In Re: Amendments to the Florida Supreme Court Approved Family Law Forms

Supreme Court of Florida
______________
No. SC16-1253
______________
IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT
APPROVED FAMILY LAW FORMS.
[September 29, 2016]
PER CURIAM.
Pursuant to the procedures approved by this Court in Amendments to the
Florida Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14
(Fla. 2000), this Court has internally reviewed the Florida Supreme Court
Approved Family Law Forms and has determined that amendments to forms
12.982(a), Petition for Change of Name (Adult), 12.982(c), Petition for Change of
Name (Minor Child(ren)), and 12.982(f), Petition for Change of Name (Family)
are necessary in light of certain statutory amendments. Input on these issues was
received from the Advisory Workgroup on the Florida Supreme Court Approved
Family Law Forms, which provided valuable assistance. We have jurisdiction. See
art. V, § 2(a), Fla. Const.
Section 68.07, Florida Statutes, was amended, effective October 1, 2014, to
require that the result of a state and national criminal history records check for the
purposes of obtaining a name change must indicate whether the petitioner has
registered as a sexual predator or sexual offender. See ch. 2014-5, § 1, Laws of
Fla. Additionally, subsection 68.07(3)(i) requires that petitions for name change
must state “whether the petitioner has ever been required to register as a sexual
predator under s. 775.21 or as a sexual offender under s. 943.0435.” § 68.07(3)(i),
Fla. Stat. (2014). The amendments to the forms incorporate this new requirement.
The amended forms are adopted as set forth in the appendix to this opinion,
fully engrossed, effective for immediate use. The forms may also be accessed and
downloaded from the Florida State Court’s website at
http://www.flcourts.org/resources-and-services/court-improvement/problem-
solving-courts/family-courts/family-law-forms.stml. By adoption of the amended
forms, we express no opinion as to their correctness or applicability. We also
direct that the new and amended forms be published for comment. Interested
persons shall have sixty days from the date of this opinion to file comments with
the Court.1
1. All comments must be filed with the Court on or before November 28,
2016, as well as a separate request for oral argument if the person filing the
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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 Proceeding – Florida Supreme Court Approved Family Law Forms
comment wishes to participate in oral argument, which may be scheduled in this
case. If filed by an attorney in good standing with The Florida Bar, the comment
must be electronically filed via the Portal in accordance with In re: Electronic
Filing in the Supreme Court of Florida via the Florida Courts E-Filing Portal, Fla.
Admin. Order No. AOSC13-7 (Feb. 18, 2013). If filed by a non-lawyer or a
lawyer not licensed to practice in Florida, the comment must be electronically filed
via e-mail in accordance with In re Mandatory Submission of Electronic Copies of
Documents, Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004). Electronically
filed documents must be submitted in Microsoft Word 97 or higher. Any person
unable to submit a comment electronically must mail or hand deliver the originally
signed comment to the Florida Supreme Court, Office of the Clerk, 500 South
Duval Street, Tallahassee, Florida 32399-1927; no additional copies are required or
will be accepted.
-3-
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(a)
PETITION FOR CHANGE OF NAME (ADULT) (09/16)
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 dissolution of marriage or for adoption of child(ren). If you want a change
of name because of a dissolution of marriage or adoption of child(ren) that is not yet final, the change
of name should be requested as part of that case.
This form should be typed or printed in black ink and must be signed 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?
Unless you are seeking to restore a former name, you must have fingerprints submitted for a state
and national criminal records check. The fingerprints must be taken in a manner approved by the
Department of Law Enforcement and must be submitted to the Department for a state and national
criminal records check. You may not request a hearing on the petition until the clerk of court has
received the results of your criminal history records check. The clerk of court can instruct you on the
process for having the fingerprints taken and submitted, including information on law enforcement
agencies or service providers authorized to submit fingerprints electronically to the Department of Law
Enforcement. The process may take several weeks and you will have to pay for the cost of processing
the fingerprints and conducting the state and national criminal history records check. Please note that
the state and national criminal records check must indicate whether you have registered as a sexual
predator or a sexual offender and you must also indicate on this petition whether you have ever been
required to register as a sexual predator under section 775.21, Florida Statutes, or as a sexual
offender under section 943.0435, F.S.
Next, you must obtain a hearing date for the court to consider your request. If you are seeking to
restore a former name, a hearing on the petition MAY be held immediately after the petition is filed.
The final hearing on any other petition for a name change may be held immediately after the clerk of
court receives the results of your criminal history records check. 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
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
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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 the amount of the charges.
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.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
-5-
IN THE CIRCUIT COURT OF THE ____________JUDICIAL CIRCUIT,
IN AND FOR______________________COUNTY, FLORIDA
Case No.: ________________________
Division: _________________________
_______________________________,
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
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
_______/_________ ____________________________________________________
(___ Please indicate here if you are continuing these facts on an attached page.)
6. Family
[Indicate all that apply]
____ I am not married.
____ I am married. My spouse’s full legal name is: _____________________________________
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
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____ I do not have child(ren).
____ 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
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(____ Please indicate here if you are continuing these facts on an attached page.)
7. Former names
[Indicate 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
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
(___ Please indicate here if you are continuing these facts on an attached page.)
9. Business [Choose one only]
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
-7-
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
[Choose 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
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
_______/_______ __________________________________________________________
(____ Please indicate 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
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
_________ _____________ __________________________________________________
(____ Please indicate here if you are continuing these facts on an attached page.)
12. Criminal History
[Indicate all that apply]
I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.
I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of adjudication.
The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(______ Please indicate here if you are continuing these facts on an attached page.)
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
-8-
I _____ have____have not ever been required to register as a sexual predator under section 775.21,
Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
13. Bankruptcy
[Choose one only]
I have never been adjudicated bankrupt.
I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(____ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.)
14. Creditor(s)’ Judgments
[Choose one only]
I have never had a money judgment entered against me by a creditor.
The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number {date} if Paid
_____
_____
_____
_____
(_____ Please indicate here if these facts are continued on an attached page.)
15. Fingerprints and Criminal History Records Check
Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a manner
approved by the Department of Law Enforcement and submitted for a state and national criminal
history records check. I understand that I cannot request a hearing on my Petition until the Clerk
of Court receives the results of the criminal history records check. I also understand that the state
and national records check must indicate whether I have registered as either a sexual predator or
sexual offender.
16. 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.
17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have
been fully restored.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
-9-
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: __________________________________
Designated 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 the Petitioner.
This form was completed with the assistance of:
{name of individual} _____________________________________ ,
{name of business} ,
{address} ______________________________________________ ,
{city} ________________, {state}_____,{zip code}_________,{telephone number} __________________
Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petition for Change of Name (Adult)
(09/16)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORM 12.982(c)
PETITION FOR CHANGE OF NAME (MINOR CHILD(REN)) (09/16)
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, dissolution of marriage, 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 requested as part of that case.
This form should be typed or printed in black ink and must be signed 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. The Petition should only be completed by one
Petitioner for one child. If you wish to change the name of more than one child or if there is
more than one Petitioner, you should complete and file a Supplemental Form for Petition for
Change of Name (Minor Child) for each child and/or a Supplemental Form for Petition for
Change of Name. The supplemental form(s) is an attachment to the petition. Be sure that the
bottom of each page of each supplemental form is initialed by the petitioner(s).
What should I do next?
Unless you are seeking to restore a former name, each adult petitioner(s)’s fingerprints must
be submitted for a state and national criminal history records check. The fingerprints must be
taken in a manner approved by the Department of Law Enforcement. The fingerprints must be
submitted to the Department of Law Enforcement for a state and national criminal history
records check. The Petitioner(s) may not request a hearing on the Petition until the copy of
the fingerprints are filed and the clerk of court has received the results of the criminal history
records check. The clerk of court can instruct you on the process for having the fingerprints
taken and submitted, including information on law enforcement agencies or service providers
authorized to submit fingerprints electronically to the Department of Law Enforcement. The
process may take several weeks and the parent or guardian of the minor must pay the cost of
processing the fingerprints and conducting the state and national history records check. Please
note that the state and national criminal records check must indicate whether you have
registered as either a sexual predator or a sexual offender and you must also indicate on this
petition whether you have ever been required to register as a sexual predator under section
775.21, Florida Statutes, or as a sexual offender under section 943.0435, Florida Statutes.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name
(Minor Child(ren)) (09/16)
- 11 -
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 [to] 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. If you are
seeking to restore a former name, a hearing on the petition MAY be held immediately after the
petition is filed. The final hearing on any other petition for a name change may be held
immediately after the clerk of court receives the results of your criminal history records check.
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 the amount of the charges.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name
(Minor Child(ren)) (09/16)
- 12 -
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 means 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name
(Minor Child(ren)) (09/16)
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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) or guardian of the minor child(ren) named in this petition.
[Choose 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 adult petitioner(s)’s fingerprints have been taken in a manner approved by the Department of Law
Enforcement and submitted for a state and national criminal history records check. I /We understand
that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of
the criminal history records check. I/We also understand that the state and national records check
must indicate whether I/we have registered as either a sexual predator or a sexual offender.
A. 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:
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
- 14 -
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
_______/________ ______________________________________________________
_______/________ ______________________________________________________
_______/________ _______________________________________________________
_______/________ ______________________________________________________
_______/________ ______________________________________________________
(____ Please indicate here if you are continuing these facts on an attached page.)
6. [Choose one only]
_____The minor child is not married.
_____ The minor child is married to: {full legal name} __________________________________.
7. [Choose 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.
[Indicate 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
- 15 -
_____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. Criminal History.
[Indicate all that apply]
_____ The minor child has never been arrested for or charged with, pled guilty or nolo
contendere to, or been found to have committed a criminal offense, regardless of
adjudication.
_____ The minor child has a criminal history. In the past, the minor child was arrested for or
charged with, pled guilty or nolo contendere to, or been found to have committed a
criminal offense, regardless of adjudication. The details of the criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(_____Please indicate here if you are continuing these facts on an attached page.)
_____ The minor child _____ has _____has not ever been required to register as a sexual
predator under section 775.21, Florida Statutes.
_____ The minor child _____has _____has not ever been required to register as a sexual
offender under section 943.0435, Florida Statutes
11. Money Judgments.
[Choose 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 {date}
_____
_____
_____
_____
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
- 16 -
B. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S):
( ) FATHER ( ) MOTHER ( ) GUARDIAN
( ) A Supplemental Form has been attached for the other parent or petitioner.
1. My complete present name is: __________________________________________________.
2. I live in ________________ County, Florida, at {street address} ___________________________
_________________________________________________________________ .
3. Bankruptcy
[Choose one only]
I have never been adjudicated bankrupt.
I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(___ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.)
4. Creditor(s)’ Judgments
[Choose one only]
I have never had a money judgment entered against me by a creditor.
The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number if Paid {date}
_____
_____
_____
_____
5. Criminal History
Indicate all that apply
I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.
I have a criminal history. In the past I have been arrested for or charged with, pled guilty or
nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
- 17 -
(______ Please indicate here if you are continuing these facts on an attached page.)
I _____ have____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
6. 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.
7. My 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
Printed Name: _________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Telephone Number: _____________________________
Fax Number: __________________________________
Designated E-Mail Address(es):____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF ____________________
Sworn to or affirmed and signed before me on ____________ by _______________________________ .
_____________________________________________
NOTARY PUBLIC or DEPUTY CLERK
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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_____________________________________________
[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 Petitioner.
This form was completed with the assistance of:
{name of individual} _____________________________________ ,
{name of business} ,
{address} ______________________________________________ ,
{city} ________________, {state}_____,{zip code}_________,{telephone number} __________________
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILDREN)
Case No.: ______________________________
THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S):
( ) FATHER ( ) MOTHER ( ) GUARDIAN
1. My complete present name is: __________________________________________________
______________________________________________________________________________ .
2. I live in ________________ County, Florida, at {street address} ___________________________
______________________________________________________________________________.
3. Bankruptcy
[Choose one only]
I have never been adjudicated bankrupt.
I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(___ Please indicate here if you have filed additional bankruptcies, and explain on an attached
page.)
4. Creditor(s)’ Judgments
[Choose one only]
I have never had a money judgment entered against me by a creditor.
The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number if Paid
{date}
______ ________ _________ ________________________________
______ ________ _________ ________________________________
______ ________ _________ ________________________________
______ ________ _________ ________________________________
______ ________ _________ ________________________________
(____ Please indicate here if these facts are continued on an attached page.)
5. Criminal History
[Indicate all that apply]
I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.
I have a criminal history. In the past I have been arrested for or charged with, pled guilty
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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or nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(____ Please indicate here if you are continuing these facts on an attached page.)
I _____ have____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
6. 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.
7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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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: __________________________________
Designated 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 the Petitioner.
This form was completed with the assistance of:
{name of individual} _____________________________________ ,
{name of business} ,
{address} ______________________________________________ ,
{city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ .
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))
Case No.:
THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :
1. Minor child’s complete present name is:
I/We request that this minor child’s name be changed to:
2. The minor child lives in County, Florida, at {street address}
.
3. The minor child was born on {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
_______/________ ______________________________________________________
_______/________ ___________________________________________________________
______/_________ ___________________________________________________________
______/_________ ___________________________________________________________
______/_________ ___________________________________________________________
______/_________ ___________________________________________________________
(_____ Please indicate here if you are continuing these facts on an attached page.)
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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MINOR CHILD # ________, continued
6. [Choose one only]
_____The minor child is not married.
_____ The minor child is married to: {full legal name} __________________________________.
7. [Choose 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.
[Indicate 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. Criminal History.
[Indicate all that apply]
_____ The minor child has never been arrested for or charged with, pled guilty or nolo
contendere to, or been found to have committed a criminal offense, regardless of
adjudication.
_____ The minor child has a criminal history. In the past, the minor child was arrested for or
charged with, pled guilty or nolo contendere to, or been found to have committed a
criminal offense, regardless of adjudication. The details of the criminal history are:
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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MINOR CHILD # ________, continued
Date City/State Event (arrest, charge, plea, or adjudication)
(_____ Please indicate here if you are continuing these facts on an attached page.)
_____ The minor child _____ has _____has not ever been required to register as a sexual
predator under section 775.21, Florida Statutes.
_____ The minor child _____has _____has not ever been required to register as a sexual
offender under section 943.0435, Florida Statutes
11. Money Judgments.
[Choose 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 {date} if Paid
_____
_____
_____
Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor
Child(ren)) (09/16)
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.982(f)
PETITION FOR CHANGE OF NAME (FAMILY) (09/16)
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 dissolution of marriage, 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 requested as part of that case.
This form should be typed or printed in black ink and must be signed 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. The petition should only be completed for one adult. If you wish to
change the name(s) of another adult and/or any child(ren), you should complete and file with the clerk
of court the attached Supplemental Form(s) for Petition for Change of Name (Family) for each additional
family member. Be sure that the bottom of each page of each supplemental form is initialed.
What should I do next?
Unless you are seeking to restore a former name, each adult petitioner must have fingerprints
submitted for a state and national criminal history records check. The fingerprints must be taken in a
manner approved by the Department of Law Enforcement and must be submitted to the Department
for a state and national criminal history records check. You may not request a hearing on the petition
until the clerk of court has received the results of your criminal history records check. The clerk of
court can instruct you on the process for having the fingerprints taken and submitted, including
information on law enforcement agencies or service providers authorized to submit finger prints
electronically to the Department of Law Enforcement. The process may take several weeks and you will
have to pay for the cost of processing the fingerprints and conducting the state and national criminal
history records check. Please note that the state and national criminal records check must indicate
whether you have registered as either a sexual predator or a sexual offender and you must also
indicate on this petition whether you have ever been required to register as a sexual predator under
section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, Florida Statutes.
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
Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)
(09/16)
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may use constructive service. For more information about personal and constructive service, you
should refer to 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. If you are seeking to
restore a former name, hearing on the petition MAY be held immediately after the petition is filed. The
final hearing on any other petition for a name change may be held immediately after the clerk of court
receives the results of your criminal history records check. 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 the amount of the charges.
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 is/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.
Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)
(09/16)
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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
IN RE: THE NAME CHANGE OF
,
Petitioner/Father,
,
Petitioner/Mother.
PETITION FOR CHANGE OF NAME (FAMILY)
I/We, {full legal name(s)} ____________________________________________________, being sworn,
certify that the following information is true:
There are {enter number} __ adults named in this petition. A supplemental form is
attached for each adult not set out below.
There are {enter number} __ children named in this petition. I am/We are the birth or
legal parents or guardian of the minor child(ren) named in this petition. I/We have attached a
completed supplemental form for each minor child.
Unless I am seeking to restore a former name, a copy of the fingerprints of each adult person seeking a
name change in this petition has/have been taken in a manner approved by the Department of Law
Enforcement, and submitted for a state and national criminal history records check. I/We understand
that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of
the criminal history records check. I/We also understand that the state and national records check
must indicate whether I/we have registered as either a sexual predator or sexual offender.
THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER:
( ) HUSBAND ( ) WIFE ( ) GUARDIAN
( ) A Supplemental Form has been attached for the other parent or petitioner.
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: .
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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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
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)
6. Family
[Indicate all that apply]
_____ I am not married.
_____ I am married. My spouse’s full legal name is: .
_____ I do not have child(ren).
_____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
(____ Please indicate here if you are continuing these facts on an attached page.)
7. Former names
[Indicate 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)}
.
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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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
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)
9. Business
[Choose 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
[Choose 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
/
/
/
(____ Please indicate 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
(____ Please indicate here if you are continuing these facts on an attached page.)
12. Criminal History
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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[Indicate all that apply]
_____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or
have been found to have committed a criminal offense, regardless of adjudication.
_____ I have a criminal history. In the past I have been arrested for or charged with, pled
guilty or nolo contendere to, or been found to have committed a criminal offense,
regardless of adjudication. The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(_____ Please indicate here if you are continuing these facts on an attached page.)
I _____ have____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
13. Bankruptcy
[Choose one only]
____ I have never been adjudicated bankrupt.
____ I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(____ Please indicate here if you have had additional bankruptcies, and explain on an attached
page.)
14. Creditor(s)’ Judgments
[Choose one only]
____I have never had a money judgment entered against me by a creditor.
____The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number if Paid
{date}
____
____
____
____
____
(____ Please indicate 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
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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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: __________________________________
Designated 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 the Petitioner.
This form was completed with the assistance of:
{name of individual} _____________________________________ ,
{name of business} ,
{address} ______________________________________________ ,
{city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ .
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY)
Case No.:
THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER:
( ) HUSBAND ( ) WIFE ( ) GUARDIAN
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
/
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)
6. Family
[Indicate all that apply]
_____ I am not married.
_____I am married. My spouse’s full legal name is: .
_____ I do not have child(ren).
_____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
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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(____ Please indicate here if you are continuing these facts on an attached page.)
7. Former names
[Indicate 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
/
/
/
/
/
/
(____ Please indicate here if you are continuing these facts on an attached page.)
9. Business
[Indicate all that apply]
____ 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
[Indicate all that apply]
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
- 34 -
____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
/
/
/
/
/
(___ Please indicate 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
(___ Please indicate here if you are continuing these facts on an attached page.)
12. Criminal History
[Indicate all that apply]
____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been
found to have committed a criminal offense, regardless of adjudication.
____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty
or nolo contendere to, or been found to have committed a criminal offense, regardless of
adjudication. The details of my criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(_____ Please indicate here if you are continuing these facts on an attached page.)
I _____ have____have not ever been required to register as a sexual predator under section
775.21, Florida Statutes.
I _____ have ______have not ever been required to register as a sexual offender under section
943.0435, Florida Statutes.
13. Bankruptcy
[Choose one only]
____I have never been adjudicated bankrupt.
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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____I was adjudicated bankrupt on {date} , in {city} ,
{county} , {state} .
(____ Please indicate here if you have had additional bankruptcies, and explain on an attached
page.)
14. Creditors’ Judgments
[Choose one only]
____I have never had a money judgment entered against me by a creditor.
____The following creditor(s)’ money judgment(s) have been entered against me:
Date Amount Creditor Court entering judgment and case number if Paid
{date}
____
____
____
____
____
(____ Please indicate here if you are continuing these facts on an attached page.)
15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner
invade the property rights of others, whether partnership, patent, good will, privacy, trademark,
or otherwise.
16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have
been fully restored.
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
- 36 -
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: __________________________________
Designated 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 the Petitioner.
This form was completed with the assistance of:
{name of individual} _____________________________________ ,
{name of business} ,
{address} ______________________________________________ ,
{city} ________________, {state}_____,{zip code}_________,{telephone number} __________________ .
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name
(Family) (09/16)
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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
/
/
/
/
/
/
/
(____ Please indicate here if continuing these facts on an attached page.)
6. [Choose one only]
____The minor child is not married
____The minor child is married to: {full legal name} .
7. [Choose 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
[Indicate 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} __________________
{court, city, and state} .
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (09/16)
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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. Criminal History
[Indicate all that apply]
____ The minor child has never been arrested for or charged with, pled guilty or nolo
contendere to, or been found to have committed a criminal offense, regardless of
adjudication.
____ The minor child has a criminal history. In the past, the minor child was arrested for
or charged with, pled guilty or nolo contendere to, or been found to have committed a
criminal offense, regardless of adjudication. The details of the criminal history are:
Date City/State Event (arrest, charge, plea, or adjudication)
(____ Please indicate here if you are continuing these facts on an attached page.)
_____ The minor child _____ has _____has not ever been required to register as a
sexual predator under section 775.21, Florida Statutes.
_____ The minor child _____has _____has not ever been required to register as a sexual
offender under section 943.0435, Florida Statutes.
11. Money Judgments
[Choose 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
{date}
______ ________ _________ ________________________________
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (09/16)
- 39 -
______ ________ _________ ________________________________
(_____Please indicate here if you are continuing these facts on an attached page.)
Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change
of Name (Family) (09/16)
- 40 -