In Re: Amendments to the Florida Family Law Rules of Procedure , 39 Fla. L. Weekly Supp. 774 ( 2014 )

Supreme Court of Florida
____________
No. SC14-236
____________
IN RE: AMENDMENTS TO THE FLORIDA FAMILY LAW RULES OF
PROCEDURE.
[December 18, 2014]
PER CURIAM.
The Family Law Rules Committee (Committee) has filed its regular-cycle
report proposing amendments to the Florida Family Law Rules of Procedure.1 The
Committee proposes new rules 12.012 (Minimization of Sensitive Information)
and 12.364 (Social Investigations). It also proposes amendments to rules 12.070
(Process); 12.200 (Case Management and Pretrial Conferences); 12.363
(Evaluation of Minor Child); 12.490 (General Magistrates); 12.491 (Child Support
Enforcement); and 12.560 (Discovery in Aid of Execution); and forms 12.901(a)
(Petition for Simplified Dissolution of Marriage); 12.902(b) (Family Law Financial
1. We have jurisdiction. See art. V, § 2(a), Fla. Const.
Affidavit (Short Form)); and 12.902(c) (Family Law Financial Affidavit (Long
Form)). After submission to the Court, the proposals were published for comment.
No comments were received. Upon consideration of the Committee’s report, we
adopt the amendments proposed by the Committee as described below.
AMENDMENTS
First, we adopt new rule 12.012 (Minimization of Sensitive Information).
This rule is patterned after recently adopted Florida Rule of Civil Procedure 1.020,
which requires pleadings and other papers filed with the court in civil cases to
comply with Florida Rule of Judicial Administration rule 2.425 (Minimization of
the Filing of Sensitive Information). New rule 12.012 requires the same in family
law cases.
Next, rule 12.070 (Process) is amended to inform parties that for
constructive service of process in cases involving parental responsibility, custody,
or time-sharing, they must file an affidavit that conforms with family law form
12.913(c) (Affidavit of Diligent Search). It is also amended to state that if the
responding party cannot be found, he or she must be served as provided in chapter
49, Florida Statutes, which governs constructive service of process, and that the
clerk of the circuit court must mail a copy of the notice to the party’s last known
address.
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Rule 12.200 (Case Management and Pretrial Conferences), is amended to
provide for the consideration at the case management conference of “any
agreements, objections, or form of production of electronically stored
information.” This is meant to allow such issues to be brought to the court’s
attention early in the case so that any conflict can be resolved on a timely basis.
Next, we adopt new rule 12.364 (Social Investigations) to specifically
address social investigations under section 61.20, Florida Statutes (2014). New
rule 12.364 provides the requirements and process for appointment of a social
investigator; provides general provisions and content for the order for a social
investigation; governs the written study by the social investigator; allows a party to
file a motion for an additional social investigation; and provides for production of
the investigator’s file to another investigator who may review it and testify.
In conjunction with the adoption of new rule 12.364, we amend current rule
12.363 (Evaluation of Minor Child) to remove references to “social investigations”
under section 61.20, Florida Statutes (2014), so as to differentiate social
investigations from evaluations of a minor child. Rule 12.363 is also amended as
follows: (1) to delete the term “licensed mental health professional” so that the
rule refers only to the appointment of an “expert” generally; (2) to require a
determination of a need for an expert before one is appointed by the court when the
parties cannot agree; (3) to require that an expert’s report be provided to the party,
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rather than the party’s attorney; (4) to require that prior notice of communication
with the court be given to the parties, rather than their attorneys; and (5) to require
that an expert’s report be properly admitted into evidence and considered by the
court before it is made part of the court file.
Rule 12.490 (General Magistrates) is amended to require appointment of a
specific magistrate. This was recommended by the Committee because it was
reported to the Committee that despite the requirement in family law form
12.920(b) (Order of Referral to General Magistrate) that the general magistrate
appointed be named, some jurisdictions were interpreting a referral to a general
magistrate as a referral to any general magistrate in the jurisdiction. The
Committee reasoned that the specific magistrate to whom the case is referred
should be identified so that parties may determine in a timely manner whether an
objection should be raised. Subdivision (d)(3) of this rule is also amended to
change the word “papers” to “documents.”
Next, subdivision (e)(2) of rule 12.491 (Child Support Enforcement) is
amended to correct a cross-reference to a recently renumbered subdivision of
Florida Rule of Judicial Administration 2.535.
Rule 12.560 (Discovery in Aid of Execution) is amended to add the name of
Florida Rule of Civil Procedure form 1.977, “Fact Information Sheet” for clarity.
Additionally, subdivision (c) of this rule is deleted.
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Finally, we amend three family law forms. Form 12.901 (Petition for
Simplified Dissolution of Marriage) is amended to remove the requirement of
filing a financial affidavit because rule 12.285(c) exempts parties in a simplified
dissolution under rule 12.105 from such filing requirement. Section II “Average
Monthly Expenses” of form 12.902(b) (Family Law Financial Affidavit (Short
Form)) is amended to provide an instruction that if an expense listed by a party is
an estimate of what he or she expects it will be post-dissolution, rather than an
actual current amount, that should be expressly indicated by writing “estimate”
next to the amount. Form 12.902(c) (Family Law Financial Affidavit (Long
Form)) currently contains similar language. Other minor changes to clarify
insurance amounts and subtotals in section II of both forms 12.902(b) and (c) are
also made.
CONCLUSION
Accordingly, the Florida Family Law Rules of Procedure and forms are
amended as set forth in the appendix to this opinion. Language added to the rules
is underscored; deleted language is struck through. The committee notes are
offered for explanation only and are not adopted as an official part of the rules.
The amended forms are fully engrossed and ready for use. The forms may
also be accessed and downloaded from the Florida State Courts’ website at
www.flcourts.org/resources-and-services/family-courts/family-law-self-help-
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information/family-law-forms.stml. By adoption of the amended forms, we
express no opinion as to their correctness or applicability.
The amended and new rules and the amended forms shall become effective
at 12:01 a.m., January 1, 2015.
It is so ordered.
LABARGA, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, POLSTON,
and PERRY, JJ., concur.
THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE
EFFECTIVE DATE OF THESE AMENDMENTS.
Original Proceedings – Family Law Rules Committee
Elizabeth Ann Blackburn, Chair, Family Law Rules Committee, Revis &
Blackburn, P.A., Daytona Beach, Florida; Mary Louise Miller Wagstaff, Past
Chair, Family Law Rules Committee, Wagstaff Law Office, P.A., Largo, Florida;
John F. Harkness, Jr., Executive Director and Ellen H. Sloyer, Bar Staff Liaison,
The Florida Bar, Tallahassee, Florida,
for Petitioner
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APPENDIX
RULE 12.012. MINIMIZATION OF SENSITIVE INFORMATION
Every pleading or other document filed with the court shall comply with
Florida Rule of Judicial Administration 2.425, Minimization of the Filing of
Sensitive Information.
RULE 12.070. PROCESS
(a) – (b) [No change]
(c) Constructive Service.
(1) [No change]
(2) For constructive service of process in any case or proceeding
involving parental responsibility, custody, or time-sharing with a minor child, the
petitioner shall file an affidavit of diligent search and inquiry that conforms with
Florida Family Law Rules of Procedure Form 12.913(c). If the responding party
cannot be located, the party shall be served with process by publication in the
manner provided by chapter 49, Florida Statutes. The clerk of the circuit court shall
mail a copy of the notice to the party’s last known address.
(23) For constructive service of process in all other cases, an affidavit
of diligent search and inquiry in substantial conformity with Florida Family Law
Rules of Procedure Form 12.913(b), must be filed.
(d) [No change]
RULE 12.200. CASE MANAGEMENT AND PRETRIAL
CONFERENCES
(a) Case Management Conference.
(1) Family Law Proceedings, Generally. A case management
conference may be ordered by the court at any time on the court’s initiative. A
party may request a case management conference 30 days after service of a petition
or complaint. At such a conference the court may:
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(A) schedule or reschedule the service of motions, pleadings,
and other documents;
(B) set or reset the time of trials, subject to rule 12.440;
(C) coordinate the progress of the action if complex litigation
factors are present;
(D) limit, schedule, order, or expedite discovery;
(E) schedule disclosure of expert witnesses and the discovery
of facts known and opinions held by such experts;
(F) schedule or hear motions related to admission or
exclusion of evidence;
(G) pursue the possibilities of settlement;
(H) require filing of preliminary stipulations if issues can be
narrowed;
(I) refer issues to a magistrate for findings of fact, if consent
is obtained as provided in rules 12.490 and 12.492 and if no significant history of
domestic, repeat, dating, or sexual violence, or stalking that would compromise the
process is involved in the case;
(J) refer the parties to mediation if no significant history of
domestic, repeat, dating, or sexual violence, or stalking that would compromise the
mediation process is involved in the case and consider allocation of expenses
related to the referral; or refer the parties to counseling if no significant history of
domestic, repeat, dating, or sexual violence or stalking that would compromise the
process is involved in the case and consider allocation of expenses related to the
referral;
(K) coordinate voluntary binding arbitration consistent with
Florida law if no significant history of domestic, repeat, dating, or sexual violence
or stalking that would compromise the process is involved in the case;
(L) appoint court experts and allocate the expenses for the
appointments;
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(M) refer the cause for a parenting plan recommendation,
social investigation and study, home study, or psychological evaluation and
allocate the initial expense for that study;
(N) appoint an attorney or guardian ad litem for a minor child
or children if required and allocate the expense of the appointment; and
(O) schedule other conferences or determine other matters
that may aid in the disposition of the action.; and
(P) consider any agreements, objections, or form of
production of electronically stored information.
(2) [No change]
(b) – (d) [No change]
Commentary
[No change]
Committee Note
[No change]
RULE 12.363. EVALUATION OF MINOR CHILD
(a) Appointment of Mental Health Professional or Other Expert.
(1) When the issue of time-sharing, parental responsibility, ultimate
decision-making, or a parenting plan for a minor child is in controversy, tThe
court, on motion of any party or the court’s own motion, may appoint a licensed
mental health professional or otheran expert for an examination, evaluation,
testing, or interview of any minor child or to conduct a social or home study
investigation. The parties may agree on the particular expert to be appointed,
subject to approval by the court. If the parties have agreed, they shall submit an
order including the name, address, telephone number, area of expertise, and
professional qualifications of the expert. If the parties have agreed on the need for
an expert and there has been a determination of the need for the appointment of an
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expert and the parties cannot agree on the selection of the expert, the court shall
appoint an expert.
(2) After the examination, evaluation, or investigation, any party
may file a motion for an additional expert examination, evaluation, interview,
testing, or investigation by a licensed mental health professional or otheranother
expert. The court upon hearing may permit the additional examination, evaluation,
testing, or interview basedonly on a showing of good cause shownand only upon a
finding that further examinations, testing, interviews, or evaluations would be in
the best interests of the minor child.
(3) – (5) [No change]
(6) A copy of the order of appointment shall be provided
immediately to the expert by the court unless otherwise directed by the court. The
order shall direct the parties to contact the expert or investigator appointed by the
court to establish an appointment schedule to facilitate timely completion of the
evaluation.
(b) Providing of Reports.
(1) Unless otherwise ordered, the expert shall prepare and provide a
written report to the attorney for each party or the party, if unrepresented, and the
guardian ad litem, if appointed, a reasonable time before any evidentiary hearing
on the matter at issue. The expert also shall send written notice to the court that the
report has been completed and that a copy of the written report has been provided
to the attorney for each party or the party, if unrepresented, and the guardian ad
litem, if appointed. In any event, the written report shall be prepared and provided
no later than 30 days before trial or 75 days from the order of appointment, unless
the time is extended by order of the court. The expert shall not send a copy of the
report to the court unless the parties and their attorneys have agreed in writing that
the report will be considered by the court and filed in the court files as provided in
subdivision (e).
(2) On motion of any party, the court may order the expert to
produce the expert’s complete file to another qualified licensed mental health
professional,expert at the initial cost of the requesting party, for review by such
qualified licensed mental health expert, who may testify.
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(c) Testimony of Other ProfessionalsExperts. Any other expert who
has treated, tested, interviewed, examined, or evaluated a child may testify only if
the court determines that good cause exists to permit the testimony. The fact that
no notice of such treatment, testing, interview, examination, or evaluation of a
child was given to both parents shall be considered by the court as a basis for
preventing such testimony.
(d) Communications with Court by Expert. No expert may
communicate with the court without prior notice to the parties and their attorneys,
who shall be afforded the opportunity to be present and heard during any such
communication between the expert and the court. A request for communication
with the court may be informally conveyed by letter or telephone. Further
communication with the court, which may be conducted informally, shall be done
only with notice to the parties.
(e) Use of Evidence. An expert appointed by the court shall be subject to
the same examination as a privately retained expert and the court shall not entertain
any presumption in favor of the appointed expert’s findings. Any finding or report
by an expert appointed by the court may be entered into evidence on the court’s
own motion or the motion of any party in a manner consistent with the rules of
evidence, subject to cross-examination by the parties. The report shall not be
considered by the court before it is properly admitted into evidence. Any report
filed with the court shall be in compliance with Florida Rule of Judicial
Administration 2.425. The report shall not be filed with the courtin the court file
unless or until it is properly admitted into evidence and considered by the court.
The court shall consider whether the report should be sealed as provided by Florida
Rule of Judicial Administration 2.420.
(f) Limitation of Scope. This rule shall not apply to parenting
coordinators or social investigators.
Committee Note
[No change]
RULE 12.364. SOCIAL INVESTIGATIONS
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(a) Applicable to Social Investigations. This rule shall apply to the
appointment of an investigator to conduct a social investigation and study under
section 61.20, Florida Statutes.
(b) Appointment of Social Investigator. When the issue of time-
sharing, parental responsibility, ultimate decision-making, or a parenting plan for a
minor child is in controversy, the court, on motion of any party or the court’s own
motion, may appoint an investigator under section 61.20, Florida Statutes. The
parties may agree on the particular investigator to be appointed, subject to approval
by the court. If the parties have agreed on the need for a social investigation or the
court has determined there is such need, and the parties cannot agree on the
selection, the court shall select and appoint an investigator. The social investigator
must be qualified as an expert under section 90.702, Florida Statutes, to testify
regarding the written study.
(c) Order for Social Investigation. The order for a social investigation
shall state whether this is an initial establishment of a parenting plan or a
modification of an existing parenting plan. The investigator shall be required to
consider the best interests of the child based upon all of factors affecting the
welfare and interest of the particular minor child and the circumstances of that
family, including, but not limited to the statutory factors set forth in section 61.13,
Florida Statutes.
(d) Order Appointing Social Investigator. An order appointing a social
investigator shall state that the investigator is being appointed under section 61.20,
Florida Statutes, and shall state:
(1) The name, address, and telephone number for each parent.
(2) The name, address, and telephone number of the investigator
being appointed.
(3) Any specific issues to be addressed.
(4) An initial allocation of responsibility for payment of the costs
for the social investigation. The court may consider taxing the costs at a final
hearing.
(5) The order shall direct the parties to contact the investigator
appointed by the court to establish an appointment schedule to facilitate timely
completion of the investigation. A copy of the order of appointment shall be
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provided immediately to the investigator by the court, unless otherwise directed by
the court.
(e) Written Study with Recommendations. The investigator shall
prepare a written study with recommendations regarding a parenting plan,
including a written statement of facts found in the social investigation on which the
recommendations are based. The written study with recommendations shall be
furnished to the court and a copy provided to all parties of record by the
investigator at least 30 days before any hearing at which the court is to consider the
written study and recommendations, unless otherwise ordered by the court.
(f) Additional Investigation. After the written study is furnished to the
court, any party may file a motion for an additional expert examination, evaluation,
interview, testing, or investigation. The court upon hearing may order the
additional examination, evaluation, testing, or interview of the minor child based
on the court finding that the investigation is insufficient and that further
examinations, testing, interviews, or evaluations of the minor child would be in the
best interests of the minor child.
(g) Production of File. On motion of any party, the court may order the
investigator to produce the investigator’s complete file to another qualified
investigator for review by such investigator, who may render an opinion and
testify.
RULE 12.490. GENERAL MAGISTRATES
(a) [No change]
(b) Reference.
(1) – (2) [No change]
(3) The order of referral shall state with specificity the matter or
matters being referred and the name of the specific general magistrate to whom the
matter is referred. The order of referral shall also state whether electronic re-
cording or a court reporter is provided by the court, or whether a court reporter, if
desired, must be provided by the litigants.
(4) [No change]
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(c) [No change]
(d) Hearings.
(1) - (2) [No change]
(3) The general magistrate shall have authority to examine under
oath the parties and all witnesses upon all matters contained in the reference, to
require production of all books, papersdocuments, writings, vouchers, and other
documents applicable to it, and to examine on oath orally all witnesses produced
by the parties. The general magistrate may take all actions concerning evidence
that can be taken by the circuit court and in the same manner. The general
magistrate shall have the same powers as a circuit judge to utilize communications
equipment as defined and regulated by Florida Rule of Judicial Administration
2.530.
(4) – (5) [No change]
(e) – (g) [No change]
Commentary
[No change]
Committee Notes
2004 Amendment. In accordance with Chapter 2004-11, Laws of Florida,
all references to general master were changed to general magistrate.
2015 Amendment. Subdivision (b)(3) has been amended to clarify that the
order of referral must include the name of the specific general magistrate to whom
the matter is being referred and who will conduct the hearing and that concurrent
referrals to multiple general magistrates is inappropriate.
RULE 12.491. CHILD SUPPORT ENFORCEMENT
(a) – (d) [No change] Limited Application. This rule shall be effective
only when specifically invoked by administrative order of the chief justice for use
in a particular county or circuit.
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(e) General Powers and Duties. The support enforcement hearing
officer shall be empowered to issue process, administer oaths, require the
production of documents, and conduct hearings for the purpose of taking evidence.
A support enforcement hearing officer does not have the authority to hear
contested paternity cases. Upon the receipt of a support proceeding, the support
enforcement hearing officer shall:
(1) assign a time and place for an appropriate hearing and give
notice to each of the parties as may be required by law;
(2) take testimony and establish a record, which record may be by
electronic means as provided by Florida Rule of Judicial Administration
2.535(g)(3)2.535(h);
(3) accept voluntary acknowledgment of paternity and support
liability and stipulated agreements setting the amount of support to be paid; and
(4) evaluate the evidence and promptly make a recommended order
to the court. Such order shall set forth findings of fact.
(f) – (h) [No change]
Commentary
[No change]
Committee Note
[No change]
RULE 12.560. DISCOVERY IN AID OF EXECUTION.
(a) [No change]
(b) Fact Information Sheet. In addition to any other discovery available
to a judgment creditor under this rule, the court, at the request of the judgment
creditor, shall order the judgment debtor or debtors to complete Florida Rules of
Civil Procedure Form 1.977 (Fact Information Sheet), including all required
attachments, within 45 days of the order or such other reasonable time as
determined by the court.
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(c) – (d) [No change]
(e) Notice of Compliance. The judgment debtor shall file with the clerk
of court a notice of compliance with the order to complete form 1.977, and serve a
copy of the notice of compliance on the judgment creditor or the judgment
creditor’s attorney. Form 1.977 shall not be filed with the clerk of the court or in
any other public record, except by order of the court after a notice and hearing and
for good cause shown. If the court permits the filing of form 1.977, it shall be in
compliance with the requirements of Florida Rule of Judicial Administration
2.425.
Committee Notes
2000 Amendment. Subdivisions (b)–(e) were added to the Florida Rules of
Civil Procedure and adopted with amendments into the Family Law Rules of
Procedure. The amendments to the Civil Rules were patterned after Florida Small
Claims Rule 7.221(a) and Form 7.343. Although the judgment creditor is entitled
to broad discovery into the judgment debtor’s finances (Fla. R. Civ. P. 1.280(b);
Jim Appley’s Tru-Arc, Inc. v. Liquid Extraction Systems, 526 So. 2d 177, 179 (Fla.
2d DCA 1988)), in family law cases inquiry into the individual assets of the
judgment debtor’s spouse must be precluded until a proper predicate has been
shown. Tru-Arc, Inc., 526 So. 2d at 179; Rose Printing Co. v. D’Amato, 338 So. 2d
212 (Fla. 3d DCA 1976)
2015 Amendment. Subdivision (e) was deleted because the filing of a
notice of compliance is unnecessary for the judgment creditor to seek relief from
the court for noncompliance with this rule and because the Fact Information Sheet
should not be filed with the clerk of the court.
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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.901(a), PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE
(01/15)
When should this form be used?
This form should be used when a husband and wife are filing for a simplified dissolution of marriage. You
and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida.
You may file a simplified dissolution of marriage in Florida if all of the following are true:
 You and your spouse agree that the marriage cannot be saved.
 You and your spouse have no minor or dependent child(ren) together, the wife does not have any
minor or dependent children born during the marriage, and the wife is not now pregnant.
 You and your spouse have worked out how the two of you will divide the things that you both
own (your assets) and who will pay what part of the money you both owe (your liabilities), and
you are both satisfied with this division.
 You are not seeking support (alimony) from your spouse, and vice versa.
 You are willing to give up your right to trial and appeal.
 You and your spouse are both willing to go into the clerk’s office to sign the petition (not
necessarily together).
 You and your spouse are both willing to go to the final hearing (at the same time).
If you do not meet the criteria above, you must file a regular petition for dissolution of marriage.
This petition should be typed or printed in black ink. Each of you must sign the petition in the presence
of a deputy clerk (in the clerk’s office), although you do not have to go into the clerk’s office at the same
time. You will need to provide picture identification (valid driver’s license or official identification card)
for the clerk to witness your signatures.
What should I do next?
1. After completing this form, you should file the original with the clerk of the circuit court in the county
where you live and keep a copy for your records.
You may document your agreement by signing a Marital Settlement Agreement, Florida Family Law
Rules of Procedure Form 12.902(f)(3) and filing it with the clerk of the circuit court or you may agree
that all of your assets (what you own) and liabilities (what you owe) have been disposed of by oral
agreement.
2. You must prove to the court that the husband and/or wife has (have) lived in Florida for more than 6
months before filing the petition for dissolution of marriage. Residence can be proved by:
 a valid Florida driver’s license, Florida identification card, or voter registration card issued to one
of you at least 6 months prior to filing for dissolution of marriage; or
 the testimony of another person who knows that either you or your spouse has resided in Florida
for more than 6 months and is available to testify in court; or
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of
Marriage (01/15)
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 an affidavit. To prove residence by affidavit, use an Affidavit of Corroborating Witness, Florida
Supreme Court Approved Family Law Form 12.902(i). This form must be signed by a person who
knows that either you or your spouse has lived in Florida for more than 6 months before the date
that you filed the petition for dissolution of marriage. This affidavit may be signed in the presence
of the clerk of the court or in the presence of a notary public, who must affix his or her seal at the
proper place on the affidavit.
3. You must pay the appropriate filing fees to the clerk of the circuit court. If you and your spouse cannot
afford to pay the filing fees, you may fill out an Application for Determination of Civil Indigent Status,
and file it with your petition for dissolution of marriage. You may obtain this form from the clerk and
he or she will determine whether you are eligible to have filing fees waived.
4. Either you or the clerk of court will need to complete a Family Court Cover Sheet, Florida Family Law
Rules of Procedure Form 12.928. The clerk’s office can provide this form.
5. You must obtain a date and time for a court appearance from the clerk of court. On that date, you
and your spouse must appear together before a judge. You should complete a Final Judgment of
Simplified Dissolution of Marriage, Florida Family Law Rules of Procedure Form 12.990(a), and bring
it with you to the hearing. At that time, if all of the papers are in order, the judge may grant a final
judgment dissolving your marriage under simplified dissolution of marriage procedures by signing the
final judgment which you have provided.
6. If you fail to complete this procedure, the court may dismiss the case to clear its records.
Where can I look for more information?
Before proceeding, you should read “General Information for 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 61, Florida Statutes, and Rule 12.105, Florida Family Law Rules of
Procedure.
Special notes...
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of
Marriage (01/15)
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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Husband,
and
,
Wife.
PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE
We, {full legal name} , Husband,
and {full legal name} , Wife,
being sworn, certify that the following information is true:
[fill in all blanks]
1. We are both asking the Court for a dissolution of our marriage.
2. Husband lives in {name} County, {state} , and has lived there
since {date} . Wife lives in {name} County,
{state} , and has lived there since {date} .
3. We were married to each other on {date} in the city of {city} _________________ in state of
{state} , or country of {country} _________________________________.
4. Our marriage is irretrievably broken.
5. We do not have any minor or dependent children together, the wife does not have any minor or
dependent children born during the marriage, and the wife is not pregnant.
6. We have divided our assets (what we own) and our liabilities (what we owe) by agreement. We are
satisfied with this agreement.
{Check one only}
( ) Our marital settlement agreement, Florida Family Law Rules of Procedure Form 12.902(f)(3), is
attached. This agreement was signed freely and voluntarily by each of us and we intend to be
bound by it.
( ) Our marital settlement agreement is not in writing. We prefer to keep our financial agreements
private.
7. {Check one only} ( ) yes ( ) no Wife wants to be known by her former name, which was
{full legal name} _________________.
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (01/15)
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8. We each certify that we have not been threatened or pressured into signing this petition. We each
understand that the result of signing this petition may be a final judgment ending our marriage and
allowing no further relief.
9. We each understand that we both must come to the hearing to testify about the things we are
asking for in this petition.
10. We understand that we each may have legal rights as a result of our marriage and that by signing
this petition we may be giving up those rights.
11. We ask the Court to end our marriage and approve our marital settlement agreement.
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this petition and that the punishment for knowingly making a false statement includes fines
and/or imprisonment.
Dated:
Signature of HUSBAND
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):__________________________
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
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (01/15)
- 20 -
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of WIFE
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):__________________________
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]
This form was prepared for: [choose only one] ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual} ________________________________________________________,
{name of business} _________________________________________________________,
{address} _________________________________________________________________,
{city} _________________________, {state}______, {telephone number}______________.
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (01/15)
- 21 -
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.902(b), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (01/15)
When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit
and your individual gross income is UNDER $50,000 per year unless:
(1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived
the filing of a financial affidavit;
(2) You have no minor children, no support issues, and have filed a written settlement agreement
disposing of all financial issues; or
(3) The court lacks jurisdiction to determine any financial issues.
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 served on the other party in your case within 45 days of being served with
the petition, if it is not served on him or her with your initial papers. Service must be in accordance with
Florida Rule of Judicial Administration 2.516.
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 Florida Family Law Rule of Procedure 12.285.
Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the
address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential
Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
The affidavit must be completed using monthly income and expense amounts. If you are paid or your
bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided
below for making these conversions.
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)
(01/15)
- 22 -
Hourly - If you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount x Hours worked per week = Weekly amount
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Daily - If you are paid by the day, you may convert your income to monthly as follows:
Daily amount x Days worked per week = Weekly amount
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Weekly - If you are paid by the week, you may convert your income to monthly as follows:
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount x 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount x 2 = Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form)
(01/15)
- 23 -
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.: ______________________
Division: _______________________
,
Petitioner,
and
,
Respondent.
FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)
(Under $50,000 Individual Gross Annual Income)
I, {full legal name} , being sworn, certify that the following
information is true:
My Occupation:
Employed by: ___________________________
Business Address: _______________________________________________________________
Pay rate: $ ( ) every week ( ) every other week ( ) twice a month ( ) monthly
( ) other: ____________
___ Check here if unemployed and explain on a separate sheet your efforts to find employment.
SECTION I. PRESENT MONTHLY GROSS INCOME:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under “other” should
be listed separately with separate dollar amounts.
1. $______ Monthly gross salary or wages
2. ______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3. _______ Monthly business income from sources such as self-employment, partnerships, close
corporations, and/or independent contracts (gross receipts minus ordinary and necessary expenses
required to produce income) (Attach sheet itemizing such income and expenses.)
4. _______ Monthly disability benefits/SSI
5. _______ Monthly Workers’ Compensation
6. _______ Monthly Unemployment Compensation
7. _______ Monthly pension, retirement, or annuity payments
8. _______Monthly Social Security benefits
9. ______ Monthly alimony actually received (Add 9a and 9b)
9a. From this case: $ _______
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
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9b. From other case(s): _______
10. _______ Monthly interest and dividends
11. _______Monthly rental income (gross receipts minus ordinary and necessary expenses required to
produce income) (Attach sheet itemizing such income and expense items.)
12. _______ Monthly income from royalties, trusts, or estates
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they reduce personal
living expenses
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains)
15. _______ Any other income of a recurring nature (list source) _________________________
16. __________________________________________________________________________
17. $ _______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1–16)
PRESENT MONTHLY DEDUCTIONS:
18. $______Monthly federal, state, and local income tax (corrected for filing status and allowable
dependents and income tax liabilities)
a. Filing Status ____________
b. Number of dependents claimed _______
19. _______ Monthly FICA or self-employment taxes
20. _______ Monthly Medicare payments
21. _______ Monthly mandatory union dues
22. _______ Monthly mandatory retirement payments
23. _______ Monthly health insurance payments (including dental insurance), excluding portion paid for
any minor children of this relationship
24. _______ Monthly court-ordered child support actually paid for children from another relationship
25. _______Monthly court-ordered alimony actually paid (Add 25a and 25b)
25a. from this case: $ _______
25b. from other case(s):$ _______
26. $_______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
(Add lines 18 through 25).
27. $_______ PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17)
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 25 -
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below
do not reflect what you actually pay currently, you should write “estimate” next to each amount that is
estimated.
A. HOUSEHOLD:
Mortgage or rent $ _______ E. OTHER EXPENSES NOT LISTED ABOVE
Property taxes $ _______ Clothing $ _______
Utilities $ _______ Medical/Dental (uninsured) $ _______
Telephone $ _______ Grooming $ _______
Food $ _______ Entertainment $ _______
Meals outside home $ _______ Gifts $ _______
Maintenance/Repairs $ _______ Religious organizations $ _______
Other: __________ $ _______ Miscellaneous $ _______
Other: ______________ $ _______
B. AUTOMOBILE ____________________ $ _______
Gasoline $ _______ ____________________ $ _______
Repairs $ _______ ____________________ $ _______
Insurance $ _______ ____________________ $ _______
____________________ $ _______
C. CHILD(REN)’S EXPENSES
Day care $ _______
Lunch money $ _______ F. PAYMENTS TO CREDITORS
Clothing $ _______ CREDITOR: MONTHLY
Grooming $ _______ PAYMENT
Gifts for holidays $ _______ ____________________ $ _______
Medical/Dental (uninsured) $ _______ ____________________ $ _______
Other: ______________ $ _______ ____________________ $ _______
____________________ $ _______
D. INSURANCE ____________________ $ _______
Medical/Dental (if not listed on ____________________ $ _______
lines 23 or 45) $ _______ ____________________ $ _______
Child(ren)’s medical/dental $ _______ ____________________ $ _______
Life $ _______ ____________________ $ _______
Other: $ _______ ____________________ $ _______
____________________ $ _______
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 26 -
28. $_______ TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above)
SUMMARY
29. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
30. $_______ TOTAL MONTHLY EXPENSES (from line 28 above)
31. $_______ SURPLUS (If line 29 is more than line 30, subtract line 30 from line 29. This is the amount of
your surplus. Enter that amount here.)
32. ($_______) (DEFICIT) (If line 30 is more than line 29, subtract line 29 from line 30. This is the amount
of your deficit. Enter that amount here.)
SECTION III. ASSETS AND LIABILITIES
Use the nonmarital column only if this is a petition for dissolution of marriage and you believe an item
is “nonmarital,” meaning it belongs to only one of you and should not be divided. You should indicate
to whom you believe the item(s) or debt belongs. (Typically, you will only use this column if property/debt
was owned/owed by one spouse before the marriage. See the “General Information for Self-
Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for
definitions of “marital” and “nonmarital” assets and liabilities.)
A. ASSETS:
DESCRIPTION OF ITEM(S). List a description of each separate item owned by Nonmarital
you (and/or your spouse, if this is a petition for dissolution of marriage). LIST Current (check correct
ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the line next to any Fair column)
asset(s) which you are requesting the judge award to you. Market
Value
husband wife
Cash (on hand) $
Cash (in banks or credit unions)
Stocks, Bonds, Notes
Real estate: (Home)
(Other)
Automobiles
Other personal property
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Other
____Check here if additional pages are attached.
Total Assets (add next column) $
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 27 -
B. LIABILITIES:
DESCRIPTION OF ITEM(S). List a description of each separate debt owed by Current Nonmarital
you (and/or your spouse, if this is a petition for dissolution of marriage). LIST Amount (check correct
ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the line next to any Owed column)
debt(s) for which you believe you should be responsible.
husband wife
Mortgages on real estate: First mortgage on home $
Second mortgage on home
Other mortgages
Auto loans
Charge/credit card accounts
Other
____Check here if additional pages are attached.
Total Debts (add next column) $
C. CONTINGENT ASSETS AND LIABILITIES:
INSTRUCTIONS: If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus,
inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities,
debts assumed by another), you must list them here.
Contingent Assets Nonmarital
Possible (check correct
Check the line next to any contingent asset(s) which you are requesting the Value column)
judge award to you.
husband wife
$
Total Contingent Assets $
Contingent Liabilities Nonmarital
Possible (check correct
Check the line next to any contingent debt(s) for which you believe you Amount column)
should be responsible. Owed
husband wife
$
Total Contingent Liabilities $
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 28 -
SECTION IV. CHILD SUPPORT GUIDELINES WORKSHEET
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, MUST be
filed with the court at or prior to a hearing to establish or modify child support. This requirement cannot
be waived by the parties.)
[Check one only]
____ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the
establishment or modification of child support.
____ A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or
modification of child support is not an issue in this case.
I certify that a copy of this document was [check all used]: ( ) e-mailed ( ) mailed ( ) faxed
( ) hand delivered to the person(s) listed below on {date} ____________________________.
Other party or his/her attorney:
Name: _____________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
E-mail Address(es): ____________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of Party
Printed Name: _____________________________
Address:___________________________________
City, State, Zip:_____________________________
Fax Number:_______________________________
E-mail Address(es): __________________________
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 29 -
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] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual} ,
{name of business} ______________________________________________________________ ,
{address} _____________________________ ,
{city} ________,{state}________, {telephone number} .
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (01/15)
- 30 -
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM
12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(01/15)
When should this form be used?
This form should be used when you are involved in a family law case which requires a financial affidavit
and your individual gross income is $50,000 OR MORE per year unless:
(1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have waived
the filing of financial affidavits;
(2) you have no minor children, no support issues, and have filed a written settlement agreement
disposing of all financial issues; or
(3) the court lacks jurisdiction to determine any financial issues.
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 served on the other party in your case within 45 days of being served with
the petition, if it is not served on him or her with your initial papers. Service must be in accordance with
Florida Rule of Judicial Administration 2.516.
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 Florida Family Law Rule of Procedure 12.285.
Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggravated
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the
address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential
Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form)
(01/15)
- 31 -
The affidavit must be completed using monthly income and expense amounts. If you are paid or your
bills are due on a schedule which is not monthly, you must convert those amounts. Hints are provided
below for making these conversions.
Hourly - If you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount x Hours worked per week = Weekly amount
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Daily - If you are paid by the day, you may convert your income to monthly as follows:
Daily amount x Days worked per week = Weekly amount
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Weekly - If you are paid by the week, you may convert your income to monthly as follows:
Weekly amount x 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount x 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as
follows:
Semi-monthly amount x 2 = Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form)
(01/15)
- 32 -
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)
($50,000 or more Individual Gross Annual Income)
I, {full legal name} , being sworn, certify
that the following information is true:
SECTION I. INCOME
1. My age is: ___________________
2. My occupation is: ________________________________________________________________
3. I am currently
[Check all that apply]
a. ____ Unemployed
Describe your efforts to find employment, how soon you expect to be employed, and the pay you
expect to receive: __________________________________________________________
____________________________________________________________________________
b. ____ Employed by: ____________________________________________________________
Address: ____________________________________________________________________
City, State, Zip code: ________________________________ Telephone Number: _________
Pay rate: $ ______ ( ) every week ( ) every other week ( ) twice a month ( ) monthly
( ) other: ________________________________________________________
If you are expecting to become unemployed or change jobs soon, describe the change you expect
and why and how it will affect your income: _________________________________
________________________________________________________________________
____ Check here if you currently have more than one job. List the information above for the
second job(s) on a separate sheet and attach it to this affidavit.
c. _____ Retired. Date of retirement: _______________________________________________
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
- 33 -
Employer from whom retired: ___________________________________________________
Address:
_____________________________________________________________________
City, State, Zip code: _______________________________ Telephone Number: __________
LAST YEAR’S GROSS INCOME: Your Income Other Party’s Income (if known)
YEAR_____ $ _______ $ _______
PRESENT MONTHLY GROSS INCOME:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly. Attach more paper, if needed. Items included under “other” should
be listed separately with separate dollar amounts.
1. $______ Monthly gross salary or wages
2. _______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments
3. _______ Monthly business income from sources such as self-employment, partnerships,
close corporations, and/or independent contracts (Gross receipts minus ordinary
and necessary expenses required to produce income.)(Attach sheet itemizing such
income and expenses.)
4. _______ Monthly disability benefits/SSI
5. _______ Monthly Workers’ Compensation
6. _______ Monthly Unemployment Compensation
7. _______ Monthly pension, retirement, or annuity payments
8. _______ Monthly Social Security benefits
9. _______ Monthly alimony actually received (Add 9a and 9b)
9a. From this case: $________
9b. From other case(s): ________
10. _______ Monthly interest and dividends
11. _______ Monthly rental income (gross receipts minus ordinary and necessary expenses required
to produce income) (Attach sheet itemizing such income and expense items.)
12. _______ Monthly income from royalties, trusts, or estates
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they
reduce personal living expenses (Attach sheet itemizing each item and amount.)
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains)
Any other income of a recurring nature (identify source)
15. _______________________________________________________________________________
16. _______________________________________________________________________________
17. $_________ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1 through 16).
PRESENT MONTHLY DEDUCTIONS:
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for
anything that is NOT paid monthly.
18. $______Monthly federal, state, and local income tax (corrected for filing status and
allowable dependents and income tax liabilities)
a. Filing Status
b. Number of dependents claimed
19. _______ Monthly FICA or self-employment taxes
20. _______ Monthly Medicare payments
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
- 34 -
21. _______ Monthly mandatory union dues
22. _______ Monthly mandatory retirement payments
23. _______ Monthly health insurance payments (including dental insurance), excluding portion paid for
any minor children of this relationship
24. _______ Monthly court-ordered child support actually paid for children from another relationship
25. _______ Monthly court-ordered alimony actually paid (Add 25a and 25b)
25a. from this case: $ _________
25b. from other case(s): _________
26. $______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES
(Add lines 18 through 25).
27. $______ PRESENT NET MONTHLY INCOME
(Subtract line 26 from line 17).
SECTION II. AVERAGE MONTHLY EXPENSES
Proposed/Estimated Expenses. If this is a dissolution of marriage case and your expenses as listed below
do not reflect what you actually pay currently, you should write “estimate” next to each amount that is
estimated.
HOUSEHOLD:
1. $______ Monthly mortgage or rent payments
2. _______ Monthly property taxes (if not included in mortgage)
3. _______ Monthly insurance on residence (if not included in mortgage)
4. _______ Monthly condominium maintenance fees and homeowner’s association fees
5. _______ Monthly electricity
6. _______ Monthly water, garbage, and sewer
7. _______ Monthly telephone
8. _______ Monthly fuel oil or natural gas
9. _______ Monthly repairs and maintenance
10. _______ Monthly lawn care
11. _______ Monthly pool maintenance
12. _______ Monthly pest control
13. _______ Monthly misc. household
14. _______ Monthly food and home supplies
15. _______ Monthly meals outside home
16. _______ Monthly cable t.v.
17. _______ Monthly alarm service contract
18. _______ Monthly service contracts on appliances
19. _______ Monthly maid service
Other:
20. __________________________________________________________________________________
21. __________________________________________________________________________________
22. __________________________________________________________________________________
23. __________________________________________________________________________________
24. __________________________________________________________________________________
25. $_______ SUBTOTAL (add lines 1 through 24).
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
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AUTOMOBILE:
26. $______ Monthly gasoline and oil
27. _______ Monthly repairs
28. _______ Monthly auto tags and emission testing
29. _______ Monthly insurance
30. _______ Monthly payments (lease or financing)
31. _______ Monthly rental/replacements
32. _______ Monthly alternative transportation (bus, rail, car pool, etc.)
33. _______ Monthly tolls and parking
34. _______ Other: _________________________________________________
35. $_______ SUBTOTAL (add lines 26 through 34)
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES:
36. $______ Monthly nursery, babysitting, or day care
37. _______ Monthly school tuition
38. _______ Monthly school supplies, books, and fees
39. _______ Monthly after school activities
40. _______ Monthly lunch money
41. _______ Monthly private lessons or tutoring
42. _______ Monthly allowances
43. _______ Monthly clothing and uniforms
44. _______ Monthly entertainment (movies, parties, etc.)
45. _______ Monthly health insurance
46. _______ Monthly medical, dental, prescriptions (nonreimbursed only)
47. _______ Monthly psychiatric/psychological/counselor
48. _______ Monthly orthodontic
49. _______ Monthly vitamins
50. _______ Monthly beauty parlor/barber shop
51. _______ Monthly nonprescription medication
52. _______ Monthly cosmetics, toiletries, and sundries
53. _______ Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.)
54. _______ Monthly camp or summer activities
55. _______ Monthly clubs (Boy/Girl Scouts, etc.)
56. _______ Monthly time-sharing expenses
57. _______ Monthly miscellaneous
58. $______ SUBTOTAL (add lines 36 through 57)
MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP
(other than court-ordered child support)
59. $________________________________________________________________________________
60. __________________________________________________________________________________
61. __________________________________________________________________________________
62. __________________________________________________________________________________
63. $_______ SUBTOTAL (add lines 59 through 62)
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (Long Form) (01/15)
- 36 -
MONTHLY INSURANCE:
64. $______ Health insurance (if not listed on lines 23 or 45)
65. _______ Life insurance
66. _______ Dental insurance
Other:
67. ________________________________________________________________________________
68. ________________________________________________________________________________
69. $_______ SUBTOTAL (add lines 66 through 68, exclude lines 64 and 65)
OTHER MONTHLY EXPENSES NOT LISTED ABOVE:
70. $______ Monthly dry cleaning and laundry
71. _______ Monthly clothing
72. _______ Monthly medical, dental, and prescription (unreimbursed only)
73. _______ Monthly psychiatric, psychological, or counselor (unreimbursed only)
74. _______ Monthly non-prescription medications, cosmetics, toiletries, and sundries
75. _______ Monthly grooming
76._______ Monthly gifts
77. _______ Monthly pet expenses
78._______ Monthly club dues and membership
79._______ Monthly sports and hobbies
80._______ Monthly entertainment
81._______ Monthly periodicals/books/tapes/CDs
82._______ Monthly vacations
83._______ Monthly religious organizations
84._______ Monthly bank charges/credit card fees
85._______ Monthly education expenses
86.______ Other: (include any usual and customary expenses not otherwise mentioned in the
items listed above)___________________________________________________________
87.__________________________________________________________________________________
88.__________________________________________________________________________________
89.__________________________________________________________________________________
90. $_______ SUBTOTAL (add lines 70 through 89)
MONTHLY PAYMENTS TO CREDITORS: (only when payments are currently made by you on outstanding
balances). List only last 4 digits of account numbers.
MONTHLY PAYMENT AND NAME OF CREDITOR(s):
91. $_________________________________________________________________________________
92.__________________________________________________________________________________
93.__________________________________________________________________________________
94.__________________________________________________________________________________
95.__________________________________________________________________________________
96.__________________________________________________________________________________
97.__________________________________________________________________________________
98.__________________________________________________________________________________
99.__________________________________________________________________________________
100.______________________________________________________________________________
101.______________________________________________________________________________
102.______________________________________________________________________________
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103. ____________________________________________________________________________
104. $_______ SUBTOTAL (add lines 91 through 103)
105. $_______TOTAL MONTHLY EXPENSES:
(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, Expenses)
SUMMARY
106. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I. INCOME)
107. $_______ TOTAL MONTHLY EXPENSES (from line 105 above)
108. $_______ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106. This is the
amount of your surplus. Enter that amount here.)
109. ($______)(DEFICIT) (If line 107 is more than line 106, subtract line 106 from line 107. This is
the amount of your deficit. Enter that amount here.)
SECTION III. ASSETS AND LIABILITIES
A. ASSETS (This is where you list what you OWN.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate item owned by you (and/or your spouse, if
this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
one of an item.
STEP 2: If this is a petition for dissolution of marriage, check the line in Column A next to any item
that you are requesting the judge award to you.
STEP 3: In column B, write what you believe to be the current fair market value of all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is “nonmarital,” meaning it belongs to only one of you and should not be divided. You should
indicate to whom you believe the item belongs. (Typically, you will only use Column C if property
was owned by one spouse before the marriage. See the “General Information for Self-Represented
Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for
definitions of “marital” and “nonmarital” assets and liabilities.)
B. LIABILITIES/DEBTS (This is where you list what you OWE.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate debt owed by you (and/or your spouse, if
this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
one of an item.
STEP 2: If this is a petition for dissolution of marriage, check the line in Column A next to any debt(s)
for which you believe you should be responsible.
STEP 3: In column B, write what you believe to be the current amount owed for all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is “nonmarital,” meaning the debt belongs to only one of you and should not be divided. You
should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the
debt was owed by one spouse before the marriage. See the “General Information for Self-
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A B C
ASSETS: DESCRIPTION OF ITEM(S) Current Nonmarital
Fair (Check correct
LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. Market column)
Check the line next to any asset(s) which you are requesting the judge award Value
to you. husband wife
Cash (on hand) $
Cash (in banks or credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
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Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets:
Total Assets (add column B) $
Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida
Statutes, for definitions of “marital” and “nonmarital” assets and liabilities.)
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A B C
LIABILITIES: DESCRIPTION OF ITEM(S) Current Nonmarital
Amount (Check correct
LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. Owed
Check the line next to any debt(s) for which you believe you should be column)
responsible.
husband wife
Mortgages on real estate: First mortgage on home $
Second mortgage on home
Other mortgages
Charge/credit card accounts
Auto loan
Auto loan
Bank/Credit Union loans
Money you owe (not evidenced by a note)
Judgments
Other:
Total Debts (add column B) $
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C. NET WORTH (excluding contingent assets and liabilities)
$_______Total Assets (enter total of Column B in Asset Table; Section A)
$_______Total Liabilities (enter total of Column B in Liabilities Table; Section B)
$_______TOTAL NET WORTH (Total Assets minus Total Liabilities)
(excluding contingent assets and liabilities)
D. CONTINGENT ASSETS AND LIABILITIES
INSTRUCTIONS:
If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, inheritance,
etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax liabilities, debts
assumed by another), you must list them here.
A B C
Contingent Assets Nonmarital
Possible (Check correct
Check the line next to any contingent asset(s) which you are requesting the Value
column)
judge award to you.
husband wife
$
Total Contingent Assets $
A B C
Contingent Liabilities Nonmarital
Possible (Check correct
Amount column)
Check the line next to any contingent debt(s) for which you believe you Owed
should be responsible.
husband wife
$
Total Contingent Liabilities $
E. CHILD SUPPORT GUIDELINES WORKSHEET. Florida Family Law Rules of Procedure Form 12.902(e),
Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to establish
or modify child support. This requirement cannot be waived by the parties.
[Check one only]
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____A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the
establishment or modification of child support.
____A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or
modification of child support is not an issue in this case.
I certify that a copy of this financial affidavit was [check all used]: ( ) e-mailed ( ) mailed, ( ) faxed
( ) hand delivered to the person(s) listed below on {date} ____________________.
Other party or his/her attorney:
Name: _____________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
E-mail Address(es): _____________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated: ______________________ __________________________________________
Signature of Party
Printed Name: ______________________________
Address: ___________________________________
City, State, Zip: ______________________________
Fax Number: ________________________________
E-mail Address(es): ____________________________
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
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IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual} ,
{name of business} ______________________________________________________________ ,
{address} _____________________________ ,
{city} ________,{state}________, {telephone number} .
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