From Casetext: Smarter Legal Research

Appendix C

Supreme Court of Florida
Jan 4, 2001
810 So. 2d 1 (Fla. 2001)

Summary

providing that Court will seek input from advisory workgroup when making more substantial changes to the Supreme Court Approved Family Law Forms

Summary of this case from In re Implementation of Committee on Privacy

Opinion

No. SC99-2.

September 21, 2000. Rehearing Denied January 4, 2001.


[Editor's Note: This Appendix C (Part 2) was issued with the opinion located at 810 So.2d 1. Click Previous or Next Document to access other parts of the opinion.]

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE 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.

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 Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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. 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 Supreme Court Approved 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 who 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Service and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b).

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. 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 Supreme Court Approved Family Law Form 12.922(a), and Default, Florida Supreme Court Approved Family Law Form 12.922(b), for further information. You will need to file a Nonmilitary Affidavit, Florida Supreme Court Approved Family 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.910(a). SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL

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 ITATION: 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: { 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 Supreme Court Approved 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 notification, para contestar la demanda adjunta, por escrito, y presentarla ante este tribunal. Localizado en: _____________. Una llamada 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 llamar 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 direccion 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 direccion actual. (Usted puede presentar ______ el Formulario: Ley de Familia de la Florida 12.915, [Florida Supreme Court Approved 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 revelacion automatica de documentos e informacion. El incumplimient, puede resultar en sanciones, incluyendo la desestimacion o anulacion de los alegatos.

IMPORTANT

Des poursuites judiciaries ont ete entreprises centre 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. II 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, sont disponible au bureau du greffier. Vous pouvez revue ces documents, sur demande.

II faut aviser le greffier de votre adresse actuelle. (Vous pouvez deposer Florida Supreme Court Approved Family Law Form 12.915, Notice of Current Address.) Les documents de Favenir de ce proces seront envoyer a l' adresse que vous donnez au bureau du greffier.

ATTENTION: La regie 12.285 des regies de procedure du droit de la famille 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 SUPREME COURT APPROVED FAMILY LAW FORM 12.910(b), PROCESS SERVICE MEMORANDUM

When should this form be used?

You should use this form to give the sheriff's 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 Rules of Procedure 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 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 Rules of Procedure 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 Self-Represented Litigants" found at the beginning of these forms. You should read the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure 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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.910(b). PROCESS SERVICE MEMORANDUM

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: _________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Dated: ________________________ ____________________________________ Signature of Party Printed Name: _________________ Address:fn_ ______________________ City, State, Zip:fn_ _____________ Telephone Number:fn_ _____________ Fax Number:fn_ ___________________

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 Supreme Court Approved 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 SUPREME COURT APPROVED FAMILY LAW FORM 12.912(a), MEMORANDUM 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 Supreme Court Approved 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: SUPERS, PERS 02116, 2 Navy Annex, Washington, D.C. 20370-0216, Phone: (703) 614-5011 or (703) 614-9221

MARINE CORPS: USMC-CMC, HQMC-MMSB-10, 2008 Elliot Road, Room 201, Quantico, VA 22134-5030, 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 46249-5301, 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 Supreme Court Approved 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 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.912(a). MEMORANDUM FOR CERTIFICATE OF MILITARY SERVICE

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. 20370-0216 ( ) USMC-CMC, HQMC-MMSB-10, 2008 Elliot Road, Room 201, Quantico, VA 22134-5030 ( ) 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 46249-5301

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.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.912(b), NON-MILITARY 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 or deputy clerk . You must file the original of this form with the clerk of the circuit court when you file your Motion for Default, Florida Supreme Court Approved 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.912(b). NONMILITARY AFFIDAVIT

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: __________________________ City, State, Zip: _________________ Fax Number: _______________________

STATE OF FLORIDA COUNTY OF ________________________________

Sworn to or affirmed and signed before me on ___________ by ___________ _____________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________ [Print, type, or stamp commissioned name of notary or 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} _________________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 Rules of Procedure Form 12.913(b). You should keep a copy for your records.

After the Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure 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 Supreme Court Approved Family Law Form 12.902(a). 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 Self-Represented 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 . . .

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 Supreme Court Approved Family Law Form 12.922(a), and Default, Florida Supreme Court Approved 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.913(a). NOTICE OF ACTION FOR DISSOLUTION OF MARRIAGE

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 Supreme Court Approved 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

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 RULES OF PROCEDURE 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 Supreme Court Approved 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 or deputy clerk . You should file the original and a Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.913(b). AFFIDAVIT OF DILIGENT SEARCH AND INQUIRY

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. I 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 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 for 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 Supreme Court Approved 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.

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 imprison merit.

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 or DEPUTY CLERK _______________________________ ____________________________________ [Print, type, or stamp commissioned name of notary or 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} __________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.914, CERTIFICATE 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 Supreme Court Approved 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 Supreme Court Approved 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 or deputy clerk. 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.

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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.914. CERTIFICATE OF SERVICE

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.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.915. NOTICE OF CURRENT ADDRESS

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: ___________________

Dated: _______________________ _________________________________ Signature of Party STATE OF FLORIDA COUNTY OF _____________________

Sworn to or affirmed and signed before me on ______________ by ________ ___________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________ [Print, type, or stamp commissioned name of notary or 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} ____________, who is the [ one only] _____ petitioner or _____________ respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORMS 12.920(a), MOTION FOR REFERRAL TO GENERAL MASTER, 12.920(b), ORDER OF REFERRAL 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 Rules of Procedure Form 12.920(a). You must also prepare an Order of Referral to General Master, Florida Family Law Rules of Procedure 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 Rules of Procedure 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 Rules of Procedure 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 Rules of Procedure 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 Rules of Procedure Form 12.920(b), and an addressed, stamped envelope for each party in the case. 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 Rules of Procedure 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.920(a). MOTION FOR REFERRAL TO GENERAL MASTER

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: _____________________________ 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). ORDER OF REFERRAL TO GENERAL MASTER

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, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 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.

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 RESPONSIVE PLEADING IS DUE. FAILURE TO FILE A WRITTEN OBJECTION 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 RECOMMENDATION MADE BY THE GENERAL MASTER, YOU MUST FILE EXCEPTIONS 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 EXCEPTIONS, OR YOUR EXCEPTIONS WILL BE DENIED. A RECORD ORDINARILY 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

FORM 12.920(c). NOTICE OF HEARING BEFORE GENERAL MASTER

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.

If the matter before the General Master is a Motion for Civil Contempt/Enforcement, FAILURE TO APPEAR AT THE HEARING MAY RESULT IN THE COURT ISSUING A WRIT OF BODILY ATTACHMENT FOR YOUR ARREST. IF YOU ARE ARRESTED, YOU MAY BE HELD IN JAIL UP TO 48 HOURS BEFORE A HEARING IS HELD.

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 RECOMMENDATION MADE BY THE GENERAL MASTER, YOU MUST FILE EXCEPTIONS 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 EXCEPTIONS, OR YOUR EXCEPTIONS WILL BE DENIED. A RECORD ORDINARILY 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} ___________________________________.

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 SUPREME COURT APPROVED FAMILY LAW FORM 12.921, NOTICE OF HEARING (CHILD SUPPORT ENFORCEMENT 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 Self Represented 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.921. NOTICE OF HEARING (CHILD SUPPORT ENFORCEMENT HEARING OFFICER)

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.

If the matter before the Child Support Enforcement Hearing Officer is a Motion for Civil Contempt/Enforcement, FAILURE TO APPEAR AT THE HEARING MAY RESULT IN THE COURT ISSUING A WRIT OF BODILY ATTACHMENT FOR YOUR ARREST. IF YOU ARE ARRESTED, YOU MAY BE HELD IN JAIL UP TO 48 HOURS BEFORE A HEARING IS HELD.

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: ________________ 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 SUPREME COURT APPROVED FAMILY LAW FORMS 12.922(a), MOTION FOR DEFAULT, and 12.922(b), DEFAULT

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 Supreme Court Approved Family Law Form 12.922(a). You will then need to file your motion for default along with the Default, Florida Supreme Court Approved 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 Supreme Court Approved 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.922(a). MOTION FOR DEFAULT

IN THE CIRCUIT COURT OF __________ THE JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA

Case No.: ________________________ Division: ________________________ ______________________________, 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.

FORM 12.922(b). DEFAULT

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: ____________________________

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: ____________________________

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.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.922(c), MOTION TO SET ASIDE DEFAULT OR DEFAULT 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 or deputy clerk. 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 Supreme Court Approved 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 Self-Represented 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 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.922(c). MOTION TO SET ASIDE DEFAULT OR DEFAULT JUDGMENT

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: ______________________ 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 or DEPUTY CLERK

____________________________________ [Print, type, or stamp commissioned name of notary or 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} _______________, who is the respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 Rules of Procedure 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 Supreme Court Approved 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 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 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 Self-Represented Litigants" found at the beginning of these forms. For further information on serving notices of 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.923. NOTICE OF HEARING (GENERAL)

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} _________________.

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 SUPREME COURT APPROVED 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 Supreme Court Approved 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 circuit 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.924. NOTICE FOR TRIAL

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 SUPREME COURT APPROVED 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 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 hand-delivered to each party in the case.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.927. NOTICE OF VOLUNTARY DISMISSAL

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: ______________________ 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 RULES OF PROCEDURE 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, Family Law Rules of Procedure Forms 12.902(b) or (c). You should carefully read the standard interrogatory forms, Family Law Rules of Procedure 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, Family Law Rules of Procedure 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 Self-Represented 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 must give you a copy of Disclosure from Nonlawyer, Family Law Rules of Procedure Form 12.900(a), 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. FORM 12.930(a). NOTICE OF SERVICE OF STANDARD FAMILY LAW INTERROGATORIES

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA

NOTICE OF SERVICE OF STANDARD FAMILY LAW INTERROGATORIES

full legal name date name of person served one ( ) Original or Enforcement Proceedings ( ) Modification Proceedings all Case No.:________________ Division: _______________ ______________________________________, Petitioner, and ______________________________________, Respondent. I, {} _______________, have on {} _______________, served upon {} __________________________________, to be answered under oath within 30 days after service, the Standard Family Law Interrogatories for [ only] I am requesting that the following standard questions be answered: [ that apply] _____ 1 _____ 2 _____ 3 _____ 4 _____ 5 _____ 6 _____ 7

one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

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 [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} ______________________________. Name: _______________________________ Address: ____________________________ City, State, Zip: ___________________ Fax Number: _________________________ Dated: ______________________________ _________________________________________________ Signature of Party Printed Name: _________________________________ Address: ________________________________________ City, State, Zip: _______________________________ Telephone Number: _______________________________ Fax Number: _____________________________________ [fill in blanks] I, {} ____________________________________________________, a nonlawyer, located at {} __________________________________, {} _________________________, {} ______________________, {} _______________________, helped {} ______________________, who is the [ only] ___________ petitioner ___________ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(b), STANDARD FAMILY LAW INTERROGATORIES 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, Family Law Rules of Procedure Form 12.902(b) or (c). 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, Family Law Rules of Procedure Form 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, Family Law Rules of Procedure Form 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 Self-Represented Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Family Law Rules of Procedure 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, Family Law Rules of Procedure Form 12.900(a), 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. FORM 12.930(b). STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, TN 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 all name of person answering interrogatories BACKGROUND INFORMATION: EDUCATION: EMPLOYMENT:

I am requesting that the following standard questions be answered: [ 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, Family Law Rules of Procedure Form 12.902(b) or (c). 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, {} ________________________, being sworn, certify that the following information is true: 1. 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. 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. 3. 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.

ASSETS: Real Estate Tangible Personal Property Intangible Personal Property

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. a. . 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. b. . 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. . 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:

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). Financial Accounts 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). Closed Financial Accounts. Trust

(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. d. . 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) 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. e. 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. . 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.

Canceled Life Insurance Policies Name of Accountant, Bookkeeper, or Records Keeper Safe Deposit Boxes, Lock Boxes, Vaults, Etc. LIABILITIES: Loans, Liabilities, Debts, and Other Obligations

(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. . 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. (8) date the policy was surrendered. (9) amount, if any, of monies distributed to the owner. h. . 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. 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 deposit 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. a. . 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.

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). Credit Cards and Charge Accounts. 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) Closed Credit Cards and Charge Accounts 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). MISCELLANEOUS:

(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. b. 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. . c. . 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. 6.

LONG FORM AFFIDAVIT: one date Other party or his/her attorney: 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. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all

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. 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. If you filed the short form affidavit, Florida Family Law Rules of Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), you must do so within the time to serve the answers to these interrogatories. I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} ________________________. Name: ______________________________________ Address: ___________________________________ City, State, Zip: __________________________ Fax Number: ________________________________ 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 or DEPUTY CLERK _______________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced __________________________________ [fill in blanks]

full legal name and trade name of nonlawyer street city state phone name one or

I, {} ____________________________________________________, a nonlawyer, located at {} __________________________________, {} _________________________, {} ______________________, {} _______________________, helped {} ______________________, who is the [ only] ___________ petitioner ___________ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(c), STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION 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 modification proceedings and are meant to supplement the information provided in the Financial Affidavits, Family Law Rules of Procedure Form 12.902(b) or (c). 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, Family Law Rules of Procedure Form 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, Family Law Rules of Procedure Form 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 Self-Represented Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Family Law Rules of Procedure 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, Family Law Rules of Procedure Form 12.900(a), 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.

FORM 12.930(c). STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEDINGS

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, TN AND FOR _____________ COUNTY, FLORIDA

STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES all Case No.: ______________________________________ Division: ______________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent. I am requesting that the following standard questions be answered: [ 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, Family Law Rules of Procedure Form 12.902(b) or (c). 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.

name of person answering interrogatories BACKGROUND INFORMATION: EDUCATION: EMPLOYMENT:

I, {} _________________________________________, being sworn, certify that the following information is true: 1. 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. 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. (2) dates of attendance. (3) degrees or certificates obtained or anticipated dates of same. 3. 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.

ASSETS: Real Estate Tangible Personal Property Intangible Personal Property 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 shorter. 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). Financial Accounts

4. a. . 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. b. . 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. . 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. d. . 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. (5) highest 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). Closed Financial Accounts Trust. Name of Accountant, Bookkeeper, or Records Keeper LIABILITIES: Loans, Liabilities, Debts, and Other Obligations

(6) lowest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. e. . 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. 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. . 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. 5. a. . 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.

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). Credit Cards and Charge Accounts 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). Closed Credit Cards and Charge Accounts. 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). MISCELLANEOUS:

(6) present balance and current status of your payments. (7) total amount of arrearage, if any. b. . 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. c. 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. (5) date the balance was paid off. (6) amount of final balance paid off. 6. 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

LONG FORM AFFIDAVIT: date Other party or his/her attorney: 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.

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. If you filed the short form affidavit, Florida Family Law Rules of Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), 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 {} ________________. Name: _____________________________________ Address: __________________________________ City, State, Zip: _________________________ Fax Number: _______________________________ 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 _________________________.

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: full legal name and trade name of nonlawyer street city state phone name one or

___________________________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________________________________ [fill in all blanks] I, {} ______________________________________________________, a nonlawyer, located at {} _____________________________, {} ________________________________, {} ____________________, {} _______________________, helped {} __________________________, who is the [ only] _______ petitioner _______ respondent, fill out this form. INSTRUCTIONS FOR SUPREME COURT APPROVED FAMILY LAW FORMS 12.931(a), NOTICE OF PRODUCTION FROM NONPARTY and 12.931(b), SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY

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 Supreme Court Approved 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 Supreme Court Approved Family Law Form 12.931(b), is the actual subpoena directing the nonparty to pro duce 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 Supreme Court Approved 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.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), be fore 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, TN AND FOR _____________ COUNTY, FLORIDA

NOTICE OF PRODUCTION FROM NONPARTY all parties 10 days name of person, organization, or agency 10 days date FORM 12.931(a). NOTICE OF PRODUCTION FROM NONPARTY Case No.: ______________________________________ Division: ______________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent. TO: ___________________________________________________________________________________________________ {} YOU ARE NOTIFIED that, after 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 { } _________, 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 . I certify that a copy of this document was [ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} ___________________. 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: __________________________________________ ________________________________________________ Signature of Party Printed Name: __________________________________ Address:________________________________________ City, State, Zip:_______________________________ Telephone Number: ______________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: full legal name and trade name of nonlawyer street city state phone name one or FORM 12.931(b). SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA

SUBPOENA FOR PRODUCTION OF DOCUMENTS FROM NONPARTY MUST place date time or 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. Fax Number: ____________________________________ [fill in all blanks] I, {} ______________________________________________________, a nonlawyer, located at {} _____________________________, {} ________________________________, {} ____________________, {} _______________________, helped {} __________________________, who is the [ only] _______ petitioner _______ respondent, fill out this form. Case No.: ______________________________________ Division: ______________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent. THE STATE OF FLORIDA TO: _________________________________________________ YOU go to {} __________________________________________________________________, on {} _____________, at {} __________, a.m./p.m. and bring with 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 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 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) By: ______________________________

This part to be filled out by the court or filled in with information you have obtained from the court: address telephone IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

Deputy Clerk 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} _______________________________________________________________________________________, {} ____________________________________, {} _________________________________________________, 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: _____________________________________________________ [fill in blanks] I, {} __________________________________________________, a nonlawyer, located at {} __________________, {} _______________________________________, {} _______, {} _____________, helped {} _____________________________________________, who is the [ only] ______ petitioner ______________ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.932, CERTIFICATE 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. Of the documents listed on this form, 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 Rules of Procedure Form 12.902(b). If your individual gross annual income is $50,000 or more, you should complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(c).

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 Self-Represented 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 Rules of Procedure Form 12.902(c), by serving the appropriate interrogatory form. (See Standard Family Law Interrogations, Florida Family Law Rules of Procedure Form 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 Rules of Procedure Form 12.902(b) or (c), 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 Rules of Procedure Form 12.900(a), 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. FORM 12.932. CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSESURE

IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA

CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE full legal name 1. FOR TEMPORARY FINANCIAL RELIEF, ONLY: all 2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF: all Case No.: ______________________________________ Division: ______________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent. I, {} _____________, certify that I have complied with the mandatery disclosure required by Florida Family Law Rule 12.285 as follows: The date the following documents were served: ______________________________________________. [ that apply] ___ a. Financial Affidavit (Filing of a Financial Affidavit cannot be waived.) ( ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) ( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) ___ b. ( ) All personal (1040) federal tax, gift tax, and intangible personal property tax returns for the preceding year; or ( ) Transcript of tax return as provided by IRS form 4506; or ( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the past year has not been prepared. ___ c. Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. The date the following documents were served: ______________________________________. [ that apply] ___ a. Financial Affidavit (Filing of a Financial Affidavit cannot be waived.) ( ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) ( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) b. ( ) All personal (1040) federal and state tax income returns, gift tax returns, and intangible personal property tax returns for the preceding 3 years; ( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the past year has not been prepared. ___ c. Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. ___ d. 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. ___ e. 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.

one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

___ f. 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. ___ g. 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. ___ h. All brokerage account statements for the last 12 months. ___ i. Most recent statement for any pension, profit sharing, deferred compensation, or retirement plan (for example, IRA, 401(k), 403(b), SEEP, KEOGH, etc.) and summary plan description for any such plan in which I am a participant or alternate payee. ___ j. 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. ___ k. All health and dental insurance cards covering either of me or my spouse and/or our dependent child(ranee). ___ l. 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%. ___ m. All credit card and charge account statements and other records showing 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. ___ n. All premarital and marital agreements between the parties to this case. ___ o. If a modification proceeding, all written agreements entered into between the parties at any time since the order to be modified was entered. ___ p. All documents and tangible evidence relating to claims for special equity or nonmarital status of an asset or debt. ___ q. Any court order directing that I pay or receive spousal support (alimony) or child support. I certify that a copy of this document was [ only] ( ) mailed ( ) fixed and mailed ( ) hand delivered to the person(s) listed below on {} ________________________________. Name: ______________________________________ Address: ___________________________________ City, State, Zip: __________________________ faux Number: _______________________________ Dated: _____________________________________ ____________________________________ Signature of Party Printed name: ______________________ Address: ___________________________ City, State, Zip: __________________ Telephone Number: __________________ Fax Number: ________________________ [fill in blanks] I, {} _________________________________________________, a nonlawyer, located at {} _________________, {} _______________________________________, {} _______, {} ______________, helped {} ___________________________________________, who is the [ only] _____ petitioner _____ respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.940(d), MOTION TO MODIFY OR DISSOLVE TEMPORARY 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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.902(d), if the custody of a minor child(ranee) is at issue.

Order . . . These family law forms contain an Order Dissolving Temporary Injunction, Florida Supreme Court Approved Family Law Form 12.940(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 must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), 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. FORM 12.940(d). MOTION TO MODIFY OR DISSOLVE TEMPORARY INJUNCTION

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA

Case No.: ______________________________ Division: ______________________________ ________________________________, Petitioner,

MOTION TO MODIFY OR DISSOLVE TEMPORARY INJUNCTION one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: full legal name and trade name of nonlawyer street city state phone name one or Form 12.940(e). ORDER DISSOLVING TEMPORARY INJUNCTION

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA

ORDER DISSOLVING TEMPORARY INJUNCTION and ________________________________, Respondent. ( ) 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 1.610, 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 [ only] ( ) mailed ( ) fixed and mailed ( ) hand delivered to the person(s) listed below on {} ____________________. Name: ______________________________________ Address: ___________________________________ City, State, Zip: __________________________ faux Number: _______________________________ Dated: _____________________________________ ___________________________________ Signature of Party Printed name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ [fill in all blanks] I, {} _________________________________________, a nonlawyer, located at {} _______________________________, {} _________________, {} ______________________, {} ________________________, helped {} __________, who is the [ only] __________ petitioner ______________ respondent, fill out this form. Case No.: ______________________________________ Division: ______________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent.

date date time

Upon ( ) Petitioner's ( ) Respondent's motion and after hearing, the Court, being fully advised in the premises, ORDERS that the temporary injunction entered on {} _______ in the above-styled case is hereby dissolved. ORDERED on {} _______________, at {} ___________. ________________________________ 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. 10522-1705 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.941(a), VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(RANEE) 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(ranee) is (are) not to be removed from the State of Florida while a case involving the child(ranee)'s custody is pending, that passport services for the minor child(ranee) 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.

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. 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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.902(d).

Temporary Injunctions . . . These family law forms contain a Temporary Injunction to Prevent Removal of Minor Child(ranee) and/or Denial of Passport Services (Ex Parte), Florida Supreme Court Approved 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(ranee) and/or Denial of Passport Services (After Notice),

Florida Supreme Court Approved 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 Rules of Procedure Form 12.900(a), be fore 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. FORM 12.941(a). VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(RANEE) AND/OR DENIAL OF PASSPORT SERVICES

IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT IN AND FOR ______________ COUNTY, FLORIDA

Case No.: ____________________________ Division: ____________________________ _______________________________, Petitioner, and _______________________________, Respondent.

Name Birth date date all If without notice, explain why there would be immediate and irreparable harm if the other party is given notice. all one date

VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(RANEE) 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(ranee) from the jurisdiction of this Court and deny passport services for the child(ranee) and says: 1. The minor child(ranee) subject to this request is (are): _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. The child(ranee) has (have) been a resident(s) of _____________________________ County, Florida since {} _______. 3. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this motion. 4. It is in the best interests of the minor child(ranee) that the Court order the following: [ that apply] ___ a. The child(ranee) not be removed from the jurisdiction of this Court while litigation is pending because: _______________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ___ b. Passport services for the minor child(ranee) be prohibited because:__________________________ ________________________________________________________________________________________________ ___ c. Existing passports for the minor child(ranee) be immediately turned over to ( ) Petitioner ( ) Respondent because: ________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. This motion should be granted ( ) with ( ) without notice to the other party. { } __________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ WHEREFORE, ( ) Petitioner ( ) Respondent requests the following from the Court: [ that apply] ___ a. enter a temporary injunction to prevent removal of the child(ranee) named above from the jurisdiction of this Court while this action is pending; ___ b. enter an order denying passport services for the minor child(ranee); ___ c. enter an order requiring that any existing passports for the minor child(ranee) 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 [ only] ( ) mailed ( ) fixed and mailed ( ) hand delivered to the person(s) listed below on {} _______ or ( ) was not delivered to the person(s) listed below because ____________________________________________________

Other party or his/her attorney: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this verified motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. If the party filing this motion is represented by an attorney, the attorney must complete the following: if no efforts have been made, why IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all

____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Name: ____________________________ Address: _________________________ City, State, Zip: ________________ Faux Number: ______________________ 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 or DEPUTY CLERK __________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced _________________________ I, the undersigned attorney for the movant, hereby certify in that the following efforts have been made to give notice, {} _______________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ ____________________________ Signature ____________________________ Florida Bar Number ____________________________ Printed Name [fill in blanks]

full legal name and trade name of nonlawyer street city state phone name one or FORM 12.941(b). TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (EX PARTE)

IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR ___________________ COUNTY, FLORIDA

TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (EX PARTE) NOTICE OF HEARING if date name room name/number, location, address, city name address telephone FINDINGS I, {} ___________________________________________________, a nonlawyer, located at {} ___________________________, {} _______________________________, {} ____________________, {} _____________________________, helped {} _________________, who is the [ only] ________ petitioner __________ respondent, fill out this form. Case No.: ___________________________________ Division: ___________________________________ _______________________________, Petitioner, and _______________________________, Respondent. 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: 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. [ 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 {} ______, 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 {} ___________________________________, at {} ____________________________________, 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 no cost to you, to the provision of certain assistance. Please contact {} ______________________________________________________________, {} ___________, {} ________________________________________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771. 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.

TEMPORARY INJUNCTION all Name Birth date name Bond. 7. Expiration. date date time FORM 12.941(c). TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (AFTER NOTICE)

2. ( ) Petitioner's ( ) Respondent's attorney has certified in writing any efforts made to give notice. 3. The reasons why notice should not be given are: ________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ [ 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: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ ___ 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 {} _____________________________________________________. 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. ___ 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. This injunction shall remain in effect until the minor child(ren) reach(es) the age of 18, until the hearing scheduled herein, if any, or {} ______, whichever occurs first, unless modified by further order of this Court. ORDERED on {} _____________, at {} ______. _______________________________ 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. 10522-1705

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR _______________ COUNTY, FLORIDA

TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES (AFTER NOTICE) all Name Birth date name Bond. Expiration. date time Case No.: _______________________________ Division: _______________________________ _______________________________, Petitioner, and _______________________________, Respondent. 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: [ 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: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ ___ 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 {} ______________________________________________________________. 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. ___ 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. This temporary injunction shall remain in effect until the minor child(ren) reach(es) the age of 18, or until {} ______, 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 {} _________. _______________________________ 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. 10522-1705 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.941(d), EMERGENCY 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 Self-Represented 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 or deputy clerk. 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 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. 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 Supreme Court Approved 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 Supreme Court Approved Family Law Form 12.902(d).

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.

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 Supreme Court Approved 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.

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 Rules of Procedure Form 12.900(a), be fore 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

EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER full legal name Name Sex Birth date Race Physical Description FORM 12.941(d). EMERGENCY VERIFIED MOTION FOR CHILD PICK-UP ORDER Case No.: _______________________________ Division: _______________________________ _______________________________, Petitioner, and _______________________________, Respondent. I, {} _______________, 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-rdered) regarding the following minor child(ren): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

full legal name Custody status of minor child(ren). all Custody has been established by a court. date name of court case number list name(s) of the child(ren) or write "all" if Custody is established as an operation of law. list name(s) of the child(ren) or write "all" Paternity has not been established. Paternity has been established. Facts relating to the minor child(ren)'s current situation. all date

____________________________________________________________________________________ ____________________________________________________________________________________ 2. Currently, the child(ren) subject to this motion is (are) in the physical possession of {} _________________________ 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. I have a superior right to custody of the minor child(ren) over the person named in paragraph 2 because: [ that apply]: ___ a. A final judgment or order awarding custody of the minor child(ren) was made on {} __________, in {} ________ {} _________. This order awarded primary physical custody of the minor child(ren) to me. This final judgment or order applies to the following minor child(ren): {} ________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ A certified copy of said final judgment or order is attached, has not been modified, and is still in effect. [ 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. 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): { } ______________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ___ A certified copy of the minor child(ren)'s birth certificate is attached and has not been amended. ___ 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 Supreme Court Approved Family Law Form 12.902(d), is filed with this motion. 6. [ that apply] ___ a. The person named in paragraph 2 wrongfully removed or wrongfully detained the minor child(ren) from my custody on {} ____________ as follows: ________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

list both the address and the people you believe will be there give name of individual to call give name of individual to call Attorneys' Fees, Costs, and Suit Monies. if 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.

___ 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 { }: _____________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 7. Advance notice of this motion to the individual named in paragraph 2 should not be required because: __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 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: { } ________________________________________________________________ Name of Contact Person: ___________________________________________________________. Address: __________________________________________________________________________. Telephone number(s) where I (or my designee) can be reached: { } _______________________________________________________________. 9. [ 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. Date: _______________________________ Signature of Party ___________________________ Printed Name: ________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Telephone Number: ____________________________ Fax Number: __________________________________ STATE OF FLORIDA COUNTY OF ___________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name FORM 12.941(e). ORDER TO PICK-UP MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR _________________ COUNTY, FLORIDA

ORDER TO PICK-UP MINOR CHILD(REN) JURISDICTION all 28 U.S.C. § 1738A 742.031 744.301 Sworn to or affirmed and signed before me on _______________________ by _______________. ________________________________________ NOTARY PUBLIC or DEPUTY CLERK ________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _______________________________ [fill in blanks] I, {} _________________________________, a nonlawyer, located at {} _____________________, {} ___________________, {} ___________, {} ________________, helped {} _____________________, who is the [ one only] ______ petitioner or ___ respondent, fill out this form. Case No.: _______________________________ Division: _______________________________ _______________________________, Petitioner, and _______________________________, Respondent. 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: This Court has jurisdiction over issues surrounding the minor child(ren) listed below based on the following: [ 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, . 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 out of 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 and , Florida Statutes.

NOTICE OF HEARING name date name room name/number, location, address, city name address telephone ORDER ORDERS AND DIRECTS 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

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.

OR

Place the minor child(ren) in the physical custody of agency who shall contact the undersigned judge for an expedited hearing. ___ 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 which took initial jurisdiction over the minor child(ren) to determine this authority. ___ e. Other: __________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Because this Order to Pick-Up Minor Child(ren) has been issued without prior notice to the non-movant {} _____________________________________________________________________, all parties involved in this matter are informed that they are scheduled to appear and testify at a hearing regarding this matter on {} ________, 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 {} ________________________________________________________, at {} ________________________________________, 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 {} _____________________________________________________________, {} ________________________________________________________________________, {} ______, within 2 working days of your receipt of this order. If you are hearing or voice impaired, call TDD 1-800-955-8771. This Court 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. {} ______, {} _______________, ___ 2. 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 Family Services of the State of Florida pending an expedited hearing herein. ___ 3. {} ______, 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 VIOLATE THE MANDATES OF THIS ORDER IN THE PRESENCE OF THE LAW ENFORCEMENT OFFICER, THIS OFFICER IS TO IMMEDIATELY ARREST AND INCARCERATE THE OFFENDING PARTY UNTIL SUCH TIME AS THE OFFENDING PARTY MAY BE BROUGHT BEFORE THIS COURT FOR FURTHER PROCEEDINGS. Name Sex Birth date Race Physical Description time

All sheriffs of the State for 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 arise 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: ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Current location/address of minor child(ren) or of party believed to have possession of the minor child(ren): ______________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ORDERED on {date} _____________, at {} ________. ______________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.942(a), MOTION FOR APPOINTMENT OF GUARDIAN 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(s) 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 Supreme Court Approved Family Law Form 12.923, or other appropriate 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 Self-Represented 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—405, Florida Statutes.

Special notes . . .

Order . . . These family law forms contain an Order Appointing a Guardian ad Litem, Florida Supreme Court Approved Family Law Form 12.942(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 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.942(a). MOTION FOR APPOINTMENT OF GUARDIAN AD LITEM

IN THE CIRCUIT COURT OF THE _________ JUDICIAL CIRCUIT, IN AND FOR ____________________ COUNTY, FLORIDA

MOTION FOR APPOINTMENT OF GUARDIAN AD LITEM

Case No.: ____________________________ Division: ____________________________ _______________________________, Petitioner, and _______________________________, Respondent.

61.403 Name Birth date Age Sex Location/Address 39.01 one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

( ) Petitioner ( ) Respondent requests that the Court enter an order appointing a guardian ad litem with all powers, privileges, and responsibilities authorized in section , Florida Statutes, and states: 1. The following minor child(ren) is (are) subject to this proceeding: __________________________ __________________ __________ ___________ _______________________ __________________________ __________________ __________ ___________ _______________________ __________________________ __________________ __________ ___________ _______________________ __________________________ __________________ __________ ___________ _______________________ __________________________ __________________ __________ ___________ _______________________ 2. Verified allegations of child abuse or neglect as defined in section (2) or (5), 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: ______________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} ______________________________________. Name: ________________________________ Address: _____________________________ City, State, Zip: ____________________ Fax Number: __________________________ Dated: _______________________________ ___________________________________ Signature of Party Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ [fill in blanks] I, {} _________________________________________________, a nonlawyer, located at {} ___________________________, {} ______________________________, {} __________________, {} _______________, helped {} _________________________________, who is the [ only] ____________ petitioner ______________ respondent, fill out this form. FORM 12.942(b). ORDER APPOINTING GUARDIAN AD LITEM

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________

ORDER APPOINTING GUARDIAN AD LITEM 39.01 OR name(s) street address 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 specify 61.403

____________________________________, Petitioner, and ____________________________________, Respondent. 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 (2) or (5), Florida Statutes, have been made and are determined to be well-founded, ___ b. it is otherwise in the best interests of the child(ren) that a guardian ad litem be appointed to advance the best interests of the minor child(ren) because: _____________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ _________________________________, it is thereupon ORDERED as follows: 1. A guardian ad litem shall be appointed for the minor child(ren), {} _________________ ____________________________________________________________________________________________ now residing at {} __________________________________________________________. 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, {} __________________________________________________________________________________ ___________________________________________________________________________________________. {} _________________________, 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, {} _________________________________________________________ ____________________________________________________________________________________________ 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 , 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).

61.403

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 (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), 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 SUPREME COURT APPROVED 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.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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, N Florida Family Law Rules of Procedure Form 12.902(b) or (c), and the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).

With this form you must also file the following, if not already filed:

Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).

Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (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 Rules of Procedure Form 12.900(a), 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.

FORM 12.943. MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES SECTION I one MORE all 61.30 61.30 LESS all

Case No.: _________________________ Division: _________________________ ____________________________________________, Petitioner, and ____________________________________________, Respondent. ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following: [ only] ___ a. 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: [ 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. The amount of time each child will spend with each parent under the shared parental arrangement; ___ 6. The direct and indirect financial expenses for each child as set forth in s. (11)(b)3, Florida Statutes; ___ 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; ___ 10. The comparative income of each parent, considering all relevant factors, as provided in s. (2)(a), Florida Statutes; ___ 11. The station in life of each parent and each child; ___ 12. The standard of living experienced by the entire family during the marriage; ___ 13. The financial status and ability of each parent; and/or ___ 14. 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. 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: [ 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 the child(ren), taking into consideration the greater needs of older child(ren);

61.30 61.30 SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES TOTAL VALUE OF ASSETS OF CHILD(REN) $_____ TOTAL MONTHLY INCOME OF CHILD(REN) $_____ SECTION III. EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES

___ 6. The amount of time each child will spend with each parent under the shared parental arrangement; ___ 7. The direct and indirect financial expenses for each child as set forth in s. (11)(b), Florida Statutes; ___ 8. The comparative income of each parent, considering all relevant factors, as provided in s. (2)(a), Florida Statutes; ___ 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; ___ 12. The station in life of each parent and each child; ___ 13. The standard of living experienced by the entire family during the marriage; ___ 14. The financial status and ability of each parent; and/or ___ 15. 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: ___________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 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. 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. $_____ 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) 21. $_____ Explain: _______________________________________________________________

explain explain TOTAL EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES one date Other party or his/her attorney: 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. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

22. Monthly insurance (life, etc.) {}: ______________________________ 22. $_____ Other {} ______________: 23. ________________________________________________________________________ 23. $_____ 24. ________________________________________________________________________ 24. $_____ 25. ________________________________________________________________________ 25. $_____ 26. (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 Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 2. Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} _____________________________________. Name: __________________________________ Address: _______________________________ City, State, Zip: ______________________ Fax Number: ____________________________ Dated: ______________________________ _____________________________________________ Signature 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 or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _________________________ [fill in blanks] I, {} ________________________________________________, a nonlawyer, located at {} ________________________, {} _________________________________, {}__________________, {} ______________________, helped {} ________________________, who is the [ only] __________ petitioner ________ respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.944(a), MOTION FOR TESTIMONY AND ATTENDANCE 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), 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 Supreme Court Approved 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.944(a). MOTION FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

Case no.: _________________________ ____________________________________, Division: _________________________ Petitioner, and

MOTION FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN) Name Birth date Age all name(s) date name(s) name(s) date location name(s) date location name(s) date location name(s) date location one date Other party or his/her attorney:

____________________________________, Respondent. ( ) 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): _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ [ that apply] ___ 1. Minor child(ren), {} _____________________________________________________________, be subpoenaed to appear at hearing now scheduled for {} ________________________________. ___ 2. Minor child(ren), {} _____________________________________________________________, attend deposition of {} _____________ now scheduled for {} ______________________ at {} ______________________________________________________________________________. ___ 3. Minor child(ren)'s, {} ___________________________________________________________, deposition be taken on {} _________________ at {} ______________________________ ___ 4. Minor child(ren), {} _____________________________________________________________, be brought to court to attend hearing now scheduled for {} _____________________________ at {} ______________________________________________________________________________. ___ 5. Minor child(ren), {} _____________________________________________________________, be brought to court to testify in a hearing now scheduled for {} _______________________ at {} ______________________________________________________________________________. The Court should do this because: _______________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} ______________________________________. 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: all full legal name and trade name of nonlawyer street city state phone name one or

[fill in blanks] I, {} ________________________________________________, a nonlawyer, located at {} __________________________, {} _____________________________, {} ______________, {} ________________, helped {} _________________________________, who is the [ only] ______________ petitioner ______ respondent, fill out this form. FORM 12.944(b). ORDER FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

ORDER FOR TESTIMONY AND ATTENDANCE OF MINOR CHILD(REN) all name(s) date name(s) name(s) date location name(s) date location name(s) date location name(s) date location name address telephone

Case No.: ________________________________ Division: ________________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. 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 [ that apply] ___ 1. Minor child(ren), {} ____________________________________________________________, be subpoenaed to appear at hearing now scheduled for {} _______________________________. ___ 2. Minor child(ren), {} ____________________________________________________________, attend deposition of {} _____________________ now scheduled for {} ___________ at {} _________________________________________________________________________________. ___ 3. Minor child(ren)'s, {} __________________________________________________________, deposition be taken on {} _________ at {} ______________________________________. ___________________________________________________________________________________________. ___ 4. Minor child(ren), {} ____________________________________________________________, be brought to court to attend hearing now scheduled for {} _______________ at {} ___________________________________________________________________________________________. ___ 5. Minor child(ren), {} ____________________________________________________________, be brought to court to testify in a hearing now scheduled for {} ____________________ at {} _________________________________________________________________________________. 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 {} ______________________________________, {} __________________, {} ____________, 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 _______________________________ ___________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 Supreme Court Approved 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 Self-Represented 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:

Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), if you are asking the court to determine temporary custody of minor child(ren).

Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (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 Rules of Procedure Form 12.932.

Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), 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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.947(a). MOTION FOR TEMPORARY SUPPORT WITH DEPENDENT OR MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

MOTION FOR TEMPORARY SUPPORT WITH DEPENDENT OR MINOR CHILD(REN)

Case No.: _________________________ Division: _________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. The ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support;

or complete all 1. Assets and Liabilities. Award temporary exclusive use and possession of the marital home address Award temporary use and possession of marital assets. Specify Enter a temporary injunction Explain Require temporary payment of specific marital debts. Explain 2. Child(ren). 3. Support. 4. Attorney's fees and costs. 5. Other Relief. specify

[ that apply] ___ a. , {} ____________________________________________________________________________________________ ____________________________________________________________________________________________ The Court should do this because: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ b. {} ________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ The Court should do this because: __________________________________________________________ ____________________________________________________________________________________________ ___ c. prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {} __________________________ The Court should do this because: __________________________________________________________ ___ d. {} __________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ The Court should do this because: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ 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: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___ a. Award temporary child support of $________ per month. ___ b. Award temporary spousal support/alimony of $______ per month. The Court should do this because: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ a. Award temporary attorney's fees of $___________. ___ b. Award temporary costs of $_____. The Court should do this because: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ {} ____________________________________________________________________ ____________________________________________________________________________________________

one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawyer street city state phone name one or

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 6. A completed Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this motion or has already been filed with the Court. 7. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932, is filed with this motion or has already been filed with the Court. 8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(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 [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} _____________________________________. Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Dated: ___________________________________ ___________________________________ Signature of Party Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ [fill in blanks] I, {} _______________________________________________, a nonlawyer, located at {} ____________________, {} ___________________________________, {} ___________, {} ____________________, helped {} _________________________________, who is the [ only] ________ petitioner _____ respondent, fill out this form. FORM 12.947(b). TEMPORARY ORDER OF SUPPORT WITH DEPENDENT OR MINOR CHILD(REN)

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) SECTION I. MARITAL ASSETS AND LIABILITIES A. Injunction. B. Temporary Use of 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. Wife Shall Husband ASSETS: DESCRIPTION OF ITEM(S) Have Shall Have Temporary Temporary Use Use

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. 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. 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. Automobiles ___________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Furniture furnishings in home _______________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Furniture furnishings elsewhere _____________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Jewelry _______________________________________________________________________________________ Business interests ____________________________________________________________________________ _________________________________________________________________________________________________ Other Assets __________________________________________________________________________________

C. Temporary Responsibility for Liabilities/Debts. Current LIABILITIES: DESCRIPTION OF DEBT(S) Amount Wife Husband Owed Shall Pay Shall Pay $ $ $ SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME all address date or event SECTION III. TEMPORARY CUSTODY OF AND VISITATION WITH DEPENDENT OR MINOR CHILD(REN) Jurisdiction. The parties' dependent or minor child(ren) is (are): Name Birth date

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. 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 _________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ [ that apply] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: {} ______________________________________________________ ____________________________________________________________________________________________ until {} ______________________________________________________________________ ____________________________________________________________________________________________ ___ 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: __________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 1. The Court has jurisdiction to determine temporary custody of and visitation with the parties' minor child(ren) listed in paragraph 2 below. 2. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Temporary Parental Responsibility for the Minor Child(ren). one shared parental responsibility primary residential OR sole parental responsibility Temporary Secondary Residential Responsibility, Temporary Visitation, or Temporary Time Sharing with Minor Child(ren). one reasonable visitation or time sharing specified visitation or time sharing specify days and times no contact explain Limitations on Temporary Parental Responsibility, Visitation, and Time Sharing. if supervised by a responsible adult name supervised visitation address

_____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. [ only] ___ a. The parties shall have temporary for the parties' minor child(ren). ( ) Mother ( ) Father shall have temporary responsibility of the minor child(ren) and the other parent shall have temporary secondary residential responsibility, as set forth in paragraph 4 below. 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 for the parties' minor child(ren). Temporary shared parental responsibility would be detrimental to 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. The parent granted temporary secondary residential responsibility, visitation, or time sharing shall have: [ only] ___ a. 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 with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: { } _____________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ c. 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). {} __________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 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 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: [ applies] ___ a. who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {} _______________________________ ___ b. at a center located at: {} ________________________________ ____________________________________________________________________________________________

Communication Arrangements for Temporary Secondary Parenting, Visitation, and Time Sharing with Child(ren). if name explain Exchange of Minor Child(ren). all name Injunction Prohibiting Removing the Child(ren). Other Temporary Provisions Relating to the Minor Child(ren). SECTION IV. TEMPORARY ALIMONY OR all

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. [ 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: {} ____________________________________________________________________ ( ) other conditions for arrangements or discussions: {} ____________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 7. 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. [ 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: {} ___________________________________________________________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: _________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ 8. 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. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 1. ( ) The Court denies the request(s) for temporary alimony. ( ) 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: [ that apply]

Temporary Periodic. explain date date/event Lump Sum. Rehabilitative. explain date date/event Retroactive. date date Reasons for Awarding/Denying Temporary Alimony Award. Retroactive Alimony. date explain date Insurance. all Health Insurance. Life Insurance (to secure payment of support).

___ a. 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 {} ____________________________________________________________________________________________ ___________________________________________________________________________________________, beginning {} _____. This temporary periodic alimony shall continue until modified by court order, the death of either party, or until, } ______, whichever occurs first. ___ b. Obligor shall pay temporary lump sum alimony to Obligee in the amount of $______. This amount shall be paid as follows: __________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___ c. 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 {} _________________ beginning {} ______. This temporary rehabilitative alimony shall continue until modified by court order, the death of either party or until {} _________________________, whichever occurs first. The temporary rehabilitative plan presented demonstrated the following: ______________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___________________________________________________________________________________________. ___ d. Obligor shall pay retroactive alimony in the amount of $____________________ for the period of {} _______ through {} _____, which shall be paid pursuant to paragraph 3 below. 2. 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. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary retroactive alimony of $______, as of {} _______. 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 {} ____________________________________________________________________________________________ beginning {} _______, until paid in full including statutory interest. 4. [ that apply] ___ a. ( ) 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. To secure the temporary alimony obligations set forth in this order, the Obligor shall temporarily maintain life insurance

Other provisions relating to temporary alimony: SECTION V. TEMPORARY CHILD SUPPORT OR Amount. explain date date/event explain Retroactive Child Support if date explain date Insurance. all Health/Dental Insurance. OR uninsured medical/dental/prescription drug costs explain

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. _____________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 1. The Court finds that there is a need for temporary 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 Rules of Procedure Form 12.902(e), filed by the ( ) Mother ( ) Father are correct 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. 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 ( ) {} _______________________________________________ _________________________________ beginning {} _______, and continuing until further court order or until {} __________________________________________________________, {} __________________________________________________________________________________. If the temporary child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: ______________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. , [ applies] ___ ( ) Mother ( ) Father shall pay to the other party the temporary retroactive child support of $________, as of {} ________. 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 {} __________________________________ ______________________________ beginning {} _______, until paid in full including statutory interest. 4. [ that apply] ___ a. ( ) 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. ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary for the minor child(ren) shall temporarily be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {}: ________________________________________________________________________ _____________________________________________________________________________________________ As to these uninsured medical/dental/prescription drug 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.

Life Insurance (to secure payment of support). date/event IRS Income Tax Deduction(s). OR Other provisions relating to temporary child support: SECTION VI. METHOD OF PAYMENT Central Governmental Depository. if name 61.13 if Immediate. Deferred. not explain AND AND OR Bonus/one-time payments.

5. 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 {} _____________________________ _____________________________________________________________________________________________ 6. 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), , if checked here, ( ) assignment of any tax deduction for the child(ren) shall be as follows: _____________________ _____________________________________________________________________________________________ 7. _______________________________________ _____________________________________________________________________________________________ Obligor shall pay any temporary court-ordered child support/alimony and arrears, if any, as follows: 1. [ applies] ___ a. Obligor shall pay temporary court-ordered support directly to the Central Governmental Depository in {} ______ 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 (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [ applies] ___ a. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this temporary support obligation until all of said support is deducted from Obligor's income. Until temporary support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ b. Income deduction is ordered 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 in the best interests of the child(ren) because: {} __________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. ( ) All ( ) _______% ( ) No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the

Other provisions relating to method of payment. SECTION VII. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY SECTION VIII. OTHER PROVISIONS Other Provisions date time

remaining balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment method prescribed above. 4. 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: __________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ : ________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ORDERED on {} ________, at {} __________. _____________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: __________________________________________ INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.947(c), 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 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 in formation 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 Supreme Court Approved 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 Self-Represented 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:

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days if not filed at the time of the petition.)

Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).

Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932.

Temporary Order . . . These family law forms contain a Temporary Support Order with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(d), 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.947(c). MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN) or complete all Assets and Liabilities. Award temporary exclusive use and possession of the marital home address Award temporary use and possession of marital assets. Specify Enter a temporary injunction Explain Require temporary payment of specific marital debts. Explain Support. Attorney's fees and costs. Case No.: ______________________ Division: ______________________ _________________________________, Petitioner, and _________________________________, Respondent. ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support: [ that apply] 1. ___ a. , {} _____________________________________________________________________________________________ _____________________________________________________________________________________________ The Court should do this because: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ b. {} __________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ The Court should do this because: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ c. prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {} ___________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ The Court should do this because: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ d. {} ___________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ The Court should do this because: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. Award temporary spousal support/alimony of $____________ per month. The Court should do this because: _______________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. ___ a. Award temporary attorney's fees of $________. ___ b. Award temporary costs of $________.

Other Relief specify date Other party or his/her attorney IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW all full legal name and trade name of nonlawyer street city state phone name or

The Court should do this because: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. , {} _____________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932, is filed with this motion or has already been filed with the Court. 6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(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 {} ______________________________________. : Name: _______________________________________ Address: ____________________________________ City, State, Zip: ___________________________ Fax Number: _________________________________ Dated: ______________________________________ ________________________________________________ Signature of Party Printed Name: __________________________________ Address: _______________________________________ City, State, Zip: ______________________________ Telephone Number: ______________________________ Fax Number: ____________________________________ : [fill in blanks] I, {} ________________________________________________, a nonlawyer, located at {} __________________________, {} _____________________________, {} _________________, {} __________________, helped {} ____________________________, who is the [ one only] __________ petitioner ___________ respondent, fill out this form. FORM 12.947(d). TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

Case No.: ______________________ Division: ______________________ _________________________________, Petitioner, and

TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN) SECTION I. MARITAL ASSETS AND LIABILITIES A. Injunction. B. Temporary Use of 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. Wife Shall Husband ASSETS: DESCRIPTION OF ITEM(S) Have Shall Have Temporary Temporary Use Use Automobiles Furniture furnishings in home Furniture furnishings elsewhere Jewelry Business interests

_________________________________, Respondent. This cause came before this Court for a hearing 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. 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. 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. _______________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ___________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ___________________________________________________________________________________________ ________________________________________________________________________________

Other Assets C. Temporary Responsibility for Liabilities/Debts. Current LIABILITIES: DESCRIPTION OF DEBT(S) Amount Wife Husband Owed Shall Pay Shall 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 address date or event SECTION III. TEMPORARY ALIMONY OR all

__________________________________________________________________________________________________ __________________________________________________________________________________________________ ______________________________________________________________________________________ 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. _______________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _______________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ______________________________________________________________ __________________________________________________________________________________________________ _____________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ [ that apply] ___ 1. ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: {} _______________________________________________________ _____________________________________________________________________________________________ until {} _______________________________________________________________________ _____________________________________________________________________________________________ ___ 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: ___________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 1. ( ) The Court denies the request(s) for temporary alimony. ( ) 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: [ that apply]

Temporary Periodic. explain date date/event Lump Sum. Rehabilitative. explain date date/event Retroactive. date date Reasons for Awarding/Denying Temporary Alimony Award. Retroactive Alimony. date explain date Insurance. all Health Insurance.

___ a. 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 {} _____________________________________________________________________________________________ ____________________________________________________________________________________________, beginning {} _______. This temporary periodic alimony shall continue until modified by court order, the death of either party, or until, {} __________________________, ___________________________________ whichever occurs first. ___ b. Obligor shall pay temporary lump sum alimony to Obligee in the amount of $____________. This amount shall be paid as follows: __________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ c. 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 {} __________________ _____________________________________________________________________________________________ beginning {} _________. This temporary rehabilitative alimony shall continue until modified by court order, the death of either party or until {} ___________________, whichever occurs first. The temporary rehabilitative plan presented demonstrated the following: __________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ d. Obligor shall pay retroactive alimony in the amount of $___________________ for the period of {} ________ through {} _______, which shall be paid pursuant to paragraph 3 below. 2. 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. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary retroactive alimony of $_________, as of {} ______. 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 {} ___________________ ____________________________________________________________________________________________, beginning {} ______, until paid in full including statutory interest. 4. [ that apply] ___ a. ( ) 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.

Life Insurance (to secure payment of support). Other provisions relating to temporary alimony SECTION IV. METHOD OF PAYMENT Central Governmental Depository. if name 61.13 Income Deduction. if Immediate. Deferred. AND AND OR Bonus/one-time payments. Other provisions relating to method of temporary payment SECTION V. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY

___ b. 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. : _____________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows: 1. [ applies] ___ a. Obligor shall pay temporary court-ordered support directly to the Central Governmental Depository in {} ______ 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 (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. [ applies] ___ a. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this temporary support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ b. Income deduction is ordered 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, there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. ( ) All ( ) ______% ( ) No income paid in the form of a bonus or other similar one-time payment, 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. : ___________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ___ 1. ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit money is (are) denied because ______________________________________________________ _____________________________________________________________________________________________

SECTION VI. OTHER PROVISIONS Other Provisions: date time

___ 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: ____________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ______________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ORDERED on {} ___________, at {} ____________. ___________________________________________________ CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: ______________________________ INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.960, MOTION FOR CIVIL CONTEMPT/ENFORCEMENT

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 or deputy clerk . 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 personally served by a sheriff or private process server or mailed* or hand delivered to any other party(ies) in your case. *Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should have the motion personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

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 on Motion for Contempt/Enforcement, Florida Supreme Court Approved Family Law Form 12.961, or, if applicable, Notice of Hearing (Child Support Enforcement Hearing Officer), Florida Supreme Court Approved Family Law Form 12.921, or Order of Referral to General Master, Florida Family Law Rules of Procedure 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. Again, if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should have the notice personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

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 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 Self-Represented Litigants" found at the beginning of these forms. See also section 61.14, Florida Statutes and rule 12.615, Florida Family Law Rules of Procedure.

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 Rules of Procedure Form 12.900(a), 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. FORM 12.960. MOTION FOR CIVIL CONTEMPT/ENFORCEMENT

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

MOTION FOR CIVIL CONTEMPT/ENFORCEMENT Case No.: ________________________________ Division: ________________________________ ____________________________________________, Petitioner, and ____________________________________________, Respondent. ( ) Petitioner ( ) Respondent requests that the Court enter an order of civil contempt/enforcement against ( ) Petitioner ( ) Respondent in this case because:

title of final judgment or order date court, city, and state Explain what the other party was ordered to do or not do Explain what the other party has or has not done explain explain

1. A final judgment or order {} __________ in this case was entered on {} ____, by {} _____________________________________ _________________________________________________________________________________________ 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: {.} _____________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 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: {.} _____________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 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 or compelling compliance with 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 and fees in connection with this motion; ___ f. if the other party is found to be in civil contempt, ordering a compensatory fine; ___ g. if the other party is found to be in civil contempt, ordering a coercive fine; ___ h. if the other party is found to be in civil contempt, ordering incarceration of the other party; ___ i. issuing a writ of possession for real property, writ for possession of personal property, or other appropriate writ; ___ j. issuing a writ of bodily attachment if the other party fails to appear at the hearing set on this motion; ___ k. requiring the other party to make payments through the central governmental depository; ___ l. requiring the support payments to be automatically deducted from the other party's income or funds; ___ m. requiring the other party to seek employment; ___ n. awarding make-up visitation with minor child(ren) as follows {}: ________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ___________________________________________________________________________; and ___ o. awarding other relief {}: _______________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

date Other party or his/her attorney: 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. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: full legal name and trade name of nonlawyer street city state phone name one or

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ I certify that a copy of this document was [ one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} _________________________________. Name: _______________________________ Address: ____________________________ City, State, Zip: ___________________ Fax Number: _________________________ 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 or DEPUTY CLERK _____________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced __________ [fill in all blanks] I, {} ___________________________________________, a nonlawyer, located at {} ____________, {} ______________________________________, {}___________, {} ______________, helped {} __________________________________, who is the [ only] ________ petitioner __________ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.961, NOTICE OF HEARING ON MOTION FOR CONTEMPT/ENFORCEMENT

When should this form be used?

Use this form anytime you have set a hearing on a Motion for Contempt/Enforcement, Florida Supreme Court Approved Family Law Form 12.960, for a support matter under rule 12.615, Florida Family Law Rules of Procedure. Before you fill out this form, you should coordinate a hearing time and date with the judge or 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.

If your case is to be heard by a child support enforcement hearing officer, the following information applies: A child sup port 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 sup port , and the enforcement of alimony in conjunction with an ongoing child support arrearage order. If your case only involves issues pertaining to child support, you can not object to the referral of your case to a hearing officer. If your case is going to be heard by a general master , you should use Notice of Hearing Before General Master, Florida Family Law Rules of Procedure Form 12.920(c).

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 personally served by a sheriff or private process server or mailed or hand delivered to any other party(ies) in your case. Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see rules 12.615 and 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 Rules of Procedure Form 12.900(a), 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. FORM 12.961. NOTICE OF HEARING ON MOTION FOR CONTEMPT/ENFORCEMENT

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

Case No.: ___________________________________________ Division: ___________________________________________ ____________________________________,

NOTICE OF HEARING ON MOTION FOR CONTEMPT/ENFORCEMENT IN SUPPORT MATTERS (RULE 12.615) name of other party name of judge or hearing officer date time FAILURE TO APPEAR AT THE HEARING MAY RESULT IN THE COURT ISSUING A WRIT OF BODILY ATTACHMENT FOR YOUR ARREST. IF YOU ARE ARRESTED, YOU MAY BE HELD IN JAIL UP TO 48 HOURS BEFORE A HEARING IS HELD. This part to be filled out by the court or to be filled in with information you obtained from the court: name address telephone one date Other party or his/her attorney: IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: full legal name and trade name of nonlawyer street city

Petitioner, and ____________________________________, Respondent. TO: {} ___________________________________________________________________ There will be a hearing before ___________ {}, on {} _____, at {} ____ m., in room ____ of the ____________ Courthouse, on the ( ) Petitioner's ( ) Respondent's Motion for Contempt on support matters. ____ hour(s)/_____ minutes have been reserved for this 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 {} _______________________________________________________________________, {} ____________, {} _______________, 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 or hearing officer's office to cancel this hearing. ___ I certify that a copy of this document was [ only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {} _________________. Name: _______________________________ Address: ____________________________ City, State, Zip: ___________________ Fax Number: _________________________ Dated: ______________________________ _____________________________________________________ Signature of Party Printed Name: _______________________________________ Address: ____________________________________________ City, State, Zip: ___________________________________ Telephone Number: ___________________________________ Fax Number: _________________________________________ [fill in all blanks] I, {} __________________________________________, a nonlawyer, located at {} _____________, {} _____________________________________,

state phone name one or

{} _____, { } _________, helped {} ___________________________________________, who is the [ only] ______ petitioner ________ respondent, fill out this form. INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a), AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR INJUNCTION 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 deputy 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 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?

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 Rules of Procedure Form 12.902(b) or (c). FORM 12.980(a). AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR INJUNCTION FOR PROTECTION

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

AFFIDAVIT AND MOTION FOR WAIVER OF FEES FOR PETITION FOR INJUNCTION FOR PROTECTION full legal name of petitioner 741.30 784.046 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. Case No.: ___________________________________________ Division: ___________________________________________ ____________________________________, Petitioner, and ____________________________________, Respondent. I, {} _______________________________________________, 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 (2)(a) or section (3)(b), Florida Statutes, the fees be waived subject to a later order of the Court about the payment of those fees.

CLERK'S CERTIFICATE AS TO AFFIDAVIT AND MOTION FOR WAIVER OF FEES

Dated: ______________________________ _____________________________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ___________________________ Sworn to or affirmed and signed before me on ________________ by ____________________________ _____________________________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _____________ 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 SUPREME COURT APPROVED FAMILY LAW FORM 12.980(b), PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE

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 Supreme Court Approved 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.

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 where you live. The clerk will take your completed petition to a judge . You should 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 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 with Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(d)(1). 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 with Minor Child(ren) (After Notice), Florida Supreme Court Approved Family Law Form 12.980(e)(1), 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 Against Domestic Violence or Repeat Violence, 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 Self-Represented 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 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 Supreme Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the court to determine issues of temporary custody or visitation with regards to a minor child(ren).

Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(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 Rules of Procedure Form 12.902(b) or (c), must be completed and filed if you are seeking temporary alimony or temporary child support.

Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), MUST be filed with the court at or prior to a hearing to establish or modify 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 Supreme Court Approved Family Law Form 12.980(i), and file it with the clerk of the circuit court and write "confidential" in the space pro vided on the petition. FORM 12.980(b). Petition for Injunction for Protection Against Domestic Violence

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE full legal name Case No.: ___________________________________________ Division: ___________________________________________ __________________________________, Petitioner, and ____________________________________, Respondent. I, {}___________, being sworn, certify that the following statements are true:

SECTION I. PETITIONER if you fear that disclosing your address to the respondent would put you in danger Petitioner's Request for Confidential Filing of Address street address city, state and zip code area code and number Filing Fees one Affidavit and Motion for Waiver of Fees for Petition for Injunction for Protection Family Law Financial Affidavit SECTION II. RESPONDENT street address, city, state, and zip code if known date

(This section is about you. It must be completed. However, , you should complete and file , Florida Supreme Court Approved 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: {} ________________________________________ {} _____________________________________________________________ Telephone Number: {} _______________________________________________ 2. [ only] ___ a. Petitioner is paying the filing fee and sheriff's 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 , Florida Supreme Court Approved Family Law Form 12.980(a), and a , Florida Family Law Rules of Procedure Form 12.902(b) or (c). Petitioner asks that he or she not have to pay the fees necessary to process 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.") (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at: {} _____________ _______________________________________________________________________________________. Respondent's Driver's License number is: {} ___________________________________. 2. Respondent is: [ all that apply] ___ 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 {} __________________________________________. 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: _________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION any other between Petitioner and Respondent include city, state, and case number, if known or date location Additional Information all person or agency

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.") (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 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, { }: ________________________________________________________________________________ ________________________________________________________________________________________ 4. Petitioner is the victim of an act of domestic violence 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 {} ______, at {} _______________________________________________________, the Respondent _________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ _______________________________________________________________________________________. Check here if you are attaching additional pages to continue these facts. 5. [ 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 { }: ______________________________________________________________________________.

SECTION IV. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME only all street address city, state, zip code street address city, state, zip code one SECTION V. TEMPORARY CUSTODY OF MINOR CHILD(REN) only Uniform Child Custody Jurisdiction Act (UCCJA) Affidavit 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. Name Place of Birth Birth date Sex

___ 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 (Complete this section 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: [ that apply] ___ a. Petitioner needs the exclusive use and possession of the home that the parties share at {} ___________________________________________________________________, {} _______________________________________________________________. ___ 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 {} _____________________________________________________, {} _______________________________________________________________. 2. The home is: [ only] ___ a. owned or rented by Petitioner and Respondent jointly. ___ b. solely owned or rented by Petitioner. ___ c. solely owned or rented by Respondent. (Complete this section 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 , Florida Supreme Court Approved Family Law Form 12.902(d).) 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. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

one any other Visitation all SECTION VI. TEMPORARY SUPPORT only Family Law Financial Affidavit Notice of Social Security Number A Child Support Guidelines Worksheet all

2. The minor child(ren) whom Petitioner is seeking temporary custody of: [ 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 minor child(ren) who were there when the domestic violence happened. Include child(ren)'s name, age, sex, and parents' names. _______________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 4. [ 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 imminently will abuse, remove, or hide the minor child(ren) from Petitioner. Explain: _________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ (Complete this section if you are seeking financial support from the Respondent. You must also complete and file a , Florida Family Law Rules of Procedure Form 12.902(b) or (c), and , Florida Supreme Court Approved Family Law Form 12.902(j), if you are seeking child support. , Florida Family Law Rules of Procedure Form 12.902(e), must be filed with the court at or prior to a hearing to establish or modify child support.) [ that apply] ___ 1. Petitioner claims a need for the money he or she is asking the Court to make Respondent pay, and that 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 TEMPORARY INJUNCTION and: all include address 741.30 I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING ON THIS PETITION, THAT BOTH RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I MUST 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.

(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 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 a. prohibiting Respondent from going to or within 500 feet of any place the Petitioner ives; b. prohibiting Respondent from 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; [ that apply] ___ d. prohibiting Respondent from going to or within 500 feet of the following place(s) Petitioner or Petitioner's minor child(ren) must go often {}: ___________ ________________________________________________________________________________________ ________________________________________________________________________________________ ___ 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; ___ 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 , Florida Statutes. _______________ (initials) Dated: ____________________________________ _____________________________________________ Signature of Petitioner STATE OF FLORIDA COUNTY OF ___________________ Sworn to or affirmed and signed before me on _____________________ by ______________________. _____________________________________________ NOTARY PUBLIC or DEPUTY CLERK

FORM 12.980(c)(1). ORDER SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION

IN THE CIRCUIT COURT OF THE _________ JUDICIAL CIRCUIT, IN AND FOR _________ COUNTY, FLORIDA

ORDER SETTING HEARING ON PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE WITHOUT ISSUANCE OF AN INTERIM TEMPORARY INJUNCTION 741.30 784.046 A Temporary NOT FINDINGS Temporary Temporary NOTICE OF HEARING date location _____________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ________________________________________________________ Case No.: ___________________________________ Division: ___________________________________ ___________________________________________, Petitioner, and __________________________________________, Respondent. The Petition for Injunction for Protection Against Domestic Violence filed under section , Florida Statutes, or Repeat Violence under section , Florida Statutes, has been reviewed. This Court has jurisdiction of the parties and of the subject matter. Injunction for Protection Against Domestic or Repeat Violence, pending the hearing scheduled below, is 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. 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 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 Injunction should be ordered which would be in effect until the hearing scheduled below. 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 {} __________, at ___ a.m./p.m. at {} __________, 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, for example, such matters as visitation, support and who should pay the filing fees and costs.

name address telephone FORM 12.980(c)(2). ORDER DENYING PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

If Petitioner and/or Respondent do not appear, orders may be entered, including the imposition of court costs or an injunction. All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: ___ a. a court reporter is provided by the court. ___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. ___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. 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 {} ______________________________________________________________________, {} ______________, {} ______________________________________________________, 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 (SEAL) By: ________________________________________ Deputy Clerk

IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ____________ COUNTY, FLORIDA

ORDER DENYING PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE Case No.: __________________________________ Division: __________________________________ ___________________________________________, Petitioner, and ___________________________________________, Respondent. The Court has reviewed the Petition for Injunction for Protection Against Domestic or Repeat Violence filed in this cause and finds that 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 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)

FORM 12.980(d)(1). TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR ___________ COUNTY, FLORIDA

TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN) 741.30 It is intended that this protection order meet the requirements 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 date name room name/number, location, address, city By: ________________________________________ Deputy Clerk Case No.: __________________________________ Division: __________________________________ ___________________________________________, Petitioner, and ___________________________________________, Respondent. The Petition for Injunction for Protection Against Domestic Violence under section , 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. 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 {} _________, at ____ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of 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, for example, such matters as visitation, support and who should pay the filing fees and costs. The hearing will be before The Honorable {} _________, at {} _________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: ___ a. a court reporter is provided by the court.

name address telephone FINDINGS 741.30 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. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, 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. ORDERED and ADJUDGED: Violence Prohibited.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. ___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. 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 {} ______________________________________________________________________, {} _____________, {} _______, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771. The statements made under oath by Petitioner make it appear that section , 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 there is an immediate and present danger of domestic violence to Petitioner or persons lawfully with Petitioner. 1. 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, kidnaping, 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.

No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this Section, or unless paragraph 14 below provides for contact connected with the temporary custody of and visitation with minor child(ren). Respondent shall not go to, in, or within 500 feet of: list address list address of current employment list address of school Firearms. all if does not NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF § 790.233, FLORIDA STATUTES, AND A FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY, POSSESSION OR CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM 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). Mailing Address. 741.30

Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Contact at legal proceedings or through legal counsel constitutes an exception. Unless otherwise provided herein, Petitioner's current residence {} __________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {} ___________________________________________________ or place where Petitioner attends school {} __________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: _________________________________________________________________________. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. ___ b. Other provisions regarding contact: _________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 3. [Initial that apply; write N/A 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 Sheriff's Department until further order of the court. ___ c. Other directives relating to firearms and ammunition: ______________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 4. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section , Florida Statutes.

Additional order necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME all if does not Possession of the Home. Transfer of Possession of the Home. Personal Items. in the presence of a law enforcement officer IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 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) Jurisdiction. Temporary Custody of Minor Child(ren).

5. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ [Initial that apply; write N/A apply] 6. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ________________ __________________________________________________________________________________. 7. ___ A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 8. ___ ( ) Petitioner ( ) Respondent, , may return to the premises described above ( ) on ____, at ____ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, 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 stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. 9. ___ ( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 10. ___ Other: ____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 11. Jurisdiction to determine custody of any minor child(ren) listed in paragraph 12 below is proper under the Uniform Child Custody Jurisdiction Act (UCCJA). 12. ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below:

Name Birth date if if does not 787.03 787.04 Contact with Minor Child(ren). 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 Florida Family Law Rule 12.610.) DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.) This injunction is valid in all counties of the State of Florida.

___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ When requested by the custodial parent, 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). [Initial applies; write N/A apply] ___ 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 and , Florida Statutes. 13. Unless otherwise provided in paragraph 14 below, the noncustodial parent shall have no contact with the parties' minor child(ren) until further order of the Court. 14. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 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. Violation of this injunction should be reported to the appropriate law enforcement agency. Law enforcement

901.15 741.31 901.15 Reporting alleged violations. FORM 12.980(d)(2). TEMPORARY INJUNCTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

officers of the jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this injunction and are authorized to arrest without warrant pursuant to section , Florida Statutes, for any violation of its provisions which constitutes a criminal act under section , Florida Statutes. 3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION (6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 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. 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 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 Case No.: _________________________________ Division: _________________________________ __________________________________________, Petitioner, and __________________________________________, Respondent.

TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN) 741.30 It is intended that this protection order meet the requirements 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 date name room name/number, location, address, city name address telephone FINDINGS

The Petition for Injunction for Protection Against Domestic Violence under section , 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. 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 {} _________, at __ a.m./p.m., when the Court will consider whether the Court should issue a Final Judgment of 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, for example, such matters as who should pay the filing fees and costs, and support. The hearing will be before The Honorable {} _________________, at {} ________________________________________________, Florida. If Petitioner and/or Respondent do not appear, this temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be granted, including the imposition of court costs. All witnesses and evidence, if any, must be presented at this time. In cases where temporary support issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit ( Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence of financial income to the hearing. NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense. YOU ARE ADVISED THAT IN THIS COURT: ___ a. a court reporter is provided by the court. ___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. ___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense. A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. 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 {} __________________________________________________________, {} ___________________________________________, {} __________________________________, within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, call TDD 1-800-955-8771.

741.30 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. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, 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. ORDERED and ADJUDGED: Violence Prohibited. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section. Respondent shall not go to, in, or within 500 feet of: list address list address of current employment list address of school

The statements made under oath by Petitioner make it appear that section , 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 there is an immediate and present danger of domestic violence to Petitioner or persons lawfully with Petitioner. 1. 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, kidnaping, 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. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Contact at legal proceedings or through legal counsel constitutes an exception. Unless otherwise provided herein, Petitioner's current residence {} _________________ ________________________________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {} _______________________________ __________________________________________________ or place where Petitioner attends school {} _______________________________________________________________ __________________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Firearms. all if does not NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT WILL BE A VIOLATION OF § 790.233, FLORIDA STATUTES, AND A FIRST DEGREE MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY, POSSESSION OR CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM 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). Mailing Address. 741.30 Additional order necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME all if does not Possession of the Home. Transfer of Possession of the Home. Personal Items. in the presence of a law enforcement officer

Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. ___ b. Other provisions regarding contact: ________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 3. [Initial that apply; write N/A 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 Sheriff's Department until further order of the court. ___ c. Other directives relating to firearms and ammunition: _____________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 4. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding the final injunction, if entered without Respondent being present at the hearing, and pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section , Florida Statutes. 5. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ [Initial that apply; write N/A apply] 6. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: __________________________ __________________________________________________________________________________. 7. ___ A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 8. ___ ( ) Petitioner ( ) Respondent, , may return to the premises described above ( ) on

IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 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. 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 (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.) This injunction is valid in all counties of the State of Florida. 901.15 741.31 901.15 Reporting alleged violations.

____, at ____ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, 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 stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 below. The law enforcement agency shall not be responsible for storing or transporting any property. 9. ___ ( ) Petitioner ( ) Respondent shall not damage or remove any furnishings or fixtures from the parties' former shared premises. 10. ___ Other; ____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 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. 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 without warrant pursuant to section , Florida Statutes, for any violation of its provisions which constitutes a criminal act under section , Florida Statutes. 3. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION (6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 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

FORM 12.980(e)(1). FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN) (AFTER NOTICE)

IN THE CIRCUIT COURT OF THE _______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITH MINOR CHILD(REN) (AFTER NOTICE) 741.30 It is intended that this protection order meet the requirements 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 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 (or his or her attorney): __ by U. S. Mail __ by hand delivery in open court 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 Case No.: ______________________________ Division: ______________________________ _____________________________________, Petitioner, and _____________________________________, Respondent. The Petition for Injunction for Protection Against Domestic Violence under section , Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter.

FINDINGS date INJUNCTION AND TERMS This injunction shall be in full force and effect until( ) further order of the Court or ( ) ______. 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. 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. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, 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. ORDERED and ADJUDGED: Violence Prohibited. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section, or unless paragraphs 13 through 19 below provide for contact connected with the temporary custody of and visitation with minor child(ren).

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 Counsel ( ) Respondent's Counsel On {} ______, 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 or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent. 1. 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, kidnaping, 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. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's

Respondent shall not go to, in, or within 500 feet of: list address list address of current employment list address of school Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of section 790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her care, custody, possession or control any firearm or ammunition. if if not 943.10 NOTE: RESPONDENT IS ADVISED THAT 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 AMMUNITION; OR TO RECEIVE ANY FIREARM 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). Evaluation/Counseling. all if does not 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.

employment or school to inquire about Petitioner or to send any messages to Petitioner. Contact at legal proceedings or through legal counsel constitutes an exception. Unless otherwise provided herein, Petitioner's current residence {} ____________________________________________________________________ _________________________________________________________________________________________________ or any residence to which Petitioner may move; Petitioner's current or any subsequent place of employment {} _________________________________________________ or place where Petitioner attends school {} ______________________________; or the following other places (if requested by Petitioner) where Petitioner or Petitioner's minor child(ren) go often: ____________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. ___ b. Other provisions regarding contact: __________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. [Initial applies; Write N/A applicable] ___ a. Respondent is a state or local officer as defined in section (14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer's employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer's employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the _______________ County Sheriff's Department. ___ c. Other directives relating to firearms and ammunition: ________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. [Initial that apply; write N/A 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.

Court Costs. 741.30 OR county Mailing Address. 741.30 Other provisions necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME if if not

b. Within ( )10 days ( ) days, (but no more than 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 ( ) days, (but no more than 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. Pursuant to section (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; costs in the amount of $_____________________ for the filing fee, plus $_____________ for the sheriff's 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 {} _____________ 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. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section , Florida Statutes. 7. _________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ [Initial applies; Write N/A applicable]

Possession of the Home. Transfer of Possession of the Home. Personal Items. in the presence of a law enforcement officer IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. TEMPORARY CUSTODY OF AND VISITATION WITH MINOR CHILD(REN) Jurisdiction. Temporary Custody of Minor Child(ren). Name Birth date Type of Contact/Visitation with Minor Child(ren). one no contact

8. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: ___________________________________________________ ______________________________________________________________________________________________ 9. ___ A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 10. ___ ( ) Petitioner ( ) Respondent, , may return to the premises described above ( ) on ______, at ____ a.m/p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, 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 stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 11 below. The law enforcement agency shall not be responsible for storing or transporting any property. 11. ___ The following other personal possessions may also be removed from the premises at this time: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 12. ___ Other: ______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 13. 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). 14. ( ) Petitioner ( ) Respondent shall have temporary custody of the parties' minor child(ren) listed below: _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ When requested by the custodial parent, 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). 15. The noncustodial parent shall have: [Initial only] ___ a. with the parties minor child(ren) until further order of the Court.

specified visitation specify days and times Limitations on Visitation. all if does not Arrangements for Contact/Visitation with Minor Child(ren). all if does not name Exchange of Minor Child(ren). all if does not name Other Additional Provisions Relating to the Minor Child(ren). TEMPORARY SUPPORT

___ b. the following with the parties' minor child(ren), subject to any limitations set out below: {} _________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 16. The above specified visitation shall be: [Initial that apply; write N/A 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: _____ _________________________________________________________________________________________________ ________________________________________________________________________________________________. 17. [Initial that apply; write N/A apply] ___ a. A responsible person shall coordinate the visitation arrangements of the minor child(ren). If specified, the responsible person shall be: {} ______________________________________________ ___ b. Other conditions for visitation arrangements as follows: _____________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 18. [Initial that apply; write N/A apply] ___ a. The parties shall exchange the child(ren) at ( ) school or daycare, or ( ) 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: {} __________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ___ c. Other conditions for visitation exchange as follows: _________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 19. _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

Temporary Alimony. all if does not explain date date 21. Temporary Child Support. all if does not OR Amount. explain date date/event explain OR uninsured medical/dental/prescription drug costs Notice of Social Security Number Method of Payment. one

20. [Initial that apply; write N/A apply] ___ 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 (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 {} __________________________________________________________ _________________ beginning {} ______. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {} _________________________, 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: ________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ [Initial that apply; write N/A apply] ___ 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 12.902(e), filed by ( ) Petitioner ( ) Respondent are correct 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. 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 {}: ____________________________________________________________________ ________________________________________________________________________________________________, beginning {} _________, and continuing until further order of the court, or until {} ___________________________________________________________________________________, {} ______________________________________________________________________________________. If the child support ordered deviates from the guidelines by more than 5%, 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. ( ) Health ( ) dental insurance is not reasonably available at this time. ___ d. Any reasonable and necessary for the minor child(ren) shall be assessed as follows: ______________________________________________ _________________________________________________________________________________________________. ___ e. Florida Supreme Court Approved Family Law Form 12.902(j), , is incorporated herein by reference. ___ f. Other provisions relating to child support: __________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 22. [Initial only] ___ a. Obligor shall pay any temporary child support/alimony ordered through income deduction, and such support shall be paid to the state disbursement unit. 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. Obligor shall also pay the applicable state disbursement unit service charge. Until child support/alimony payments

name of county not 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 (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.) This injunction is valid in all counties of the State of Florida. 901.15 741.31 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. 901.15 Reporting alleged violations.

are deducted from Obligor's paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely payments directly to the state disbursement unit. ___ b. Temporary child support/alimony shall be paid through the state disbursement unit in the office of the {} ______________ County Clerk of Circuit Court. Obligor shall also pay the applicable state disbursement unit service charge. Income deduction is in the best interests of the child(ren) because: ___________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ___ c. Other provisions relating to method of payment: ______________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 1. 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 without warrant pursuant to section , Florida Statutes, for any violation of its provisions, except those regarding child support and/or alimony, which constitutes a criminal act under section , Florida Statutes. 2. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION (6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 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 extended until such time as service of this injunction is effected upon Respondent. ORDERED on _____________________. __________________________________ CIRCUIT JUDGE COPIES TO:

ACKNOWLEDGMENT Name of Petitioner ACKNOWLEDGMENT Name of Respondent FORM 12.980(e)(2). FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN) (AFTER NOTICE)

IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

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) ___ Central Governmental Depository (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 I, {} _____________, acknowledge receipt of a certified copy of this Injunction for Protection. _____________________________________________ Petitioner I, {} _________________, acknowledge receipt of a certified copy of this Injunction for Protection. __________________________ Respondent Case No.: ___________________________________ Division: ___________________________________ ____________________________________________, Petitioner, and ____________________________________________, Respondent.

FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE WITHOUT MINOR CHILD(REN) (AFTER NOTICE) 741.30 It is intended that this protection order meet the requirements 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 FINDINGS date INJUNCTION AND TERMS This injunction shall be in full force and effect 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. 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. Certain willful violations of the terms of this injunction, such as: refusing to vacate the dwelling that the parties share; going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction; telephoning, contacting or communicating with Petitioner if prohibited by this injunction; or committing an act of domestic violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, punishable by up to life imprisonment, depending on the nature of the violation, 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. ORDERED and ADJUDGED:

The Petition for Injunction for Protection Against Domestic Violence under section , Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of the parties and the subject matter. 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 Counsel ( ) Respondent's Counsel On {} ______, 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 or has reasonable cause to believe that he/she is in imminent danger of becoming a victim of domestic violence by Respondent.

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, kidnaping, 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. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner. 2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section. a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Contact at legal proceedings or through legal counsel constitutes an exception. 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: _____________________________________ Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. b. Other provisions regarding contact: Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, custody, possession or control any firearm or ammunition. It is a violation of section 790.233, Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her care, custody, possession or control any firearm or ammunition. if if not 943.10

________________________________________________________________________________________ _________________________________________________________________________________________________ _____________________________ _________________________________________________________________________________________________ _________________________; _________________________________________________________________________________________________ ___ __________________________________________________________ _________________________________________________________________________________________________ 3. [Initial applies; Write N/A applicable] ___ a. Respondent is a state or local officer as defined in section (14), Florida Statutes, who holds an active certification, who receives or possesses a firearm or ammunition for use in performing official duties on behalf of the officer's employing agency and is not prohibited by the court from having in his or her care, custody, possession or control a firearm or ammunition. The officer's employing agency may prohibit the officer from having in his or her care, custody, possession or control a firearm or ammunition. ___ b. Respondent shall surrender any firearms and ammunition in the Respondent's possession to the ___________ County Sheriff's Department. ___ c. Other directives relating to firearms and ammunition: ________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

NOTE: RESPONDENT IS ADVISED THAT 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 AMMUNITION; OR TO RECEIVE ANY FIREARM 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). Evaluation/Counseling. all if does not 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. Court Costs. 741.30 county Mailing Address. 741.30

4. [Initial that apply; write N/A 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. b. Within ( )10 days ( )__ days, (but no more than 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 ( )__ days, (but no more than 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. Pursuant to section (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 sheriff's 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 {} ______ 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. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section , Florida Statutes.

Other provisions necessary to protect Petitioner from domestic violence: TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME if if not Possession of the Home. Transfer of Possession of the Home. Personal Items. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. TEMPORARY SUPPORT Temporary Alimony. all if does not

7. ________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ [Initial applies; Write N/A applicable] 8. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the dwelling located at: __________________________________. ____________________________________________________________________________________________ 9. ___ A law enforcement officer with jurisdiction over the home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner ( ) Respondent in possession of the home. 10. ___ ( ) Petitioner ( ) Respondent, in the presence of a law enforcement officer, may return to the premises described above ( ) on __, at ________ a.m./p.m., or ( ) at a time arranged with the law enforcement department with jurisdiction over the home, 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 stand by to insure that he/she vacates the premises with only his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 12 below. The law enforcement agency shall not be responsible for storing or transporting any property. 11. ___ The following other personal possessions may also be removed from the premises at this time: _________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 12. ___ Other: _____________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 13. [Initial that apply; write N/A apply] ___ 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 (hereinafter Obligee) in the amount of $____ per month, payable ( ) in accordance with Obligor's employer's

explain date date Method of Payment. one name of county 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 (Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction.) This injunction is valid in all counties of the State of Florida. 901.15 741.31 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. 901.15 Reporting alleged violations.

payroll cycle, and in any event, at least once a month ( ) other {} ______________________ _________________________________________________________________________________________________ beginning {} ___. This alimony shall continue until modified by court order, until a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction expires, or until {} ___, 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: _______________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 14. [Initial only] ___ a. Obligor shall pay any temporary alimony ordered through income deduction, and such support shall be paid to the Central Government 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. Obligor shall also pay the applicable Central Government Depository service charge. Until alimony payments are deducted from Obligor's paycheck pursuant to the Income Deduction Order, Obligor is responsible for making timely payments directly to the Central Government Depository. ___ b. Temporary alimony shall be paid through the Central Government Depository in the office of the {} _____ County Clerk of Circuit Court. Obligor shall also pay the applicable Central Government Depository service charge. ___ c. Other provisions relating to method of payment: ___________________________________ 1. 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 without warrant pursuant to section , Florida Statutes, for any violation of its provisions, except those regarding child support and/or alimony, which constitutes a criminal act under section , Florida Statutes. 2. THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION (6), FLORIDA STATUTES. The arresting agent shall notify the State Attorney's Office immediately after arrest. 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

ACKNOWLEDGMENT ACKNOWLEDGMENT

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 extended until such time as service of this injunction is effected upon Respondent. 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 a certified copy of this injunction.) ___ State Attorney's Office ___ Batterer's intervention program (if ordered) ___ Central Governmental Depository (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 I, {Name of Petitioner} _____________, acknowledge receipt of a certified copy of this Injunction for Protection. ______________________________________ Petitioner I, {Name of Respondent} __________, acknowledge receipt of a certified copy of this Injunction for Protection.

FORM 12.980(f). ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

ORDER OF DISMISSAL OF TEMPORARY INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE date all 741.30 784.046 ______________________________________ Respondent Case No.: ____________________________ Division: ____________________________ _________________________________________, Petitioner, and _________________________________________, Respondent. THIS CAUSE came before the Court on {} ___, upon Petitioner's action for an injunction for protection against domestic violence or repeat violence, and it appearing to the Court as follows: [ 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 or , 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 __________ 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 SUPREME COURT APPROVED FAMILY LAW FORM 12.980(g), PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE

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 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 on your behalf.

The parent or legal guardian of any minor child who is living at home may seek an injunction for protection against repeat violence on behalf of the minor child. With respect to a minor child who is living at home, the parent or legal guardian must have been an eye-witness to, or have direct physical evidence or affidavits from eyewitnesses of, the specific facts and circumstances that form the basis of the petition.

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, you should use Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(b), rather than this form.

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 re peat 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 Supreme Court Approved Family Law Form 12.980(f). 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 (After Notice) , Florida Supreme Court Approved 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 Supreme Court Approved 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 Self-Represented 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. FORM 12.980(g). PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

PETITION FOR INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE CASE No.: ________________________________ Division: ________________________________ ______________________________________, Petitioner, and ______________________________________, Respondent.

full legal name SECTION I. PETITIONER if Petitioner seeks an injunction for protection on behalf of a minor child. Filing Fees one Affidavit and Motion for Waiver of Fees for Petition for injunction for Protection Family Law Financial Affidavit SECTION II. RESPONDENT address, city, state, and zip code if known date SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION

I, {} _____________, being sworn, certify that the following statements are true: (This section is about you. It must be completed.) 1. Petitioner currently lives at: {address, city, state, zip code} _______________________ _______________________________________________________________________________________ [ applies] ___ Petitioner is the parent or legal guardian of {full legal name} ________, a minor child who ( ) is ( ) is not living at home. 2. [ only] ___ a. Petitioner is paying the filing fee and sheriff's (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 , Florida Supreme Court Approved Family Law Form 12.980(a), and a , Florida Family Law Rules of Procedure Form 12.902(b) or (c). 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.") (This section is about the person you want to be protected from. It must be completed.) 1. Respondent currently lives at: {} __________________. _______________________________________________________________________________________ Respondent's Driver's License number is: {} __________________________________. 2. Petitioner has known Respondent since {} _________________________________________. 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: ____________________________________________________ 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.") (This section must be completed.)

include case number, if known any other between Petitioner and Respondent date location date location Additional Information all

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? {} _______________________________________________________________________________________ _______________________________________________________________________________________ 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 court case that is either going on now or that happened in the past (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 {} _____________________, at {} _______________________________________, 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 {} _________________, at {} __________________________________________, Respondent ____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Check here if you are attaching additional pages to continue these facts. 6. Petitioner genuinely fears repeat violence by Respondent. Explain: ____________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 7. [ that apply]

person or agency SECTION IV. INJUNCTION all 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.

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: { } ___________________________________________________________________ __________________________________________________________________________________. (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; [ 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. 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 or DEPUTY CLERK __________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification

Type of identification produced ___________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(h), SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

When should this form be used?

You may use this form if your Petition for Injunction for Protection Against Domestic Violence, Florida Supreme Court Approved Family Law Form 12.980(b), or your Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(g), was denied by the judge. You should use this supple mental 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." FORM 12.980(h). SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE?

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

SUPPLEMENTAL AFFIDAVIT IN SUPPORT OF PETITION FOR INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE full legal name CASE No.: ___________________________ Division: ___________________________ ____________________________, Petitioner, and ____________________________, Respondent. I, {} _____________, 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 affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Date: _____________________________ ________________________________ Signature of Petitioner

STATE OF FLORIDA COUNTY OF _________________________

Sworn to or affirmed and signed before me on ___________ by ___________

______________________________________ NOTARY PUBLIC or DEPUTY CLERK

______________________________________

[Print, type, or stamp commissioned name of notary or clerk.]

_____ Personally known

_____ Produced identification

Type of identification produced __________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(i), PETITIONER'S REQUEST FOR CONFIDENTIAL 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.

FORM 12.980(i). PETITIONER'S REQUEST FOR CONFIDENTIAL FILING OF ADDRESS

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.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: __________________________________ Deputy Clerk

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(j), MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

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 motion 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 motion. You must properly notify the other party of the motion 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 Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing to the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. *Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

You will need to appear at the hearing on your motion. After the hearing, if the judge grants your motion, he or she will prepare an Order Extending Injunction for Protection Against Domestic Violence of Repeat Violence, Florida Supreme Court Approved 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 at all times.

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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 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 Supreme Court Approved Family Law Form 12.980(i), if your petition is for protection against domestic violence and you wish to keep your address confidential.

• When completing this form, you should make sure that your reasons for requesting that the injunction be extended are stated clearly and that you include all relevant facts.

FORM 12.980(j). MOTION FOR EXTENSION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR ________ COUNTY, FLORIDA

Case No.: ___________________________ Division: ___________________________

_______________________________, Petitioner,

and

_______________________________, Respondent.

MOTION 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 Supreme Court Approved 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. 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 motion). ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

2. 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. ___________________ ___________________________________________________________________ ___________________________________________________________________

3. Petitioner requests that the previously entered injunction for protection against domestic violence or repeat violence be extended for the following specific reasons: { State in detail why you wish the injunction to remain in effect} ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Check here if you are attaching additional pages to continue these facts.

4. 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 motion 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 certify that a copy of this document was [ one only] ( ) mailed ( ) faxed and mailed ( ) mailed by certified mail, return receipt requested, ( ) furnished to a law enforcement officer for personal service 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 motion 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 or DEPUTY CLERK

_____________________________________ [Print, type, or stamp commissioned name of notary or clerk.]

______ Personally known ______ Produced identification Type of identification produced ___________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(k), MOTION FOR MODIFICATION 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. If you use this form, you are called the moving party.

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 motion 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 motion. You must properly notify the other party of the motion 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 Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. You will need to serve a copy of your motion and Notice of Hearing to the other party. Service of your motion must be in a manner that is reasonably calculated to apprise the other party of your motion and the hearing. *Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you should consider using certified mail, return receipt requested, or having the motion personally served. If you are not represented by an attorney in this action, you must file proof that the other party personally received notice of your motion. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).

You will need to appear at a hearing on your motion for modification of injunction. After the hearing, if the judge grants your motion, 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 Self-Represented 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 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 change in circumstance(s), as required by chapters 61, Florida Statutes, or 741, Florida Statutes, as applicable, that requires this (these) modification(s). Be sure that you make these change(s) clear in your motion.

With this form you may also file the following:

Petitioner's Request for Confidential Filing of Address, Florida Supreme Court Approved 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 Supreme Court Approved Family Law Form 12.902(d), must be completed and attached if the modification(s) you are seeking involves temporary custody of any minor child(ren).

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and attached if the modification(s) you are seeking involves temporary alimony or temporary child support.

• When completing this form, you should make sure that your reasons for requesting that the injunction be modified are stated clearly and that you include all relevant facts.

FORM 12.980(k). MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT, IN AND FOR __________ COUNTY, FLORIDA

Case No.: _____________________________ Division: _____________________________

__________________________________, Petitioner,

and

__________________________________, Respondent.

MOTION FOR MODIFICATION OF INJUNCTION FOR PROTECTION AGAINST ( ) DOMESTIC VIOLENCE ( ) REPEAT VIOLENCE

I, { full legal name} ________, being sworn, certify that the following statements are true:

SECTION I. MOVING PARTY (This section is about you. It must be completed. However, if you are the Petitioner and 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 Supreme Court Approved Family Law Form 12.980(i), and write "confidential" in the space provided on this form for your address and telephone number.)

1. Moving Party is the ( ) Petitioner ( ) Respondent in this case.

2. Moving Party currently lives at: { street address} _________________ { city, state and zip code} ________________________________________ Telephone Number: { area code and number} __________________________

3. Moving Party'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 the other party's new address, place of employment, physical description, vehicle, aliases or nicknames, or attorney's name.) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

SECTION III. CASE HISTORY AND REASON FOR SEEKING MODIFICATION 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 motion). _________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

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. Moving Party 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. Moving Party understands that the court will hold a hearing on this motion and that he or she must appear at the hearing.

2. Moving Party 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.} ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

I certify that a copy of this document was [ one only] ( ) mailed ( ) faxed and mailed ( ) mailed by certified mail, return receipt requested, ( ) furnished to a law enforcement officer for personal service 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 motion 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 or DEPUTY CLERK

____________________________________ [Print, type, or stamp commissioned name of notary or clerk.]

_____ Personally known _____ Produced identification Type of identification produced ________________

FORM 12.980( l ). TEMPORARY INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE

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.

It is intended that this protection order meet the requirements 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.

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 issue a Final Judgment of 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, for example, such matters as 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. All witnesses and evidence, if any, must be presented at this time.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

___ a. a court reporter is provided by the court.

___ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

___ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

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 of repeat violence 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. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. 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. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word, or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided in this section.

a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. Contact at legal proceedings or through legal counsel constitutes an exception. 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]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: __________________________ __________________________________________________________________ __________________________________________________________________

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 Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: ________

4. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section 784.046, Florida Statutes.

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

( Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of 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 and enforceable 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 without a warrant pursuant to section 901.15, Florida Statutes, 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 ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

4. Reporting alleged violations. 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.

ORDERED on _____________________

_____________________________ CIRCUIT JUDGE

COPIES TO: Sheriff of _______________________ County Petitioner _____ by U.S. Mail _______ by hand delivery Respondent: _______ forward 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(m). FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST REPEAT VIOLENCE (AFTER NOTICE)

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.

It is intended that this protection order meet the requirements 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.

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

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 ( ) further order of the Court ( ) { date } ___________________ This injunction is valid and enforceable 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. Willful violation of the terms of this injunction, such as refusing to vacate the dwelling which the parties share, going to Petitioner's residence, place of employment, school, or other place prohibited in this injunction, telephoning, contacting or communicating with Petitioner, if prohibited by this injunction, or committing an act of repeat violence against Petitioner constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by sections 775.082 and 775.083, Florida Statutes. 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. Respondent shall not commit any other violation of the injunction through an intentional unlawful threat, word or act to do violence to the Petitioner.

2. No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in this section.

a. 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. Further, Respondent shall not contact or have any third party contact anyone connected with Petitioner's employment or school to inquire about Petitioner or to send any messages to Petitioner. 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]

___ b. Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time.

___ c. Other provisions regarding contact: __________________________

__________________________________________________________________ __________________________________________________________________

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 Sheriff's Department.

___ c. Other directives relating to firearms and ammunition: ________ __________________________________________________________________ __________________________________________________________________

4. Court Costs. Pursuant to section 784.046(3)(b), 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 sheriff's 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. Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her mailing address within ten (10) days of the change. All further papers (excluding pleadings requiring personal service) shall be served by mail to Respondent's last known address. Such service by mail shall be complete upon mailing. Rule 12.080, Fla. Fam. L.R.P., section 784.046, Florida Statutes.

6. 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

( Provisions in this injunction that do not include a line for the judge to either initial or write N/A are considered mandatory provisions and should be interpreted to be part of this injunction. )

1. This injunction is valid and enforceable 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 without a warrant pursuant to section 901.15, Florida Statutes, 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 ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES.

3. Reporting alleged violations. 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 extended until such time as service of this injunction is effected upon Respondent.

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 a 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

FORM 12.980(n) ORDER EXTENDING INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE OR REPEAT VIOLENCE

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 __________.

NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at public expense.

YOU ARE ADVISED THAT IN THIS COURT:

__ a. a court reporter is provided by the court.

__ b. electronic audio tape recording only is provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

__ c. no electronic audio tape recording or court reporting services are provided by the court. A party may arrange in advance for the services of and provide for a court reporter to prepare a written transcript of the proceedings at that party's expense.

A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED.

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

__ 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 ___ 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 SUPREME COURT APPROVED 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 or deputy clerk. 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.

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 Self-Represented Litigants" found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and N Florida Supreme Court Approved Family Law Form 12.913(a). 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 con sent 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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.902(d).

Stepparent Adoption: Consent of Adoptee, Florida Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 SUPPORT 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.981(a)(1). JOINT PETITION FOR ADOPTION BY STEPPARENT

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:

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 Supreme Court Approved Family Law Form 12.902(d), 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: [ 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 child(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 nr affirmed and signed before me on ___________ by ___________.

___________________________________ NOTARY PUBLIC or DEPUTY CLERK

___________________________________ [Print, type, or stamp commissioned name of notary or 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 ( ) 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 or DEPUTY CLERK

___________________________________ [Print, type, or stamp commissioned name of notary or 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} __________________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(2), PETITION 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 or deputy clerk.

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 the "General Instructions for Self-Represented Litigants" found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). 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 judicial assistant to set a final hearing , and notify the other party(ies) using a Notice of Hearing (General), Florida Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.981(b)

Stepparent Adoption: Consent of Adult Adoptee's Spouse, Florida Supreme Court Approved Family Law Form 12.981(c)(2)

Stepparent Adoption: Consent of Adult Adoptee's Birth Parents, Florida Supreme Court Approved 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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.981(a)(2). PETITION FOR ADOPTION OF ADULT BY STEPPARENT

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 adult} Adoptee

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.

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 is (are) absent, or does (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 or DEPUTY CLERK

___________________________________ [Print, type, or stamp commissioned name of notary or 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} __________________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(b), STEPPARENT 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 or deputy clerk and two witnesses other than the notary public or deputy clerk.

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 Rules of Procedure Form 12.900(a), be fore 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.

FORM 12.981(b). STEPPARENT ADOPTION: CONSENT OF ADOPTEE

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.

Dated: ___________________________ ___________________________________ Signature of Adoptee

Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________

________________________________________________________________________ Signature of Witness

Printed Name: __________________________________________________________ Business Address: ______________________________________________________ Home Address: Social Security No: ____________________________________________________

________________________________________________________________________ Signature of Witness

Printed Name: __________________________________________________________ Business Address: ______________________________________________________ Home Address: Social Security No: ____________________________________________________

STATE OF FLORIDA COUNTY OF ______________________

Sworn to or affirmed and signed before me on ___________ by ____________.

_________________________________________________ NOTARY PUBLIC or DEPUTY CLERK

_________________________________________________ [Print, type, or stamp commissioned name of notary or 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} _____________, who is the adoptee, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(c)(1), STEPPARENT 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 or deputy clerk and two witnesses other than the notary or clerk. 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.981(c)(1). STEPPARENT ADOPTION: CONSENT AND WAIVER BY PARENT

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 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 Witness Printed Name: _______________________ Business Address: ___________________ Home Address: _______________________ Social Security No.: ________________

_____________________________________ Signature of Parent ______________________________ Signature of Witness Printed Name: _______________________ Printed NAME: ________________ Address: ____________________________ Business Address: ____________ City, State, Zip: ___________________ Home Address: ________________ Telephone Number: ___________________ Social Security No.: _________ Fax Number: _________________________

STATE OF FLORIDA COUNTY OF ____________________

Sworn to or affirmed and signed before me on _________ by _____________ _________________________________________ NOTARY PUBLIC or DEPUTY CLERK _________________________________________ [Print, type, or stamp commissioned name of notary or 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} ____________ ___________________________, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(c)(2), STEPPARENT 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 or deputy clerk. 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.981(c)(2). STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S SPOUSE

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

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 or DEPUTY CLERK _____________________________________ [Print, type, or stamp commissioned name of notary or 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} __________________, who is the ___, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(c)(3), STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S BIRTH PARENT(S)

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 or deputy clerk. 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.981(c)(3). STEPPARENT ADOPTION: CONSENT OF ADULT ADOPTEE'S BIRTH PARENT(S)

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 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 proceeding.

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 Sworn to or affirmed and signed before me COUNTY OF __________________ on __________________ by _______________.

________________________________________ NOTARY PUBLIC or DEPUTY CLERK ________________________________________ [Print, type, or stamp commissioned name of notary or 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 consent and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated: _____________________

________________________________________ Signature of Birth 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 or DEPUTY CLERK ______________________________________ [Print, type, or stamp commissioned name of notary or 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} ________________ _____________________, who is the _____, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(d), STEPPARENT 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 Supreme Court Approved 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.981(d). STEPPARENT ADOPTION: AFFIDAVIT OF DILIGENT SEARCH

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: 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 not 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's 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 in-laws, 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 me.

__ 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.

__ 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 the 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 Supreme Court Approved 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 or DEPUTY CLERK __________________________________ [Print, type, or stamp commissioned name of notary or 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} ____________ __________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 or deputy clerk. 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.981(e). PETITION FOR ADOPTION INFORMATION

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

Case No.: _________________________ Division: _________________________

IN RE: THE ADOPTION OF

_______________________________, 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/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 or DEPUTY CLERK ___________________________________ [Print, type, or stamp commissioned name of notary or 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} __________ ______________, who is the ____, fill out this form.

FORM 12.981(f). ORDER RELEASING ADOPTION INFORMATION

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: Petitioner (or his or her attorney) Respondent (or his or her attorney)

FORM 12.981(g). FINAL JUDGMENT OF STEPPARENT ADOPTION

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} _____________________________________

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 SUPREME COURT APPROVED FAMILY 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 or deputy clerk. 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 Supreme Court Approved 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.

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 Self-Represented 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 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.982(a). PETITION FOR CHANGE OF NAME (ADULT)

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 ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ ______/____ ____________________________________________ 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 {l ast, 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.

__ 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 ___________ _____________ ___________________________ ___________ _____________ ___________________________ ___________ _____________ ___________________________ 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 have never been adjudicated bankrupt.

__ 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: if

Date Amount Creditor Court entering judgment and case number 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.

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 or DEPUTY CLERK _______________________________ [Print, type, or stamp commissioned name of notary or 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} ____________, who is the petitioner, fill out this form.

FORM 12.982(b). FINAL JUDGMENT OF CHANGE OF NAME (ADULT)

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 purpose; and

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 SUPREME COURT APPROVED FAMILY LAW FORM 12.982(c), PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

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 or deputy clerk. 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(ren)), Florida Supreme Court Approved 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 Self-Represented Litigants" found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). 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 may be required to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Minor Child(ren)), Florida Supreme Court Approved 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 petitioner(s) 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 Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.982(c). PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

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(REN))

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.

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's 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.

[ 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: if

Date Amount Credit Court entering judgment and case number Paid _____ ______ _______ _______________________________________ _____ ______ _______ _______________________________________ 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 or DEPUTY CLERK _______________________________________ ______________________________ [Print, type, or stamp commissioned name of notary or 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 Petitioner/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 or DEPUTY CLERK __________________________________ ____________________________ [Print, type, or stamp commissioned name of notary or 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} ________________________, who is (are) the petitioner(s), fill out this form.

SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # Minor child's complete present name is: I/We request that minor child's name be changed to: street address date city, county, state, country one full legal name one enter name(s) and date(s) of birth Former names all by a court. by court order date court, city, and state date city, county, and state list name(s) and explain where child was known or called by such name(s)

Case No.: ______________________________________ ________: 1. ___________________________________________________________________________________ ___________________________________________________________________________________ 2. The minor child lives in _________ County, Florida, at {} ___________ ___________________________________________________________________________________ 3. The minor child was born on {} _________, in {} ___ ___________________________________________________________________________________ ___________________________________________________________________________________ 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 birth: Dates (to/from) Address ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ ____________/____________ ______________________________________________________ Check here if you are continuing these facts on an attached page. 6. [ only] ___ The minor child is not married. ___ The minor child is married to: {} __________________________________. 7. [ only] ___ The minor child has no children. ___ The minor child is the parent of the following child(ren): { } ____________________________________________________________________________. 8. [ that apply] ___ The minor child's name has never been changed ___ The minor child's name previously was changed from __________________ to __________ on {} _______, by {} __________________________. A copy of the court order is attached. ___ The minor child's name previously was changed by marriage from ________ to __________ on {} ________, in {} ____________________________________. 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): { } ________________________

one date city county state Money Judgments one if

___________________________________________________________________________________ ___________________________________________________________________________________ 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 [ only] ___ The minor child has never been convicted of a felony. ___ The minor child was convicted of a felony on {} _______, in {} ______, {} ____________, {} ________________. 11. [ 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 (have) been entered against him or her: Date Amount Creditor Court entering judgment and case number Paid ______ ______ ________ ________________________________________ ______ ______ ________ ________________________________________ PETITIONER(S) MUST INITIAL HERE ____________________

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 or deputy clerk .

This form should be typed or printed in black ink. After this form is signed and notarized, you should file it 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(ren)), Florida Supreme Court Approved 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 Self-Represented 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(ren)), Florida Supreme Court Approved Family Law Form 12.982(c), or Petition for Change of Name (Family), Florida Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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. FORM 12.982(d). CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN))

IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT, IN AND FOR __________________ COUNTY, FLORIDA

CONSENT FOR CHANGE OF NAME (MINOR CHILD(REN)) full legal name Minor child(ren)'s complete present Minor child(ren)'s name(s) to be changed name(s): to: 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. Case No.: ___________________________ Division: ___________________________ IN RE: THE NAME CHANGE OF ___________________________, Petitioner. I, {} _________________________, 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: (1) ____________________________________ (1) ____________________________________ (2) ____________________________________ (2) ____________________________________ (3) ____________________________________ (3) ____________________________________ (4) ____________________________________ (4) ____________________________________ (5) ____________________________________ (5) ____________________________________ (6) ____________________________________ (6) ____________________________________ 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 __________________ __________________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawer street city state phone name one or FORM 12.982(e). FINAL JUDGMENT OF CHANGE OF NAME (MINOR CHILD(REN))

IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR ____________ COUNTY, FLORIDA

FINAL JUDGMENT OF CHANGE OF NAME (MINOR CHILD(REN)) date 68.07 NOTARY PUBLIC or DEPUTY CLERKS ___________________________________________ _____________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced __________________________ [fill in blanks] I, {} ________________________________________, a nonlawyer, located at {} _______________, {} _______________________________, {} ___________, {} __________________, helped {} _________________________, who is the [ only] _______ petitioner ________ consenting parent, fill out this form. Case No.: ____________________ Division: ____________________ IN RE: THE NAME CHANGE OF _______________________________________, Petitioner/Father, _______________________________________, Petitioner/Mother. This cause came before the Court on {} __________, for a hearing on Petition for Change of Name under section , Florida Statutes, and it appearing to the Court that: 1. Petitioner(s) is (are) a bona fide resident(s) of ________________ County, Florida; 2. ____ Petitioners are the parents of the minor child(ren) named in the petition; 3. ____ 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 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 SUPREME COURT APPROVED 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 case.

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 or deputy clerk . 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(ren)), Florida Supreme Court Approved 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 Self-Represented Litigants" found at the beginning of these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). 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 Supreme Court Approved 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 petitioner(s) 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 Self-Represented 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 (are) 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 Rules of Procedure Form 12.900(a), 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. FORM 12.982(f). PETITION FOR CHANGE OF NAME (FAMILY)

IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR ____________ COUNTY, FLORIDA

PETITION FOR CHANGE OF NAME (FAMILY) full legal name(s) There are enter number adults named in this petition. A supplemental form is attached for each adult not set out below. Case No.: ___________________________ Division: ___________________________ IN RE: THE NAME CHANGE OF ________________________________________, Petitioner/Father, ________________________________________, Petitioner/Mother. I/We, {} _______________________, being sworn, certify that the following information is true: {} _________________

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. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER ( ) HUSBAND ( ) WIFE: My complete present name is: I request that my name be changed to: street address date city county country Family all including those over 18 Name last, first, middle initial Age Address, City, State Former names all by a court.

{} _____________ I/We have attached a completed supplemental form for each minor child. 1. __________________________________________________________________________________________. __________________________________________________________________________________________. 2. I live in _____________ County, Florida, at {} _____________________________ __________________________________________________________________________________________. 3. I was born on {} ___________, in {} __________, {} ________, {state} _______, {} _______________. 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. [ 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, , must be listed): {} __________________________________ _____________ _________________________________ __________________________________ _____________ _________________________________ __________________________________ _____________ _________________________________ __________________________________ _____________ _________________________________ __________________________________ _____________ _________________________________ __________________________________ _____________ _________________________________ Check here if you are continuing these facts on an attached page. 7. [ that apply] ____ My name has never been changed

by court order date court, city, and state by marriage date city, county, and state list name(s) and explain where you were known or called by such name(s) Occupation company and address Business one date Profession one Education

____ My name previously was changed from ____________ to _____________ on {} __________, by {} __________________________________________________. A copy of the court order is attached. ____ My name previously was changed from to ____________ on {} _____________, in {} ________________________________________________________________. 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): {} ________________ __________________________________________________________________________________________ __________________________________________________________________________________________. 8. My occupation is: ________________________________________________________________________. I am employed at: {} __________________________________________________ __________________________________________________________________________________________. 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. [ 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: {} _____________________________________. 10. [ 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. I have graduated from the following school(s):

Felony Convictions one date city county state Bankruptcy one date city county state Creditor(s)' Judgments one if 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.

Degree Date of Received Graduation School __________ ____________ ____________________________________________________________ __________ ____________ ____________________________________________________________ __________ ____________ ____________________________________________________________ Check here if you are continuing these facts on an attached page. 12. [ only] ____ I have not been convicted of a felony. ____ I was convicted of a felony on {} ________, in {} __________, {} ___________, {} _______________. Check here if you have been convicted of additional felonies, and explain on an attached page. 13. [ only] ____ I have never been adjudicated bankrupt. ____ I was adjudicated bankrupt on {} _________, in {} __________, {} ___________, {} __________. Check here if you have had additional bankruptcies, and explain on an attached page. 14. [ 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 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. 16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have been fully restored. 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 ____________________________.

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM/HE/SHE MUST FILL IN THE BLANKS BELOW: all full legal name and trade name of nonlawer street city state phone name ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY) THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER ( ) HUSBAND ( ) WIFE: My complete present name is: I request that my name be changed to: street address date city county state country Family all

___________________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ____ Personally known ____ Produced identification Type of identification produced ________________________ [fill in blanks] I, {} _______________________________________________, a nonlawyer, located at {} _________________________, {} ____________________________, {} _______________, {} _________________, helped {} _____________________________, who is the petitioner, fill out this form. Case No.: ____________________________ 1. ___________________________________________________________________________________________ ___________________________________________________________________________________________ 2. I live in ____________________ County, Florida, at {} _______________________ ___________________________________________________________________________________________ 3. I was born on {} _________, in {} ___________, {} ________, {} _________, {} _________________. 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. [ 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. __ 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 _________ ____________ _________________________________ _________ ____________ _________________________________ _________ ____________ _________________________________ 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 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} ____, { county} ____, { state} _____. Check here if you have had additional bankruptcies, and explain on an attached page.

14. Creditors' 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 ____ _______ _________ ____________________________________ ____ _______ _________ ____________________________________ ____ _______ _________ ____________________________________ ____ _______ _________ ____________________________________ ____ _______ _________ ____________________________________

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.

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 or DEPUTY CLERK

____________________________ [Print, type, or stamp commissioned name of notary or 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} ___________, who is the petitioner, fill out this form. PETITIONER(S) MUST INITIAL HERE ______

CHILD SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY)

Case No.: _______________

THE FOLLOWING INFORMATION IS TRUE ABOUT MINOR 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 ___, 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 birth:

Dates (to/from) Address ____/__________ _______________________________________________ ____/__________ _______________________________________________ ____/__________ _______________________________________________ ____/__________ _______________________________________________ ____/__________ _______________________________________________ ____/__________ _______________________________________________ ____/__________ _______________________________________________ Check here if 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 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. __ 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 number if Paid ____ ______ ________ _____________________________________ ____ ______ ________ _____________________________________

PETITIONER(S) MUST INITIAL HERE ___________

FORM 12.982(g). FINAL JUDGMENT OF CHANGE OF NAME (FAMILY)

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 (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 SUPREME COURT APPROVED 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 or deputy clerk. 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 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 Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 counter-petition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.983(d).

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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 Supreme Court Approved 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 Supreme Court Approved Family Law Form 12.902(d).

Notice of Social Security Number, N Florida Supreme Court Approved Family Law Form 12.902(j).

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days if not filed with the petition.)

Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days, if not filed with the petition, unless you and the other party have agreed not to exchange these documents.)

Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (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 Supreme Court Approved Family Law Form 12.902(a), 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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.983(a). PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF

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, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.

7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition.

8. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 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 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 [ 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 Rules of Procedure Form 12.902(e), is, or will be, filed. Such support should be ordered retroactive to [ one only]

__ a. the date when the parents did not reside together in the same household with the child, not to exceed a period of 24 months before the date of filing of this petition.

__ 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 Supreme Court Approved 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 Rules of Procedure Form 12.902(e)

__ 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.

__ 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 hearing.

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. changes the child(ren)'s name(s);

__ g. 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 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 or DEPUTY CLERK

_______________________________ [Print, type, or stamp commissioned name of notary or 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} ___________, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.983(b), ANSWER TO PETITION 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. 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 Supreme Court Approved 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 or deputy clerk. 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 Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.902(d).

Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (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.)

Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 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 Rules of Procedure Form 12.902(e). (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) 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

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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.983(b). ANSWER TO PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF

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 am 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 Supreme Court Approved Family Law Form 12.902(d), is filed with this petition.

5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition.

6. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 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.

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 or DEPUTY CLERK

__________________________________ [Print, type, or stamp commissioned name of notary or 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} _________, who is the respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(c), ANSWER TO PETITION AND COUNTERPETITION 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 or deputy clerk . 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 Supreme Court Approved 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:

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 Supreme Court Approved 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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved Family Law Form 12.902(d).

Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).

Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (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 Rules of Procedure 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, N Florida Family Law Rules of Procedure Form 12.902(e). (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

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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.983(c). ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF

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} ____________________________________ _________________________________________________________.

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 Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition.

7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this counterpetition.

8. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 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 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. 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] ___ 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 Rules of Procedure Form 12.902(e), is, or will be, filed. Such support should be ordered retroactive to: [ one only] ___ a. the date when the parents did not reside together in the same household with the child, not to exceed a period of 24 months before the date of filing of this counterpetition. ___ 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 from Child Support Guidelines, Florida Supreme Court Approved 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 Rules of Procedure Form 12.902(e). ___ 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); ___ 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. changes the child(ren)'s name(s); and ___ g. other relief as follows: _______________________________________ ___________________________________________________________________ ___________________________________________________________________ ______________________________________________________________; and grants such other relief as may be appropriate and in the best interests of the minor child(ren).

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/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 or DEPUTY CLERK

___________________________________ [Print, type, or stamp commissioned name of notary or 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} __________________, who is the respondent, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 or deputy clerk . 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 Supreme Court Approved Family Law Form 12.983(a).

Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.983(d). ANSWER TO COUNTERPETITION

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} ______________.

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 Petitioner/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 or DEPUTY CLERK

___________________________________________ [Print, type, or stamp commissioned name of notary or 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} _______, who is the petitioner, fill out this form.

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 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 or deputy clerk . 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.

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 Supreme Court Approved 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 Self-Represented 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 Supreme Court Approved 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.983(e). MOTION FOR SCIENTIFIC PATERNITY TESTING

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) _______________________________________________________________ (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 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 or DEPUTY CLERK

___________________________________________ [Print, type, or stamp commissioned name of notary or 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} _________________, who is the [ one only] ______ petitioner or ______ respondent, fill out this form.

FORM 12.983(f). ORDER ON MOTION FOR SCIENTIFIC PATERNITY TESTING

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). ___ 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 _____ County, Florida, and that I have furnished copies of this order as indicated above.

CLERK OF THE CIRCUIT COURT

(SEAL)

By: __________________________ Deputy Clerk

FORM 12.983(g). FINAL JUDGMENT OF PATERNITY

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 (are):

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: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 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, 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 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} __________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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 Rules of Procedure Form 12.902(e), 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 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 more than 5%, 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. ( ) Mother ( ) Father, ( ) 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/prescription drug 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/prescription drug 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, ( ) Mother ( ) Father ( ) 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 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 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 Governmental Depository,

2. Income Deduction.

[ if applies]

__ a. Immediate. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order.

__ b. Deferred. Income deduction is ordered 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 an income deduction order in cases of modification,

AND

( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance OR ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee.

3. Bonus/one-time payments. ( ) All ( ) ______% ( ) No income paid in the form of a bonus or other similar one-time payment, 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 shall 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) 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

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.984, 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/were 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 Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved 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 Supreme Court Approved 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 Supreme Court Approved 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 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 Supreme Court Approved 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 Supreme Court Approved 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 Self-Represented Litigants" found at the beginning of these forms. For further information, see chapter 752 and section 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 Rules of Procedure Form 12.900(a), 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.

FORM 12.984. PETITION FOR GRANDPARENT VISITATION

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 ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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 mother and father of the grandchild(ren) are divorced.

__ c. The ( ) mother ( ) father of the grandchild(ren) has (have) deserted the grand-child(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 or DEPUTY CLERK ______________________________ [Print, type, or stamp commissioned name of notary or 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} ______________________________________, 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.

FORM 12.990(a). FINAL JUDGMENT OF SIMPLIFIED DISSOLUTION OF MARRIAGE

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 Petition for Simplified 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.

ORDERED on __________.

____________________________ CIRCUIT JUDGE

COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: ____________________________

FORM 12.990(b)(1). FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) (UNCONTESTED)

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 Family Law 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

COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: ___________________________

FORM 12.990(b)(2). FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) (UNCONTESTED)

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 Family Law 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

COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Other: ___________________________

FORM 12.990(b)(3). FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH NO PROPERTY OR DEPENDENT OR MINOR CHILD(REN)(UNCONTESTED)

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: ____________________________

FORM 12.990(c)(1) FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN)

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 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 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. The assets listed below are nonmarital 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 The assets listed below are marital 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

1. 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. _________________________________________________________________________________________ _________________________________________________________________________________________ $ $ $ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ $ $ $ _________________________________________________________________________________________ 2. 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. _________________________________________________________________________________________ Cash (on hand or in banks/credit unions) $ $ $ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Stocks/bonds _________________________________________________________________________________________ _________________________________________________________________________________________ Notes _________________________________________________________________________________________ Business interests _________________________________________________________________________________________

Total Marital Assets C. Division of Liabilities/Debts. The liabilities listed below are nonmarital liabilities 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

_________________________________________________________________________________________ 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 _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ $ $ $ _________________________________________________________________________________________ 1. 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. _____________________________________________________________________________________________ _________________________________________________________________________________________ $ $ $ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

Total Nonmarital Liabilities The liabilities listed below are marital liabilities LIABILITIES: DESCRIPTION OF DEBT(S) Current (Describe each item as clearly as possible. Amount Wife Husband You do not need to list account numbers.) Owed Shall Pay Shall Pay Total Marital Liabilities D. E.

_________________________________________________________________________________________ $ $ $ 2. 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. _________________________________________________________________________________________ _________________________________________________________________________________________ Mortgages on real estate: (Home) $ $ $ _________________________________________________________________________________________ (Other) _________________________________________________________________________________________ _________________________________________________________________________________________ Charge/credit card accounts _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Auto loan _________________________________________________________________________________________ Auto loan _________________________________________________________________________________________ Bank/Credit Union loans _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Other _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ $ $ $ _________________________________________________________________________________________ Contingent assets and liabilities will be divided as follows: _______________________ 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 or 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 (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). ( ) 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 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 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 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 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 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 Rules of Procedure Form 12.902(e), 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 $________.

Amount. explain date OR OR date/event explain Arrearage/Retroactive Child Support. one date date explain date Insurance. all Health/Dental Insurance. OR uninsured medical/dental/prescription drug costs explain Life Insurance (to secure payment of support).

2. 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 {}: __________________________________ __________________________________________________________ beginning {} ____, 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 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. ( ) {} _________________________________________________________________, {} ________________________________________________________________________. If the child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: _________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. [ 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 {} ______. $_____ for previously ordered unpaid child support, as of {} ____. 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 {} ___________________________________________ __________________________________________________________________________________ beginning {} ____, until paid in full including statutory interest. 4. [ that apply] ___ a. ( ) 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. ( ) Health ( ) dental insurance is not reasonably available at this time. ___ b. Reasonable and necessary for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {}: ___________________________________________________________ ___________________________________________________________________________________________ As to these uninsured medical/dental/prescription drug 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. 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

IRS Income Tax Exemption(s). OR Other provisions relating to child support: SECTION VI. METHOD OF PAYMENT Central Governmental Depository. if name 61.13 Income Deduction. if Immediate. Deferred. explain AND AND OR Bonus/one-time payments.

continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise becomes self-supporting. 6. 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), , 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. _______________________________________ ____________________________________________________________________________________ Obligor shall pay court-ordered child support/alimony and arrears, if any, as follows: 1. [ applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {} ____________ 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 (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. [ applies] ___ a. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ b. Income deduction is ordered 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: {} _______________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. ( ) All ( ) ____% ( ) No income paid in the form of a bonus or other similar one-time payment, 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.

Other provisions relating to method of payment. SECTION VII. ATTORNEY FEES, COSTS, AND SUIT MONEY SECTION VIII. OTHER PROVISIONS Former Name. full name Other Provisions. FORM 12.990(c)(2). FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN)

IN THE CIRCUIT COURT OF THE _________ JUDICIAL CIRCUIT, IN AND FOR _______________ COUNTY, FLORIDA

4. ____________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___ 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: ____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 1. The wife's former name of {} ____ is restored. 2. __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 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: __________________________ Case No.: ______________________________ Division: ______________________________ __________________________, Petitioner, and __________________________, Respondent.

FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) SECTION I. MARITAL ASSETS AND LIABILITIES A. Date of Valuation of Property. B. Division of Assets. The assets listed below are nonmarital 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 $ $ $ The assets listed below are marital 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 $ $ $

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. 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 _____. 1. 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. numbers.) _____________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ _____________________________________________________________ 2. 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. Cash (on hand or in banks/credit unions) ____________________________________________ ________________________________________________________________________________________

Total Marital Assets $ $ $ C. Division of Liabilities/Debts. The liabilities listed below are nonmarital liabilities

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 ___________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________ 1. 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 $ $ $ The liabilities listed below are marital liabilities LIABILITIES: DESCRIPTION OF DEBT(S) Current (Describe each item as clearly as possible. Amount Wife Husband You do not need to list account numbers.) Owed Shall Pay Shall Pay $ $ $ Total Marital Liabilities $ $ $ D. E.

_____________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________ 2. 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. Mortgages on real estate: (Home) ______________________________________________________________ ________________________________________________________________________________________ (Other) ________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Charge/credit card accounts ____________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Auto loan ______________________________________________________________________________ ________________________________________________________________________________________ Auto loan ______________________________________________________________________________ ________________________________________________________________________________________ Bank/Credit Union loans ________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Other __________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ___________________________________________________________ Contingent assets and liabilities will be divided as follows: ______________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 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 date or event SECTION III. ALIMONY all Permanent Periodic. explain date Rehabilitative. explain date date/event Retroactive. date date

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ [ that apply] ___ 1. ( ) Petitioner ( ) Respondent, as a condition of support, shall have exclusive use and possession of the dwelling located at: _______________________________________ until {} ____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ___ 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: ________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 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: [ that apply] ___ a. 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 {} ________________________________________________________________________ __________________________________________________________________________________ beginning {} ______. 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. 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 {} _______________ beginning {} ______. This rehabilitative alimony shall continue until modified by court order, the death of either party or until {} _________________, whichever occurs first. The rehabilitative plan presented demonstrated the following: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ___ d. Obligor shall pay retroactive alimony in the amount of $__________ for the period of {} ___, through {} ____, which shall be paid pursuant to paragraph 3 below.

Reasons for ( ) Awarding ( ) Denying Alimony. Arrearage/Retroactive Alimony. one date date explain date Insurance. all Health Insurance. Life Insurance (to secure payment of support). Other provisions relating to alimony: SECTION IV. METHOD OF PAYMENT if

2. 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. [ 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 {} ___________________. $_________ for previously ordered unpaid alimony, as of {} ________. 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 {} __________________________________ __________________________________________________________________________________ beginning {} _______, until paid in full including statutory interest. 4. [ that apply] ___ a. ( ) 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. 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. ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Obligor shall pay court-ordered alimony and arrears, if any, as follows: 1. Central Governmental Depository. [ applies]

name 61.13 if Immediate. Deferred. AND AND OR Bonus/one-time payments. Other provisions relating to method of payment. SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY SECTION VI. OTHER PROVISIONS Former Name. full name Other Provisions.

___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {} ______ County, along with any depository service charge. ___ b. Both parties have requested and the court finds that support payments need not be directed through the Central Governmental Depository. However, either party may subsequently apply to the depository pursuant to section (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. Income Deduction. [ applies] ___ a. Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ b. Income Deduction is ordered 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 or dependent child(ren) common to the parties, there is proof of timely payment of a previously ordered obligation without an income deduction order in cases of modification, ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. ( ) All ( ) _____% ( ) No income paid in the form of a bonus or other similar one-time payment, 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. ____________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___ 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: ___________________________ __________________________________________________________________________________ __________________________________________________________________________________ 1. The wife's former name of {} ______ is restored. 2. __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

FORM 12.993(a). SUPPLEMENTAL FINAL JUDGMENT MODIFYING PARENTAL RESPONSIBILITY/VISITATION

IN THE CIRCUIT COURT OF THE ________ JUDICIAL CIRCUIT, IN AND FOR _______________ COUNTY, FLORIDA

SUPPLEMENTAL FINAL JUDGMENT MODIFYING PARENTAL RESPONSIBILITY/VISITATION SECTION I. FINDINGS date 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: __________________________ Case No.: ___________________ Division: ___________________ __________________________, Petitioner, and __________________________, Respondent. 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: 1. The Court has jurisdiction over the subject matter and the parties. 2. The last order establishing or modifying parental responsibility or visitation was entered on {} _________________________________________________________________. 3. There has been a substantial change in circumstances of the parties since the entry of the last order, specifically: ______________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4. It is in 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. 2. The parties' dependent or minor child(ren) is (are): Name Birth date 3. Parental Responsibility for the Minor Child(ren). one shared parental responsibility primary residential responsibility OR sole parental responsibility 4. Secondary Residential Responsibility, Visitation, or Time Sharing with Minor Child(ren). one reasonable visitation or time sharing the following specified visitation or time sharing specify days and times no contact explain

____________________________________________________________________________________ ____________________________________________________________________________________ The Court has jurisdiction to determine custody of and visitation with the parties' minor child(ren) listed in paragraph 2 below. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ [ only] ___ a. The parties shall have for the parties' minor child(ren). ( ) Mother ( ) Father shall have of the minor child(ren) and the other parent shall have secondary residential responsibility, as set forth in paragraph 4 below. 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 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. The parent granted secondary residential responsibility, visitation, or time sharing shall have: [ only] ___ a. 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. with the parties' minor child(ren), subject to any limitations set out in paragraph 5 below: {} ________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___ c. 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). {} __________________________________

5. Limitations on Parental Responsibility, Visitation or Time Sharing. if supervised by a responsible adult name supervised visitation center address 6. Communication Arrangements for Secondary Parenting, Visitation, or Time Sharing with Child(ren). name explain 7. Exchange of Minor Child(ren). all name ___ 8. Injunction Prohibiting Removing the Child(ren). specify

_____________________________________________________________________ _____________________________________________________________________ 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: [ applies] ___ a. who is mutually agreeable to the parties. If the parties cannot agree, the supervising adult shall be: {} _________________________________________________________. ___ b. at the located at: {} ___________________________________________________________ _____________________________________________________________________ subject to the available times and rules of the supervised visitation center. The cost of such visits shall be paid by ( ) Mother ( ) Father ( ) Both. [ 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 arrangements of the minor child(ren). If the parties cannot agree, the responsible person shall be: {} _____________________________________________________________________ _____________________________________________________________________ ( ) other conditions for arrangements or discussions: {} _____ _____________________________________________________________________ _____________________________________________________________________ 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. [ 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: {} ______________________________________________________________ ___ d. Other conditions for exchange of the child(ren) are as follows: ____________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ The Court hereby prohibits and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor child(ren) from the ( ) State of Florida ( ) other {} _________________________________________ _____________________________________________________________________ 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. 2. Amount. explain date date/event explain 3. Arrearage/Retroactive Child Support. date date explain date

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ [ 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 Rules of Procedure Form 12.902(e), 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 $______________. 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 {}: ____________________________________________________ ____________________________________________________________________, beginning {} _______________, 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 ( ) {} _____________________________________________________, {} _________________________________________________________ If the child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: _____ _____________________________________________________________________ _____________________________________________________________________ [ 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 {} ______________. $____________ for previously ordered unpaid child support, as of {} __________________________. 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 {} _________________________________________ _____________________________________________________________________ beginning {} ____________, until paid in full including statutory interest.

4. Insurance. ___ a. Health/Dental Insurance. uninsured medical/dental/prescription drug costs explain: 5. Life Insurance (to secure payment of support). 6. IRS Income Tax Exemption(s). OR 7. Other provisions relating to child support: SECTION IV. METHOD OF PAYMENT 1. Central Governmental Depository. name of county 61.13 2. Income Deduction.

[ all that apply] ( ) 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 for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {} _______________________________________ _____________________________________________________________________ As to these uninsured medical/dental/prescription drug 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. 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 shall be recomputed. 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), , 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. _____________________________ _____________________________________________________________________ _____________________________________________________________________ Obligor shall pay court-ordered child support and arrears, if any, as follows: [ if applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {} _________________ 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 (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. [ if applies]

a. Immediate. b. Deferred. explain AND AND OR 3. Bonus/one-time payments. 4. Other provisions relating to method of payment. SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY SECTION VI. OTHER Other Provisions

___ Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ Income deduction is ordered 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: {} __________________________________________________ _____________________________________________________________________ _____________________________________________________________________ there is proof of timely payment of a previously ordered obligation without an income deduction order, ( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. ( ) All ( ) ______% ( ) No income paid in the form of a bonus or other similar one-time payment, 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. _____________________ _____________________________________________________________________ ___ 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: _______________________________________________ _____________________________________________________________________ _____________________________________________________________________ 1. . ___________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 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 ________________. ___________________________________

FORM 12.993(b). SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT

IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR ____________ COUNTY, FLORIDA

SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT SECTION I. FINDINGS The parties' dependent or minor child(ren) is (are): Name Birth date date CIRCUIT JUDGE COPIES TO: Petitioner (or his or her attorney) Respondent (or his or her attorney) Central Governmental Depository Other: __________________________________ Case No.: _________________________ Division: _________________________ ___________________________________, Petitioner, and ___________________________________, Respondent. 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: 1. The Court has jurisdiction over the subject matter and the parties. 2. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3. The last order awarding or modifying child support was entered on {} ___________________. 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 OR Amount. explain date OR date/event explain Arrearage/Retroactive Child Support. one date date explain date Insurance. a. Health/Dental Insurance. uninsured medical/dental/prescription costs explain:

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 Rules of Procedure Form 12.902(e), filed by the ( ) Mother ( ) Father are correct 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. 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 {}: ____________________________________________________, beginning {} _______________, 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. ( ) {} _______________________________________________ {} ______________________________________________________ If the child support ordered deviates from the guidelines by more than 5%, the factual findings which support that deviation are: ________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3. [ 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 {} ________________. $___________ for previously ordered unpaid child support, as of {} ________________. 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 {} ___________________________________________________________ _____________________________________________________________________ beginning {} __________, until paid in full including statutory interest. 4. [ all that apply] ___ ( ) 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 for the minor child(ren) shall be assessed as follows: ( ) Shared equally by both parents. ( ) Prorated according to the child support guideline percentages. ( ) Other {} ________________________________________________ _____________________________________________________________________ As to these uninsured medical/dental/prescription 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

Life Insurance (to secure payment of support). 6. IRS Income Tax Exemption(s). OR 7. Other provisions relating to child support: SECTION III. METHOD OF PAYMENT 1. Central Governmental Depository. if name of county 61.13 Income Deduction. if a. Immediate. b. Deferred. explain AND AND

for that expense, according to the schedule of reimbursement set out in this paragraph. 5. To secure the child support obligations in this judgment, ( ) Mother ( ) Father ( ) 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. 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), , 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. ________________ _____________________________________________________________________ _____________________________________________________________________ [ applies] ___ a. Obligor shall pay court-ordered support directly to the Central Governmental Depository in {} ______ 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 (1)(d)3, Florida Statutes, to require payments through the Central Governmental Depository. 2. [ applies] ___ Obligor shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from Obligor's income. Until support payments are deducted from Obligor's paycheck, Obligor is responsible for making timely payments directly to the Central Governmental Depository or the Obligee, as previously set forth in this order. ___ Income deduction is ordered 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: {} ____________________________________ _____________________________________________________________________ _____________________________________________________________________ there is proof of timely payment of a previously ordered obligation without an income deduction order,

OR Bonus/one-time payments. Other provisions relating to method of payment. _____________________ SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY SECTION V. OTHER Other Provisions. FORM 12.993(c). SUPPLEMENTAL FINAL JUDGMENT MODIFYING ALIMONY

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT, IN AND FOR ______ COUNTY, FLORIDA

( ) there is an agreement by the Obligor to advise the central governmental depository of any change in payor and health insurance ( ) there is a signed written agreement providing an alternative arrangement between the Obligor and the Obligee. 3. ( ) All ( ) ________% ( ) No income paid in the form of a bonus or other similar one-time payment, 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. ___ 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: _______________________________________________ _____________________________________________________________________ _____________________________________________________________________ 1. ___________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 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: ________________________________

SUPPLEMENTAL FINAL JUDGMENT MODIFYING ALIMONY SECTION I. FINDINGS date SECTION II. ALIMONY all Permanent Periodic. explain date Lump Sum. Rehabilitative. explain date date/event

Case No.: ______________________ Division: ______________________ _____________________________________, Petitioner, and _____________________________________, Respondent. 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: 1. The Court has jurisdiction over the subject matter and the parties. 2. The last order awarding or modifying alimony was entered on {} ___________________. 3. There has been a substantial change in circumstances of the parties since the entry of the last order, specifically: ____________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ____________________________________________________________________