren), OR, if checked here, ( ) assignment of any tax exemption(s) for the child(ren) shall be as follows: ____________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. METHOD OF PAYMENT Obligor shall pay court-ordered child support and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name of county} _______________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} __________ ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $__________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee to the payment method prescribed above. *410 4. Other provisions relating to the method of payment. _____________________ _________________________________________________________________________ _________________________________________________________________________ SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY. ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $__________ in attorney fees, and $__________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $__________ per hour and __________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: __________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VI. OTHER 1. Other Provisions. _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment. 3. Unless specifically modified by this supplemental final judgment, the provisions of all final judgments or orders in effect remain the same. ORDERED on_________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ Form 12.993(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. *411 SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT This cause came before this Court on a Supplemental Petition for Modification of Child Support. The Court, having heard the testimony and reviewed the file and financial affidavits of the parties and being otherwise fully advised, makes these findings of fact and reaches these conclusions of law: SECTION I. FINDINGS 1. The Court has jurisdiction over the subject matter and the parties. 2. The parties' dependent or minor child(ren) is: NAME Birth date ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. The last order awarding or modifying child support was entered on {date} ____________________________________________________________________________. 4. There has been a substantial change in circumstances of the parties since the entry of the last order, specifically: _____________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. It is in the best interests of the minor child(ren) that the current child support order be changed because: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________. SECTION II. CHILD SUPPORT 1. The Court finds that there is a need for modification of child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $__________, (Child Support Guidelines ___%). The Father's net monthly income is $__________, (Child Support Guidelines ___%). Monthly child care costs are $__________. Monthly health/dental insurance costs are $__________. 2. Amount. Obligor shall be obligated to pay child support in the amount of $__________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain}: _________________________________________________________________________ _________________________________________________________________________, beginning {date} __________, and continuing until ( ) the youngest of the minor ehild(ren) reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting OR *412 one of the minor children reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes self-supporting and either party files a supplemental petition to modify child support and the court enters such an order. OR ( ) {date/event} ___________________________________________________, {explain} _________________________________________________________. If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: _________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [√ one only] ___ a. There is no child support arrearage at the time of this Supplemental Final Judgment. ___ b. The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of: _________ for retroactive child support, as of {date} __________________. _________ for previously ordered unpaid child support, as of {date} ____. The total of $______in child support arrearage shall be repaid in the amount of $_________, per month payable ( ) in accordance with his or her employer's payroll cycle, and in any event at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( ) Dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary uninsured medical/dental costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain} _____________________________________________________ ____________________________________________________________________________ As to these uninsured medical/dental expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $__________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary(ies)( ) primary residential parent as the beneficiary as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage shall continue until the first of the parties' minor children reaches the age of 18 or until one of the parties' children becomes emancipated, marries, dies, otherwise becomes self-supporting, at which time the amount of life insurance coverage shall be recomputed. *413 6. IRS Income Tax Exemption(s). The party granted primary residential responsibility or sole parental responsibility of the minor child(ren) shall have the benefit of any tax exemption(s) for the child(ren), OR, if checked here, ( ) assignment of any tax exemption(s) for the child(ren) shall be as follows: ____________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. METHOD OF PAYMENT 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name of county} _______________________ County, along with any depository service charge ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to 61.13(1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} ________ ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $_________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the *414 other party $__________ in attorney fees, and $__________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $________ per hour and ________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION V. OTHER 1. Other provisions. _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment. 3. Unless specifically modified by this supplemental final judgment, the provisions of all final judgments or orders in effect remain the same. ORDERED on_________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ Form 12.993(c) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. SUPPLEMENTAL FINAL JUDGMENT MODIFYING ALIMONY This cause came before this Court on a Supplemental Petition for Modification of Alimony. The Court, having heard the testimony and reviewed the file and financial affidavits of the parties and being otherwise fully advised, makes these findings of fact and reaches these conclusions of law: SECTION I. FINDINGS 1. The Court has jurisdiction over the subject matter and the parties. 2. The last order awarding or modifying alimony was entered on {date} ______ _______________. *415 3. There has been a substantial change in circumstances of the parties since the entry of the last order, specifically: _____________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. ALIMONY 1. ( ) The Court denies the request(s) for modification of alimony OR ( ) The Court finds that there is a need to modify alimony and that ( ) Petitioner ( ) Respondent (hereinafter Obligor) has/had the present ability to pay alimony as follows: [√ all that apply] ___ a. Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ____________________________________________________ _________________________________________________________________________ beginning {date} __________. This alimony shall continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. ___ b. Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________________________________________________________________________ This amount shall be paid as follows: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________________________________________________ beginning {date} ____________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ____________________________________________________________________________ whichever occurs first. The rehabilitative plan presented demonstrated the following: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ d. Retroactive. Obligor shall pay retroactive alimony in the amount of $__________ for the period of {date} ____________, through {date} _______________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Modification of Alimony. The Court has considered all of the following in awarding/denying the modification of alimony request: a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision: _________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ *416 [] Check here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [√ one only] ___ a. There is no alimony arrearage at the time of this Supplemental Final Judgment. ___ b. The ( ) Petitioner ( ) Respondent shall pay to the other party the alimony arrearage of: $________ for retroactive alimony, as of {date} ___________. $________ for previously ordered unpaid alimony, as of {date} ___________. The total of $_________ in alimony arrearage shall be repaid in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _________________________________________________________________________ _________________________________________________________________________ beginning {date} __________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $________ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $_________ and shall remain in effect until the obligation for alimony terminates. 5. Other provisions relating to modification of alimony: ___________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. METHOD OF PAYMENT 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name of county} __________________ County, along with any depository service charge ___ b. Both parties have requested that support payments not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to 61.08, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. *417 ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $__________, or, if not specified, an implemented immediately based on the following findings: ___________________ ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $__________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $__________ in attorney fees, and $__________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $__________ per hour and __________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION V. OTHER 1. Other Provisions: _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment. 3. Unless specifically modified by this supplemental final judgment, the provisions of all final judgments or orders in effect remain the same. ORDERED on_________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ Form 12.993(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA *418 Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. Petitioner has custody of the following minor child(ren) common to the parties or the child(ren) has (have) primary residence with Petitioner. Name Birth date _________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION I. ALIMONY 1. ( ) The Court denies the request(s) for alimony. OR ( ) The Court finds that there is a need for alimony and that Respondent has/had the ability to support Petitioner and has failed to do so. Respondent (hereinafter Obligor) has the present ability to pay alimony as follows: [√ all that apply] ___ a. Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _________________________________________________________ _________________________________________________________________________ beginning {date} __________. This alimony shalll continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. ___ b. Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________________________________________________________________________. This amount shall be paid as follows: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________________________________________________ *419 beginning {Date}____________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ____________________________________________________________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ d. Retroactive. Obligor shall pay retroactive alimony in the amount of $________ for the period of {date} __________, through {date} ___________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony: a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the court has considered the following factors in reaching its decision: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [] Check here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [√ one only] ___ a. There is no alimony arrearage at the time of this Final Judgment. ___ b. Respondent shall pay to Petitioner the alimony arrearage of: $________ for retroactive alimony, as of {date} ____________. $________ for previously ordered unpaid alimony, as of {date} __________. The total of $__________ in alimony arrearage shall be repaid in the amount of $_ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $________ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $________ per year. As to the uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit a request for reimbursement to the other party within 30 days, and the other party shall, within 30 days of receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $________ and shall remain in effect until the obligation for alimony terminates. *420 5. Other provisions relating to alimony: ___________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _________________________________________________________________________ SECTION II. CHILD SUPPORT 1. The Court finds that there is a need for child support and that the ( ) Mother ( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family Law Form 12.901(g), filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The Mother's net monthly income is $________, (Child Support Guidelines ___ %). The Father's net monthly income is $________, (Child Support Guidelines ___%). Monthly child care costs are $________. Monthly health/dental insurance costs are $________. 2. Amount. Under the child support guidelines, the ( ) Mother ( ) Father shall be obligated to pay child support in the amount of $________, per month payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} _________________________ ____________________________________________________________________________, beginning {date} ________________, and continuing ( ) until the first of the parties' minor children reaches the age of 18 or until one of the parties' children becomes emancipated, marries, dies, otherwise becomes self-supporting, at which time the child support shall be recomputed under the then-current Child Support Guidelines. OR ( ) until {Date/event} ____________________________________________, {explain} _________________________________________________________. If the child support ordered deviates from the guidelines by 5% or more, the factual findings which support that deviation are: ______________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Arrearage/Retroactive Child Support. [√ one only] ___ a. There is no child support arrearage at the time of this Final Judgment. ___ b. The ( ) Mother ( ) Father shall pay to the other party the child support arrearage of: $_________ for retroactive child support, as of {date} ________. $_________ for previously ordered unpaid child support, as of {date} ___. The total of $________ in child support arrearage shall be repaid in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date}____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health/Dental Insurance. ( ) Mother ( ) Father shall be required to maintain ( ) health ( ) dental insurance coverage for the parties' minor child(ren), so long as reasonably available. The party providing coverage shall be required to convey insurance cards demonstrating said coverage to the other party. OR ( ) Health ( ) dental insurance is not reasonably available at this time. *421 ___ b. Reasonable and necessary uninsured medical/dental costs for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {explain} _____________________________________________________ ____________________________________________________________________________ As to these uninsured medical/dental expenses, the party who incurs the expense shall submit a request for reimbursement to the other party within 30 days, and the other party, within 30 days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule of reimbursement set out in this paragraph. 5. Life Insurance (to secure payment of support). To secure the child support obligations in this judgment, ( ) Petitioner ( ) Respondent ( ) Each party shall maintain life insurance coverage, in an amount of at least $________, on ( ) his life ( ) her life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary(ies)( ) primary residential parent as the beneficiary as Trustee for the minor child(ren). The obligation to maintain the life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. IRS Income Tax Exemption(s). Petitioner shall have the benefit of any tax exemption(s) for the child(ren), OR, if checked here, ( ) assignment of any tax exemption(s) for the ehild(ren) shall be as follows: ____________________ _________________________________________________________________________. Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this paragraph. 7. Other provisions relating to child support: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION III. METHOD OF PAYMENT Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {name} __________________________ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that it is in the best interests of the child(ren) that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section 61.08 or 61.13, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but is shall not be effective until a delinquency of $________, or, if not specified, an amount equal to one month's obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} __________ *422 ____________________________________________________________________________ ____________________________________________________________________________ AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment. _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________. ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other $________ in attorney fees, and $________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $__________ per hour and ________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ____________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VIII. OTHER PROVISIONS 1. Other Provisions: _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on_________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ Form 12.994(b) IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR_________ COUNTY, FLORIDA Case No.: _________________________________ Division: _________________________________ _____________________________________, Petitioner, *423 and _____________________________________, Respondent. FINAL JUDGMENT FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILDREN This cause came before this Court on a Petition for Support Unconnected with Dissolution of Marriage under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: 1. The Court has jurisdiction over the subject matter and the parties. 2. The parties have no minor or dependent children in common, and the wife is not pregnant. SECTION I. ALIMONY 1. ( ) The Court denies the request(s) for alimony. OR ( ) The Court finds that there is a need for alimony and that Respondent has/had the ability to support Petitioner and has failed to do so. Respondent (hereinafter Obligor) has the present ability to pay alimony as follows: [√ all that apply] ___ a. Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _________________________________________________________ ____________________________________________________________________________ beginning {date} ________ This alimony shall continue until modified by court order, the death of either party, or remarriage of Obligee, whichever occurs first. ___ b. Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________________________________________________________________________. This amount shall be paid as follows: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ c. Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of $________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________________________________________________ beginning {date} ______________. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {date/event} ____________________________________________________________________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: _________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___ d. Retroactive. Obligor shall pay retroactive alimony in the amount of $__________ for the period of {date} ____________, through {date} ____________, which shall be paid pursuant to paragraph 3 below. 2. Reasons for ( ) Awarding ( ) Denying Alimony. The Court has considered all of the following in awarding/denying alimony. a. The standard of living established during the marriage; b. The duration of the marriage; c. The age and the physical and emotional condition of each party; d. The financial resources of each party, the nonmarital and the marital assets and liabilities distributed to each; *424 e. The contribution of each party to the marriage, including, but not limited to, services rendered in homemaking, child care, education, and career building of the other party; and f. All sources of income available to either party. Additionally, the Court has considered the following factors in reaching its decision: __________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ [] Check here if additional pages are attached. 3. Arrearage/Retroactive Alimony. [√ one only] ___ a. There is no alimony arrearage at the time of this Final Judgment. ___ b. Respondent shall pay to Petitioner the alimony arrearage of: $________ for retroactive alimony, as of {date} ____________. $________ for previously ordered unpaid alimony, as of {date} __________. The total of $________ in alimony arrearage shall be repaid in the amount of $__________ per month, payable ( ) in accordance with Obligor's employer's payroll cycle, and in any event at least once a month ( ) other {explain} ____________________________________________________________________________ ____________________________________________________________________________ beginning {date} ____________, until paid in full including statutory interest. 4. Insurance. [√ all that apply] ___ a. Health Insurance. ( ) Petitioner ( ) Respondent shall be required to pay health insurance premiums for the other party not to exceed $________ per month. Further, ( ) Petitioner ( ) Respondent shall pay any reasonable and necessary uninsured medical costs for the other party not to exceed $________ per year. As to these uninsured medical expenses, the party who is entitled to reimbursement of the uninsured medical expense shall submit a request for reimbursement to the other party within 30 days, and the other party shall, within 30 days after receipt, submit the applicable reimbursement for that expense. ___ b. Life Insurance (to secure payment of support). To secure the alimony obligations set forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance shall be in the amount of at least $________ and shall remain in effect until the obligation for alimony terminates. 5. Other provisions relating to alimony: ___________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION II. METHOD OF PAYMENT. 1. Central Governmental Depository. [√ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central governmental Depository in {name} ______________________ County, along with any depository service charge. 2. Income Deduction. [√ if applies] ___ a. Immediate. Obligor shall pay through income deduction. Obligor is individually responsible for paying this support obligation in the event that all or any portion of said support is not deducted from Obligor's income. Until *425 support payments are deducted from Obligor's paycheck pursuant to the Income Deduction Notice authorized this day, Obligor is responsible for making timely payments directly to the Central Governmental Depository. ___ b. Deferred. An Income Deduction Notice is authorized this day, but it shall not be effective until a delinquency of $________, or, if not specified, an amount equal to one moth's obligation occurs. Income deduction is not being implemented immediately based on the following findings: There are no minor child(ren) common to the parties AND there is proof of timely payment of a previously ordered obligation without income deduction. 3. Bonus/one-time payments. ( ) All ( ) $________ ( ) No income paid in the form of a bonus or other similar one-time payments, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment: _________________________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY ___ 1. ( ) Petitioner ( ) Respondent's request(s) for attorney fees, costs, and suit money is (are) denied because ______________________________________________ ____________________________________________________________________________ ___ 2. The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party $________ in attorney fees, and $________ in costs. The Court further finds that the attorney fees awarded are based on the reasonable rate of $________ per hour and ________ reasonable hours. Other provisions relating to attorney fees, costs, and suit money are as follows: ___________ ____________________________________________________________________________ ____________________________________________________________________________ SECTION VIII. OTHER PROVISIONS 1. Other Provisions. _______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Final Judgment. ORDERED on_________________. _________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: _________________________________________ NOTES [1] The rules and steering committees are in disagreement as to the financial affidavit forms to be used. We have amended the financial affidavit forms after reviewing comments from both committees.