DocketNumber： SC08-2443
Citation Numbers： 78 So. 3d 1045
Judges： Canady, Labarga, Lewis, Pariente, Per Curiam, Perry, Polston, Quince
Filed Date： 11/3/2011
Status： Precedential
Modified Date： 8/30/2023
Supreme Court of Florida.
*1046 Judith L. Kreeger, Chair, the Florida Courts Technology Commission, Senior Judge, Eleventh Judicial Circuit, Miami, FL, Paul Regensdorf, Chair, Subcommittee on Access to Court Records, and Judge Melanie G. May, Fourth District Court of Appeal, West Palm Beach, FL; Ashley McCorvey Myers, Chair, McCorvey and Myers, Jacksonville, FL and Steven Patrick Combs, Past Chair, Family Law Rules Committee, Jacksonville, FL, for Petitioners.
Frank T. Pilotte, Past Chair, Florida Probate Rules Committee, and John F. Harkness, Jr., Executive Director, The Florida Bar, Tallahassee, FL; Russell Robert Winer, St. Petersburg, FL; Robyn L. Vines, Past Chair, Family Law Rules Committee, Fort Lauderdale, FL; Carol Jean LoCicero and Deanna K. Shullman of Thomas, LoCicero and Bralow, PL, Tampa, FL; John S. Mills, Past Chair, Appellate Court Rules Committee, Jacksonville, FL; Judge Robert W. Lee, Past Chair, Small Claims Rules Committee, Seventeenth Judicial Circuit, Fort Lauderdale, FL; Mark Romance, Past Chair, Civil Procedure Rules Committee, Miami, FL; Jack A. Moring, Past Chair, Family Law Rules Committee, Crystal River, FL; John G. Crabtree, Past Chair, Appellate Court Rules Committee, Key Biscayne, FL; Fleur J. Lobree, Past Chair, Criminal Procedure Rules Committee; Dale R. Sanders of Lyons and Sanders, Fort Lauderdale, FL; and Judge Renee Goldenberg, Seventeenth Judicial Circuit, Fort Lauderdale, FL, Responding with comments.
Robert T. Strain, Past Chair, Criminal Procedure Rules Committee, Tampa, FL; Keith H. Park, on behalf of the Rules of Judicial Administration Committee, West Palm Beach, FL, Donald E. Christopher, Chair, Civil Procedure Rules Committee, Orlando, FL, and Jeffrey S. Goethe, Chair, Florida Probate Rules Committee, Bradenton, FL, Also attended oral arguments.
PER CURIAM.
We have for consideration proposed amendments to the Florida rules of court and forms intended to minimize the amount of unnecessary personal information included in documents filed with the courts.[1] Reducing the amount of extraneous personal information in court records is another necessary step in the Court's ongoing effort to provide the public with electronic access to nonconfidential court records.[2] As part of that effort, we recently *1047 adopted procedures that allow clerks of court to readily identify and screen from the public confidential information filed with the courts and refine the procedures for sealing and unsealing court records. See In re Amends. to Fla. Rule of Jud. Admin. 2.420 & Fla. Rules of App. Pro., 31 So. 3d 756, 757 (Fla.2010) (recognizing that refinement of rule governing confidential court records was a necessary step in providing the public electronic access to court records).
The amendments at issue here further implement recommendations of the Committee on Privacy and Court Records (Privacy Committee) and are the result of the combined efforts of the Committee on Access to Court Records (Access Committee), its successor, the Florida Court Technology Commission's Subcommittee on Access to Court Records (Access Subcommittee),[3] and the Florida Bar Rules Committees. After considering the various proposals and comments filed in this case, and hearing oral argument, we amend the rules and forms to minimize the personal information filed with the court. Most notably, we adopt new Rule of Judicial Administration 2.425 (Minimization of the Filing of Sensitive Information) to govern the filing of sensitive personal information, which is the linchpin of the minimization efforts. We take this opportunity to emphasize that in order to avoid the electronic dissemination of sensitive personal information unnecessary to court proceedings, both attorneys and pro se litigants must be vigilant to file only authorized documents that comply with the requirements adopted here.
The newly enacted rules provide for sanctions for violations of these rules. However, continual education and a change in mindset for all those involved in the litigation process are necessary for these rules to work as intended. After all, with the benefits of electronic access to documents comes the responsibility to minimize unnecessary personal information in court records. With those beginning cautions, we explain the evolution of the amendments and the substance of the major amendments.
The Privacy Committee was created in November 2003 and charged with providing recommendations to the Court regarding electronic access to court records. See In re Comm. on Privacy and Court Records, Fla. Admin. Order No. AOSC04-04 (Feb. 12, 2004) (substituted for AOSC03-49). As relevant to the amendments at issue here, the Privacy Committee was charged with recommending strategies for reducing the amount of unnecessary personal information in court records. Id. at 5. After the Privacy Committee submitted its report and recommendations[4] and the Court held public hearings on the recommendations, an administrative order was issued partially implementing the Privacy Committee's recommendations.[5] That administrative order noted the Court's *1048 agreement with the Privacy Committee that the Florida judicial branch should have a goal of providing electronic access to nonconfidential court records when appropriate conditions are met, one of which is minimizing the amount of unnecessary personal information in court records.[6] By separate administrative order, the Access Committee was created to assist the Court in implementing a number of the Privacy Committee recommendations,[7] including the "minimization" recommendations addressed here.[8]
As relevant here, the Privacy Committee reported as follows:
Florida court files commonly contain information which is not required by law or rule and which is not needed by the court for purposes of adjudication or case management. Once entered into a court file this information becomes a matter of public record. Much of this information is personal or sensitive in nature. The Committee perceives that there is not a clear understanding on the part of attorneys and the general public of the negative effects on personal privacy of placing unnecessary information in a court record.
Privacy Committee Report at 56. The inclusion of unnecessary personal information in court filings is of special concern because providing electronic access, which would include internet access, to court records will make nonconfidential personal information contained in those records more readily accessible to the public.
To mitigate this concern, the Privacy Committee made four recommendations intended to minimize the filing of extraneous personal information. Privacy Committee Recommendation Seven urges the review and revision of court rules and forms to avoid the filing of personal information that is not necessary for adjudication or case management.[9] Recommendation Eight recommends the study of a court rule to prohibit the filing of unauthorized documents.[10] Recommendation Nine suggests clarifying Family Law Rule of Procedure 12.285 (Mandatory Disclosure) to avoid the unnecessary filing of financial information in family law cases.[11] And Recommendation Ten urges the adoption of a rule that prohibits the filing of discovery information with the court unless the information is filed for good cause and that provides for sanctions if the rule is violated.[12] These "minimization" recommendations were referred to the Florida Bar rules committees to propose rule and form amendments implementing the recommendations.[13] The rules committees' proposals *1049 were then referred to the Access Committee for consideration[14] and preparation of an omnibus petition of proposed rule amendments. The Access Committee's petition of proposed amendments, as well as revised and new proposals offered by the rules committees are before the Court here.
In considering the proposals, the Court had the benefit of comments from interested persons, as well as responses and input from the Access Subcommittee (successor to the Access Committee)[15] and the various rules committees on a number of issues of concern to the Court. See In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed April 1, 2010) (seeking input on a number of issues); see also In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed May 19, 2010) (seeking input on suggested new rule 2.425). In response to the Court's concern about consistency among the various rules proposed to govern the filing of sensitive personal information, the committees now urge the adoption of new Rule of Judicial Administration 2.425 (Minimization of the Filing of Sensitive Information) and conforming amendments to the other bodies of rules and forms.
After considering the various proposals, we amend the Florida Rules of Civil Procedure, the Florida Rules of Judicial Administration, the Florida Rules of Criminal Procedure, the Florida Probate Rules, the Florida Small Claims Rules, the Florida Rules of Appellate Procedure, and the Florida Family Law Rules of Procedure and forms, as reflected in the appendix to this opinion. We discuss the more significant amendments below.
New rule 2.425 (Minimization of the Filing of Sensitive Information) is the centerpiece of the amendments adopted in this case. The new rule governs the filing of sensitive personal information in all types of cases, except traffic and criminal proceedings.[16] It implements Privacy Committee Recommendation Seven, which urges revision of court rules and forms to avoid the filing of personal information that is not necessary for adjudication or case management.[17] The new rule of judicial administration sets forth the categories of personal information that must not be filed or must be truncated or redacted before filing, and provides exceptions that allow for the filing of complete information in appropriate circumstances.
The new rule serves as a companion to recently amended Rule of Judicial Administration 2.420 (Public Access to Judicial Branch Records).[18] New rule 2.425 provides *1050 the procedures for protecting personal information being filed with the court; while rule 2.420 governs the procedures for determining the confidentiality of information after it has been filed and for providing public access to nonconfidential information. Rule 2.425 is loosely modeled after Federal Rule of Civil Procedure 5.2 (Privacy Protection for Filings Made with the Court). The most important provisions of the new rule are discussed below.
First, under subdivision (a) (Limitations for Court Filings) of the new rule, unless exempted by subdivision (b) (Exceptions), or authorized by statute, another rule, or court order,[19] personal information of the type listed either must not be filed or must be truncated or redacted before filing. Under subdivisions (a)(1) and (a)(2) only the initials of a minor and the year of birth of a person's birth date may be included in filings, and under subdivision (a)(3), no portion of a social security number, bank account number, credit card account number, charge account number, or debit account number can be filed,[20] unless the number falls within one of the subdivision (b) exceptions, or is authorized by statute, another rule, or court order.
Only the last four digits of certain other personal identifying numbers (i.e., driver's license number, passport number, taxpayer identification number, and patient or health care number) are allowed under subdivision (a)(4). Similarly, a truncated version of other types of personal information (i.e., email address, password, and other sensitive information as provided by court order) is allowed under subdivisions (a)(5) and (a)(6).
Next, subdivision (b) (Exceptions) allows for the filing of complete information under certain circumstances. For example, under subdivisions (b)(1), (b)(5), and (b)(6) respectively, an account number that identifies the property alleged to be the subject of a proceeding, the birth date of a minor whenever the birth date is necessary for the court to establish or maintain subject matter jurisdiction, and the name of a minor in any document or order affecting the minor's ownership of real property are exempt from the subdivision (a) limitations. Under subdivision (b)(10), information that is relevant and material to an issue before the court also is exempt.
Subdivision (b)(8), which we adopt on an interim basis, exempts from the requirements of the rule filings in traffic and criminal proceedings. This exception is strongly supported by the Criminal Procedure Rules Committee, prosecutors, and defense attorneys, as well as numerous Florida criminal justice organizations.[21]*1051 The Rules Committee and criminal justice organizations maintain that much of the information filed in criminal cases that would have to be truncated or redacted under the new rule must be available to defense attorneys, law enforcement, and others in the criminal justice system. The proponents of the exception also caution that application of the rule would result in substantial workload issues for prosecutors' offices that would be required to truncate or redact massive amounts of information routinely contained in arrest affidavits, search warrants, charging documents, traffic citations, police reports, and discovery documents filed with the court. We acknowledge the reasons advanced for treating filings in criminal and traffic proceedings differently than filings in other cases. However, filings in criminal and traffic cases contain a large portion of the personal information filed with our courts and a "blanket" exception for those filings would not be necessary if a finely tailored rule can be drafted to govern them. Therefore, we direct the Criminal Procedure Rules Committee, the Traffic Court Rules Committee, and the Rules of Judicial Administration Committee to work together to propose a rule or rules similar to Federal Rule of Criminal Procedure 49.1 (Privacy Protection for Filings Made with the Court) to govern the filing of sensitive personal information in criminal and traffic proceedings.[22]
Finally, subdivision (c) (Remedies) provides remedies and sanctions for violations of the rule. And subdivisions (d) (Motions Not Restricted) and (e) (Application) clarify the new rule's interplay with rule 2.420 (Public Access to Judicial Branch Records) and explain that the new rule does not affect the application of constitutional provisions, statutes, or rules of court governing confidential information or access to public records.
Other rules of procedure and forms are amended to conform to or reference new rule 2.425.[23] For example, new Rule of *1052 Appellate Procedure 9.050 (Maintaining Privacy of Personal Data) requires all briefs, petitions, replies, appendices, motions, notices, stipulations, and responses filed with the court comply with rule 2.425. Family Law Rules 12.130(c) (Protection of Account and Personal Identifying Numbers), 12.440(a) (Setting for Trial), 12.540 (Relief from Judgment, Decrees, or Orders), and 12.620 (Receivers) are amended to require compliance with rule 2.425. Amendments to the civil and family law discovery rules also incorporate the requirements of rule 2.425. See Appendix, infra, pp. 1055-57, 1074-78 (amending Fla. R. Civil P. 1.280; 1.310; 1.340; 1.350; Fla. Fam. L.R.P. 12.280; 12.285; 12.340; 12.370; 12.410; 12.560).
To further implement Privacy Committee Recommendation Seven (Revision of Rules and Forms Leading to Extraneous Personal Information), the various civil judgment forms are amended to require that only the last four digits of the judgment debtor's social security number be included in the judgment. Probate Rules 5.200 (Petition for Administration), 5.210 (Probate of Wills without Administration), and 5.530 (Summary Administration) are likewise amended to require that only the last four digits of the decedent's social security number be included in petitions filed under those rules.[24] Similarly, to limit the filing of personal information in criminal cases, Rule of Criminal Procedure 3.140(c)(4) (Personal Statistics) is amended to delete the requirement that the defendant's social security number be included in the charging document.[25]
New Rule of Civil Procedure 1.280(f) (Court Filing of Documents and Discovery) works in conjunction with new rule 2.425, by requiring that all discovery documents filed with the court comply with the requirements for the filing of personal information. However, the new discovery rule's primary purpose is to implement Privacy Committee Recommendation Ten,[26] by prohibiting the filing of information obtained during discovery unless the information is filed for good cause and giving the court authority to impose sanctions for violation of the rule. The Court *1053 revised the language of proposed rule 1.280(f) to clarify that good cause is satisfied only where the filing of the information is allowed or required by another applicable rule of procedure or by court order. This requirement is intended to stop abuses of personal information obtained during discovery by preventing the filing of discovery information unless it is necessary to the proceedings. Other civil discovery rules are amended to require compliance with new rule 1.280(f). See Appendix, infra, pp. 1055-57 (amending Fla. R. Civ. P. 1.310; 1.340; 1.350).
Family law discovery rules also are amended to limit the filing of discovery information. New subdivision (c) is added to Family Law Rule 12.340 (Interrogatories to Parties) to require that responses to interrogatories be served but not filed with the court, unless they are admitted into evidence and are in compliance with rule 2.425. Rule 12.370 (Requests for Admissions) is amended to require that documents attached to a request for admissions be served with the request but not filed with the court. The amendments to rule 12.560 (Discovery in Aid of Execution) prohibits the filing of a fact information sheet, civil form 1.977, unless ordered by the court for good cause shown.
Similarly, subdivisions (b) and (e) of rule 12.363 (Evaluations of Minor Child) are amended to prevent the filing of an evaluation of a minor child unless the report is being admitted into evidence. If the report is filed, the filing must comply with rule 2.425. The Media Organizations[27] that commented on these amendments urge us to reject the requirement, added to subdivision (e), that the court consider whether the report should be sealed under rule 2.420. The Media Organizations maintain that rule 2.420 places the burden of seeking a determination of confidentiality of court records on the proponent of closure, not the court. In response, the Family Law Rules Committee points out that the court has inherent authority to protect the interests of children whose parents are before the court, citing Simms v. State Department of Health & Rehabilitative Services, 641 So. 2d 957, 961 (Fla. 3d DCA 1994). The Access Subcommittee explains that the recent amendments to rule 2.420 were not intended to affect the power of a court to determine, sua sponte, that a particular court record is confidential. Therefore, we defer to the committee and adopt the subdivision (e) requirement.
Next, to implement Privacy Committee Recommendation Nine, which requested that the mandatory disclosure rule be clarified to avoid the unnecessary filing of financial information in family law cases,[28] as well as Recommendations Seven and Ten, we adopt new Family Law Rule of Procedure 12.285(a)(3) (Mandatory Disclosure; Documents Not to be Filed with Court; Sanctions), and amend rule 12.287 (Financial Affidavits in Enforcement and Contempt Proceedings). New rule 12.285(a)(3)(A) highlights language currently in the rule stating that except for financial affidavits and child support guidelines worksheets, documents produced under the rule are not to be filed with the court absent a court order. Subdivision (a)(3)(B) requires that account numbers and personal identifying information are governed by rule 2.425. And subdivision (a)(3)(C) provides that sanctions are governed *1054 by new rule 1.280(f). New rule 12.285(c) (Exemption for Requirement to File and Serve Financial Affidavit) prohibits the filing and service of a financial affidavit if the parties are seeking a simplified dissolution of marriage under 12.105 and certain conditions are met. The current rule 12.105(c) requirement that the parties to a simplified dissolution proceeding file a financial affidavit and marital settlement agreement is deleted, and the family law forms are amended accordingly. Rule 12.287 is amended to delete the requirement that a requested financial affidavit be filed with the court in enforcement and contempt proceedings and to add a requirement that a notice of compliance with the service requirement be filed instead.[29]
The family law rules of procedure forms are amended to conform with the amendments to the family law rules. Additionally, the instructions to several of the rules forms and approved forms are amended to conform to section 119.071(2)(j)(1), Florida Statutes (2010), which was enacted to protect the confidentiality of victims of domestic violence, sexual battery, aggravated child abuse, aggravated stalking, and aggravated battery.
Finally, with input from the Court's Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms,[30] we amend the Florida Supreme Court Approved Family Law Forms to ensure that the forms do not prompt those who use them to provide unnecessary personal information, such as "place of marriage," "date of separation," "place of birth of minor children," or "gender of minor children." The requirement to include a statement of the "best interest of the child(ren)" is deleted from form 12.905(d) (Supplemental Petition for Temporary Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to Military Service), as unnecessary. Requests for financial information that is required to be provided in the family financial affidavits also is removed from form 12.943 (Motion to Deviate from Child Support Guidelines). Other more minor changes also are made to the approved forms.
We thank the Access Committee, the Access Subcommittee, the Florida Bar Rules Committees, the Court's Advisory Workgroup on the Florida Supreme Court Approved Family Law Forms, and those who submitted comments for assisting the Court in moving closer to our goal of providing the public with electronic access to court records. We also take this opportunity to emphasize that in order to avoid the electronic dissemination of sensitive personal information unnecessary to court proceedings, both attorneys and pro se litigants must be vigilant to file only authorized documents that comply with the requirements adopted here.
Accordingly, we amend the Florida Rules of Civil Procedure, the Florida Rules of Judicial Administration, the Florida Rules of Criminal Procedure, the Florida Probate Rules, the Florida Small Claims Rules, the Florida Rules of Appellate *1055 Procedure, and the Florida Family Law Rules as reflected in the appendix to this opinion.[31] New language is indicated by underscoring; deletions are indicated by struck-through type. The committee notes are offered for explanation only and are not adopted as an official part of the rules. We also amend the Family Law Rules of Procedure Forms and the Florida Supreme Court Approved Family Law Forms, as set forth in the appendix to this opinion, fully engrossed for use on the effective date of the amendments. The forms can be accessed and downloaded from this Court's website at www.flcourts. org/gen_public/family/forms_rules/index. shtml. By adopting the amended forms, we express no opinion as to their correctness or applicability.
The amendments to the rules and forms are effective, nunc pro tunc, October 1, 2011, at 12:01 a.m.
It is so ordered.
CANADY, C.J., and PARIENTE, LEWIS, POLSTON, LABARGA, and PERRY, JJ., concur.
QUINCE, J., concurs in result.
(a)-(e) [No change]
(f) Court Filing of Documents and Discovery. Information obtained during discovery shall not be filed with the court until such time as it is filed for good cause. The requirement of good cause is satisfied only where the filing of the information is allowed or required by another applicable rule of procedure or by court order. All filings of discovery documents shall comply with Florida Rule of Judicial Administration 2.425. The court shall have authority to impose sanctions for violation of this rule.
1972 Amendment1996 Amendment. [No change]
2011 Amendment. Subdivision (f) is added to ensure that information obtained during discovery is not filed with the court unless there is good cause for the documents to be filed, and that information obtained during discovery that includes certain private information shall not be filed with the court unless the private information is redacted as required by Florida Rule of Judicial Administration 2.425.
(a)-(e) [No change]
(f) Filing; Exhibits.
(1)-(2) [No change]
(3) A copy of a deposition may be filed only under the following circumstances:
(A) It may be filed in compliance with Florida Rule of Judicial Administration 2.425 and rule 1.280(f) by a party or the witness when the contents of the deposition must be considered by the court on any matter pending before the court. Prompt notice of the filing of the deposition shall be *1056 given to all parties unless notice is waived. A party filing the deposition shall furnish a copy of the deposition or the part being filed to other parties unless the party already has a copy.
(B) If the court determines that a deposition previously taken is necessary for the decision of a matter pending before the court, the court may order that a copy be filed by any party at the initial cost of the party, and the filing party shall comply with rules 2.425 and 1.280(f).
(g)-(h) [No change]
1972 Amendment2010 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.
(a)-(d) [No change]
(e) Service and Filing. Interrogatories shall be arranged so that a blank space is provided after each separately numbered interrogatory. The space shall be reasonably sufficient to enable the answering party to insert the answer within the space. If sufficient space is not provided, the answering party may attach additional papers with answers and refer to them in the space provided in the interrogatories. The interrogatories shall be served on the party to whom the interrogatories are directed and copies shall be served on all other parties. A certificate of service of the interrogatories shall be filed, giving the date of service and the name of the party to whom they were directed. The answers to the interrogatories shall be served upon the party originally propounding the interrogatories and a copy shall be served on all other parties by the answering party. The original or any copy of the answers to interrogatories may be filed in compliance with Florida Rule of Judicial Administration 2.425 and rule 1.280(f) by any party when the court should consider the answers to interrogatories in determining any matter pending before the court. The court may order a copy of the answers to interrogatories filed at any time when the court determines that examination of the answers to interrogatories is necessary to determine any matter pending before the court.
1992 Amendment1988 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.
(a)-(c) [No change]
(d) Filing of Documents. Unless required by the court, a party shall not file any of the documents or things produced with the response. Documents or things may be filed in compliance with Florida *1057 Rule of Judicial Administration 2.425 and rule 1.280(f) when they should be considered by the court in determining a matter pending before the court.
1972 Amendment1980 Amendment. [No change]
2011 Amendment. A reference to Florida Rule of Judicial Administration 2.425 and rule 1.280(f) is added to require persons filing discovery materials with the court to make sure that good cause exists prior to filing discovery materials and that certain specific personal information is redacted.
(a) General Form. This form is the general form for a judgment after default, not including recovery for prejudgment interest and attorneys' fees:
This action was heard after entry of default against defendant and
IT IS ADJUDGED that plaintiff, ..... (name and address) ....., recover from defendant, ..... (name and address, and last 4 digits of social security number if known) ....., the sum of $.......... with costs in the sum of $.........., that shall bear interest at the rate of. .... % a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ Judge(b) Form with Interest and Fees. This form is for judgment after default including prejudgment interest and attorneys' fees recovered:
This action was heard after entry of default against defendant and
IT IS ADJUDGED that plaintiff, ..... (name and address) ....., recover from defendant,.....(name and address, and last 4 digits of social security number if known) ....., the sum of $.......... on principal, $.......... for attorneys' fees with costs in the sum of $.........., and prejudgment interest in the sum of $.........., making a total of $.......... that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
1980 Adoption. This form is new.
*1058 2003 Amendment. Subdivision (b) is amended to include prejudgment interest in the total judgment pursuant to Quality Engineered Installation, Inc. v. Higley South, Inc., 670 So. 2d 929 (Fla.1996).
Pursuant to the verdict rendered in this action
IT IS ADJUDGED that plaintiff,.....(name and address) ....., recover from defendant,.....(name and address, and last 4 digits of social security number if known) ....., the sum of $.......... with costs in the sum of $.........., making a total of $.........., that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
Pursuant to the verdict rendered in this action
IT IS ADJUDGED that plaintiff,.....(name and address, and last 4 digits of social security number if known)....., take nothing by this action and that defendant,.....(name and address)....., shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear interest at the rate of.....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
........ JudgeNOTE: The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
This action was tried before the court. On the evidence presented
IT IS ADJUDGED that:
1. (list adjudications in numbered paragraphs)
2. .........................
(See note below on name, address, and social security number requirements.)
ORDERED at ...................., Florida, on .....(date)......
......... JudgeNOTE: Findings of fact can be inserted after "presented" if desired. The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
This action was tried before the court. On the evidence presented
IT IS ADJUDGED that plaintiff, ..... (name and address, and last 4 digits of social security number if known) ....., take nothing by this action and that defendant,..... (name and address) ....., shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear interest at the rate of .....% a year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: Findings of fact can be inserted after "presented" if desired. The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
NOTE APPLICABLE TO FORMS (a)-(d): The address of the person who claims a lien as a result of the judgment must be included in the judgment in order for the judgment to become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For the specific *1060 requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of each person against whom the judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy reasons, only the last 4 digits of the social security number should be shown.
(a) Judgment in Favor of Plaintiff when Plaintiff Has Possession.
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Plaintiff, .....(name and address)....., has the right against defendant,.....(name and address, and last 4 digits of social security if known)....., to retain possession of the following described property:
(list the property and include a value for each item)
2. Plaintiff shall recover from defendant the sum of $.......... as damages for the detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of ..........% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: This form applies when the plaintiff has recovered possession under a writ of replevin and prevailed on the merits. Pursuant to section 78.18, Florida Statutes (1995), paragraph 2 of the form provides that the plaintiff can also recover damages for the wrongful taking and detention of the property, together with costs. Generally these damages are awarded in the form of interest unless loss of use can be proven. Ocala Foundry & Machine Works v. Lester, 49 Fla. 199, 38 So. 51 (1905).
If the defendant has possession of part of the property, see form 1.995(b).
(b) Judgment in Favor of Plaintiff when Defendant Has Possession.
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Plaintiff, .....(name and address)....., has the right against defendant,.....(name and address, and last 4 digits of social security number if known)....., to possession of the following described property:
(list the property and include a value for each item) for which the clerk of the court shall issue a writ of possession; or
2. Plaintiff shall recover from defendant [if applicable add "and surety on the forthcoming bond"] the sum of $.......... for the value of the property, which shall bear interest at the rate of..........% per year, for which let execution issue.
3. Plaintiff shall recover from defendant the sum of $.......... as damages for the detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ Judge*1061 NOTE: This form applies when the plaintiff prevails on the merits and the defendant retains possession of the property. Section 78.19, Florida Statutes (1995), allows the plaintiff to recover the property or its value or the value of the plaintiff's lien or special interest. The value for purposes of paragraph 2 is either the value of the property or the value of the plaintiff's lien or special interest.
Paragraph 3 of the form provides for damages for detention only against the defendant because the defendant's surety obligates itself only to ensure forthcoming of the property, not damages for its detention.
Pursuant to section 78.19(2), Florida Statutes, paragraphs 1 and 2 of the form provide the plaintiff the option of obtaining either a writ of possession or execution against the defendant and defendant's surety on a money judgment for property not recovered. Demetree v. Stramondo, 621 So. 2d 740 (Fla. 5th DCA 1993). If the plaintiff elects the writ of possession for the property and the sheriff is unable to find it or part of it, the plaintiff may immediately have execution against the defendant for the whole amount recovered or the amount less the value of the property found by the sheriff. If the plaintiff elects execution for the whole amount, the officer shall release all property taken under the writ.
If the plaintiff has possession of part of the property, see form 1.995(a).
(c) Judgment in Favor of Defendant when Defendant Has Possession under Forthcoming Bond.
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
1. Defendant, .....(name and address)....., has the right against plaintiff,.....(name and address, and last 4 digits of social security number if known)....., to possession of the following described property:
(list the property and include a value for each item)
2. Defendant retook possession of all or part of the property under a forthcoming bond, and defendant's attorney has reasonably expended ..... hours in representing defendant in this action and $.......... is a reasonable hourly rate for the services.
3. Defendant shall recover from plaintiff the sum of $.......... for the wrongful taking of the property, costs in the sum of $.........., and attorneys' fees in the sum of $.........., making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: This form applies when the defendant prevails and the property was retained by or redelivered to the defendant. Section 78.20, Florida Statutes (1995), provides for an award of attorneys' fees. The prevailing defendant may be awarded possession, damages, if any, for the taking of the property, costs, and attorneys' fees.
If the plaintiff has possession of part of the property, see form 1.995(d).
(d) Judgment in Favor of Defendant when Plaintiff Has Possession.
This matter was heard on plaintiff's complaint. On the evidence presented
IT IS ADJUDGED that:
*1062 1. Defendant, .....(name and address)....., has the right against plaintiff,.....(name and address, and last four digits of social security number if known)....., to recover possession of the following described property:
(list the property and include a value for each item) for which the clerk of the court shall issue a writ of possession; or
2. Defendant shall recover from plaintiff [if applicable add "and surety on plaintiff's bond"] the sum of $.......... for the value of the property, which shall bear interest at the rate of.....% per year, for which let execution issue.
3. Defendant shall recover from plaintiff the sum of $.......... as damages for detention of the property and the sum of $.......... as costs, making a total of $.........., which shall bear interest at the rate of .....% per year, for which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______ JudgeNOTE: This form should be used when the defendant prevails but the plaintiff has possession of the property. Section 78.21, Florida Statutes (1995), does not provide for an award of attorneys' fees when the defendant prevails and possession had been temporarily retaken by the plaintiff. Sections 78.21 and 78.19 allow the defendant to recover the property or its value or the value of the defendant's special interest.
Paragraphs 1 and 2 of the form provide to the defendant the option of obtaining either a writ of possession or execution against the plaintiff and plaintiff's surety on a money judgment for property not recovered and costs. Demetree v. Stramondo, 621 So. 2d 740 (Fla. 5th DCA 1993). If the defendant elects the writ of possession for the property and the sheriff is unable to find it or part of it, the defendant may immediately have execution against the plaintiff and surety for the whole amount recovered or the amount less the value of the property found by the sheriff. If the defendant elects execution for the whole amount, the officer shall release all property taken under the writ.
If the defendant has possession of part of the property, see form 1.995(c).
(a) Limitations for Court Filings. Unless authorized by subdivision (b), statute, another rule of court, or the court orders otherwise, designated sensitive information filed with the court must be limited to the following format:
(1) The initials of a person known to be a minor;
(2) The year of birth of a person's birth date;
(3) No portion of any
(A) social security number,
(B) bank account number,
(C) credit card account number,
(D) charge account number, or
(E) debit account number;
(4) The last four digits of any
(A) taxpayer identification number (TIN),
(B) employee identification number,
(C) driver's license number,
(D) passport number,
(E) telephone number,
*1063 (F) financial account number, except as set forth in subdivision (a)(3),
(G) brokerage account number,
(H) insurance policy account number,
(I) loan account number,
(J) customer account number, or
(K) patient or health care number;
(5) A truncated version of any
(A) email address,
(B) computer user name,
(C) password, or
(D) personal identification number (PIN); and
(6) A truncated version of any other sensitive information as provided by court order.
(b) Exceptions. Subdivision (a) does not apply to the following:
(1) An account number which identifies the property alleged to be the subject of a proceeding;
(2) The record of an administrative or agency proceeding;
(3) The record in appellate or review proceedings;
(4) The birth date of a minor whenever the birth date is necessary for the court to establish or maintain subject matter jurisdiction;
(5) The name of a minor in any order relating to parental responsibility, time-sharing, or child support;
(6) The name of a minor in any document or order affecting the minor's ownership of real property;
(7) The birth date of a party in a writ of attachment or notice to payor;
(8) Traffic and criminal proceedings;
(9) Information used by the clerk for case maintenance purposes or the courts for case management purposes; and
(10) Information which is relevant and material to an issue before the court.
(c) Remedies. Upon motion by a party or interested person or sua sponte by the court, the court may order remedies, sanctions or both for a violation of subdivision (a). Following notice and an opportunity to respond, the court may impose sanctions if such filing was not made in good faith.
(d) Motions Not Restricted. This rule does not restrict a party's right to move for protective order, to move to file documents under seal, or to request a determination of the confidentiality of records.
(e) Application. This rule does not affect the application of constitutional provisions, statutes, or rules of court regarding confidential information or access to public information.
(a)-(b) [No change]
(c) Caption, Commencement, Date, and Personal Statistics.
(1)-(3) [No change]
(4) Personal Statistics. Every indictment or information shall include the defendant's race, gender, and date of birth, and social security number when any of these facts are known. Failure to include these facts shall not invalidate an otherwise sufficient indictment or information.
(d)-(o) [No change]
(a)-(b) [No change]
(c) Written Findings of Experts. Any written report submitted by the experts shall:
(1) identify the specific matters referred for evaluation;
(2) describe the evaluative procedures, techniques, and tests used in the examination and the purpose or purposes for each;
(3) state the expert's clinical observations, findings, and opinions on each issue referred for evaluation by the court, and indicate specifically those issues, if any, on which the expert could not give an opinion; and
(4) identify the sources of information used by the expert and present the factual basis for the expert's clinical findings and opinions.
The procedure for determinations of the confidential status of f reports is governed by Rule of Judicial Administration 2.420.
(d) [No change]
(a)-(c) [No change]
(d) Release on Finding of Incompetence. If the court decides that a defendant is not mentally competent to proceed but does not meet the criteria for commitment, the defendant may be released on appropriate release conditions for a period not to exceed 1 year. The court may order that the defendant receive outpatient treatment at an appropriate local facility and that the defendant report for further evaluation at specified times during the release period as conditions of release. A report shall be filed with the court after each evaluation by the persons appointed by the court to make such evaluations, with copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.
(a) Commitment; 6-Month Report. The Department of Children and Family Services shall admit to an appropriate facility a defendant found not guilty by reason of insanity under rule 3.217 and found to meet the criteria for commitment for hospitalization and treatment and may retain and treat the defendant. No later than 6 months from the date of admission, the administrator of the facility shall file with the court a report, and provide copies to all parties, which shall address the issues of further commitment of the defendant. If at any time during the 6-month period, or during any period of extended hospitalization that may be ordered under this rule, the administrator of the facility shall determine that the defendant no longer meets the criteria for commitment, the administrator shall notify the court by such a report and provide copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.
(b)-(c) [No change]
(a) Release Plan. The committing court may order a conditional release of any defendant who has been committed according to a finding of incompetency to proceed or an adjudication of not guilty by reason of insanity based on an approved plan for providing appropriate outpatient care and treatment. When the administrator shall determine outpatient treatment of the defendant to be appropriate, the administrator may file with the court, and provide copies to all parties, a written plan for outpatient treatment, including recommendations from qualified professionals. The plan may be submitted by the defendant. The plan shall include:
(1) special provisions for residential care, adequate supervision of the defendant, or both;
(2) provisions for outpatient mental health services; and
(3) if appropriate, recommendations for auxiliary services such as vocational training, educational services, or special medical care.
In its order of conditional release, the court shall specify the conditions of release based on the release plan and shall direct the appropriate agencies or persons to submit periodic reports to the court regarding the defendant's compliance with the conditions of the release, and progress in treatment, and provide copies to all parties. The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420.
(b)-(c) [No change]
The petition for administration shall be verified by the petitioner and shall contain:
(a) [No change]
(b) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, date and place of death of the decedent, and state and county of the decedent's domicile;
(c)-(j) [No change]
Rule History
1977 Revision2010 Revision: [No change]
2011 Revision: Subdivision (b) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]
(a) Petition and Contents. A petition to admit a decedent's will to probate without administration shall be verified by the petitioner and shall contain:
(1) [No change]
(2) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, date and place of death of the decedent, and state and county of the decedent's domicile;
(3)-(8) [No change]
(b)-(d) [No change]
Rule History
1975 Revision2010 Revision: [No change]
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]
(a) Petition. The petition shall be verified as required by law and shall contain:
(1) [No change]
(2) the name, and last known address of the decedent, last 4 digits of the decedent's social security number, and date and place of death of the decedent, and the state and county of the decedent's domicile;
(3)-(12) [No change]
(b)-(d) [No change]
Rule History
1977 Revision2007 Revision: [No change]
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent's social security number to last four digits.
Statutory References
[No change]
Rule References
[No change]
(a)-(d) [No change]
(e) Unrepresented Parties. In an effort to further the proceedings and in the interest of securing substantial justice, the court shall assist any party not represented by an attorney on:
(1) courtroom decorum;and
(2) order of presentation of material evidence; and
(3) handling private information.
The court may not instruct any party not represented by an attorney on accepted rules of law. The court shall not act as an advocate for a party.
(f) [No change]
1984 Amendment1996 Amendment. [No change]
2011 Amendment. Subdivision (e)(3) was added so that a judge can assist an unrepresented party in the handling of private information that might otherwise inadvertently become public by placement in the court file.
(CAPTION)
It is adjudged that the plaintiff(s),...................., recover from the defendant(s), ...................., the sum of $.......... on principal, $.......... as prejudgment interest, $.......... for attorneys' fees, with costs of $.........., all of which shall bear interest at the rate of .....% per year as provided for by Florida Statute, for all of which let execution issue.
ORDERED at ...................., Florida, on .....(date)......
______
*1067 County Court Judge Copies furnished to: PLAINTIFF(S) DEFENDANT(S) Plaintiff(s)'s address: .................... .................... Defendant(s)'s last known address and last four digits of defendant(s)'s Social Security Number (if known): ..................... ..................... .....................(OPTIONAL ENFORCEMENT PARAGRAPHTO BE INCLUDED UPON REQUEST PURSUANT TO RULE 7.221)
It is further ordered and adjudged that the defendant(s) shall complete Florida Small Claims Rules Form 7.343 (Fact Information Sheet) and return it to the plaintiff's attorney, or to the plaintiff if the plaintiff is not represented by an attorney, within 45 days from the date of this final judgment, unless the final judgment is satisfied or a motion for new trial or notice of appeal is filed. The defendant should NOT file the completed form 7.343 with the court.
Jurisdiction of this case is retained to enter further orders that are proper to compel the defendant(s) to complete form 7.343 and return it to the plaintiff's attorney, or the plaintiff if the plaintiff is not represented by an attorney.
1992 Amendment. The optional enforcement paragraph was added to facilitate discovery.
*1068 FORM 7.343. FACT INFORMATION SHEET (a) For Individuals (CAPTION) FACT INFORMATION SHEET INDIVIDUAL Full Legal Name: _____________________________________________________________________ Nicknames or Aliases: ________________________________________________________________ Residence Address: ___________________________________________________________________ Mailing Address (if different): ______________________________________________________ Telephone Numbers: (Home) __________ (Business) ______________________________________ Name of Employer: ____________________________________________________________________ Address of Employer: _________________________________________________________________ Position or Job Description: _________________________________________________________ Rate of Pay: $ _____ per _______. Average Paycheck: $ __________ per _________________ Average Commissions or Bonuses: $ ______ per _______. Commissions or bonuses are based on _________________ Other Personal Income: $ __________ from _____________________________________________ (Explain details on the back of this sheet or an additional sheet if necessary.) Social Security Number: _________________ Birthdate: _________________________________ Driver's License Number: _____________________________________________________________ Marital Status: __________ Spouse's Name: ____________________________________________ Spouse's Address (if different): _____________________________________________________ Spouse's Social Security Number: ___________________ Birthdate: ______________________ Spouse's Employer: ___________________________________________________________________ Spouse's Average Paycheck or Income: $ _____________ per _____________________________ Other Family Income: $ ______ per _______ (Explain details on back of this sheet or an additional sheet if necessary.) Names and Ages of All Your Children (and addresses if not living with you): ___________ _______________________________________________________________________________________ Child Support or Alimony Paid: $ ________ per _________________________________________ Names of Others You Live With: ________________________________________________________ Who is Head of Your Household? _________ You ________ Spouse _______ Other Person Checking Account at: _________ Account # ______________________________________________ Savings Account at: __________ Account # ______________________________________________ (Describe all other accounts or investments you may have, including stocks, mutual funds, savings bonds, or annuities, on the back of this sheet or an additional sheet if necessary.) For Real Estate (land) You Own or Are Buying: Address: _________________________________________________________________________________ All Names on Title: ______________________________________________________________________ Mortgage Owed to: ________________________________________________________________________ Balance Owed: ____________________________________________________________________________ Monthly Payment: $ _______________________________________________________________________ *1069 (Attach a copy of the deed or mortgage, or list the legal description of the property on the back of this sheet or an additional sheet if necessary. Also provide the same information on any other property you own or are buying.) For All Motor Vehicles You Own or Are Buying: Year/Make/Model: ________________________________ Color: _________________________________ Vehicle ID #: __________ Tag No: ___________ Mileage: ____________________________________ Names on Title: __________________________ Present Value: $ ______________________________ Loan Owed to: ____________________________________________________________________________ Balance on Loan: $________________________________________________________________________ Monthly Payment: $____________________ (List all other automobiles, as well as other vehicles, such as boats, motorcycles, bicycles, or aircraft, on the back of this sheet or an additional sheet if necessary.) Have you given, sold, loaned, or transferred any real or personal property worth more than $100 to any person in the last year? If your answer is "yes," describe the property and sale price, and give the name and address of the person who received the property. Does anyone owe you money? Amount Owed: $_________________________________________________ Name and Address of Person Owing Money: __________________________________________________ Reason money is owed: ____________________________________________________________________ Please attach copies of the following: 1. Your last pay stub. 2. Your last 3 statements for each bank, savings, credit union, or other financial account. 3. Your motor vehicle registrations and titles. 4. Any deeds or titles to any real or personal property you own or are buying, or leases to property you are renting. UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. ______________ Judgment Debtor STATE OF FLORIDA COUNTY OF ................ The foregoing instrument was acknowledged before me on ..... (date)....., by ........., who is personally known to me or has produced ............. as identification and who .....did/did not..... take an oath. WITNESS my hand and official seal, on .....(date)...... _________ Notary Public State of Florida *1070 My Commission expires: ............ MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT. (b) For Corporate Entities (CAPTION) FACT INFORMATION SHEET BUSINESS ENTITY Name/Title of person filling out this form: ________________________________________ Address: ___________________________________________________________________________ Telephone Number: Home: _______________ Business: __________________________________ Address of Business Entity: ________________________________________________________ Type of Entity: (Check One) [] Corporation [] Partnership [] Limited Partnership [] Sole Proprietorship [] Limited Liability Corporation (LLC) [] Professional Association (PA) [] Other: (Please Explain) Does Business Entity own/have interest in any other business entity? If so please explain. Gross/Taxable income reported for Federal Income Tax purposes last three years: $__________________ $__________________ $____________________________________ Taxpayer Identification Number: _____________________________________________________ List Partners (General or Limited and Designate Percentage of Ownership): ___________ Average No. of Employees/Month: _____________________________________________________ Names of Officers and Directors: ____________________________________________________ Checking Account at: _________________ Account No: __________________________________ Savings Account At: ____________________________ Account No: ________________________ Does the Business Entity own any vehicles: __________________________________________ Years/Makes/Models: _________________________________________________________________ Vehicle I.D. Nos.: __________________________________________________________________ Tag Nos.: ___________________________________________________________________________ Loans Outstanding: __________________________________________________________________ Does the Business Entity own any real property: YES _____________ NO ________________ If Yes: Address: ____________________________________________________________________ Please check if the business entity owns the following: _______ Boat ______ Camper _______ Stocks/Bonds ______ Other Real Property _______ Other Personal Property ______ Intangible Property Please attach copies of the following: 1. All tax returns for the past 3 years, including but not limited to state and federal income tax returns and tangible personal property tax returns. *1071 2. All bank, savings and loan, and other account books or statements for accounts in institutions in which the defendant had any legal or equitable interest for the past 3 years. 3. All canceled checks for the 12 months immediately preceding the date of this judgment for accounts in which the defendant held any legal or equitable interest. 4. All deeds, leases, mortgages, or other written instruments evidencing any interest in or ownership of real property at any time within the 12 months immediately preceding the date of this judgment. 5. Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any personal or real property to or from the defendant within the 12 months immediately preceding the date of filing this lawsuit. Any transfer of property within the last year other than ordinary course of business transactions. 6. Motor vehicle documents, including titles and registrations relating to any motor vehicles owned by the defendant alone or with others. 7. Financial statements and any other business records, including but not limited to accounts payable and accounts receivable ledgers, as to the defendant's assets and liabilities prepared within the 12 months immediately preceding the date of this judgment. 8. Copies of articles, by-laws, partnership agreement, operating agreement, and any other governing documents, and minutes of all meetings of the defendant's shareholders, board of directors, or members held within 2 years of the date of this judgment. 9. Resolutions of the shareholders, board of directors, or members passed within 2 years of the date of this judgment. 10. A list or schedule of all inventory and equipment. UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING ANSWERS ARE TRUE AND COMPLETE. __________________________________ Defendant's Designated Representative Title:............. STATE OF FLORIDA COUNTY OF.................... The foregoing instrument was acknowledged before me on .....(date)..... by..........., as the defendant's duly authorized representative, who is personally known to me or has produced ................... as identification and who ....did/did not..... take an oath. *1072 WITNESS my hand and official seal, on .....(date)...... ________________ Notary Public State of Florida My Commission expires: .................... MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE JUDGMENT CREDITOR'S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT.(a) Application. Unless otherwise required by another rule of court or permitted by leave of court, all briefs, petitions, replies, appendices, motions, notices, stipulations, and responses and any attachment thereto filed with the court shall comply *1073 with the requirements of Florida Rule of Judicial Administration 2.425.
(b) Limitation. This rule does not require redaction of personal data from the record.
(c) Motions Not Restricted. This rule does not restrict a party's right to move to file documents under seal.
(a) Requirements for Use. The parties to the dissolution may file a petition for simplified dissolution if they certify under oath that
(1) there are no minor or dependent children of the parties and the wife is not now pregnant the parties do not have any minor or dependent children together, the wife does not have any minor or dependent children who were born during the marriage, and the wife is not now pregnant;
(2) the parties have made a satisfactory division of their property and have agreed as to payment of their joint obligations; and
(3) the other facts set forth in Florida Family Law Rules of Procedure Form 12.901(a) (Petition for Simplified Dissolution of Marriage) are true.
(b) [No change]
(c) Financial Affidavit and Settlement Agreement. The parties must each file a financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) or 12.902(c)), and a marital settlement agreement (Florida Family Law Rules of Procedure Form 12.902(f)(3)).
(dc) Final Judgment. Upon the entry of the judgment, the clerk shall furnish to each party a certified copy of the final judgment of dissolution, which shall be in substantially the form provided in Florida Family Law Rules of Procedure Form 12.990(a).
(ed) Forms. The clerk or family law intake personnel shall provide forms for the parties whose circumstances meet the requirements of this rule and shall assist in the preparation of the petition for dissolution and other papers to be filed in the action.
Attachment of documents supporting an action or defense shall be governed by Florida Rule of Civil Procedure 1.130.
(a) Documents Attached. If it is essential to state a cause of action, a copy of the bonds, notes, bills of exchange, contracts, accounts, or other documents or the relevant portions of the documents shall be incorporated in or attached to the pleadings.
(b) Part for All Purposes. Any exhibit attached to a pleading shall be considered part of the pleading. Statements in a pleading may be adopted by reference in a different part of the same pleading, in another pleading, or in any motion.
(c) Protection of Account and Personal Identifying Numbers. Any reference in any pleading or exhibit filed with the court to account numbers, social security numbers, employee identification numbers, driver's license numbers, passport numbers, or other personal identifying information shall be presented as provided in Florida Rule of Judicial Administration 2.425.
Florida Rule of Civil Procedure 1.280 shall govern general provisions concerning discovery in family law matters with the following exceptions:
(a) Redaction of Personal Information. All filings of discovery information shall comply with Florida Rule of Judicial Administration 2.425. The court shall have authority to impose sanctions for violation of this rule.
(ab) Supplementing of Responses. A party is under a duty to amend a prior response or disclosure if the party:
(1)-(2) [No change]
(bc) Time for Serving Supplemental Responses. Any supplemental response served pursuant to this rule shall be served as soon as possible after discovery of the incorrect information or change, but in no case shall the supplemental response be served later than 24 hours before any applicable hearing absent a showing of good cause.
(cd) Documents Considered Confidential. A determination as to the confidentiality of a court record shall be made in accordance with Florida Rule of Judicial Administration 2.420.
(de) Sealing of Records. Records found to be confidential under Florida Rule of Judicial Administration 2.420 shall be sealed on request of a party.
(1)-(2) [No change]
(3) Documents Not to be Filed with Court; Sanctions.
(A) Except for the financial affidavit and child support guidelines worksheet, no documents produced under this rule shall be filed in the court file without first obtaining a court order.
(B) References to account numbers and personal identifying information to be filed in the court file shall be governed by Florida Rule of Judicial Administration 2.425.
(C) Sanctions shall be governed by Florida Rule of Civil Procedure 1.280(f).
(b) [No change]
(c) Exemption from Requirement to File and Serve Financial Affidavit. The parties shall not be required to file and serve a financial affidavit under subdivisions (d) and (e) if they are seeking a simplified dissolution of marriage under rule 12.105, they have no minor children, have no support issues, and have filed a written settlement agreement disposing of all financial issues, or if the court lacks jurisdiction to determine any financial issues.
(ed) Disclosure Requirements for Temporary Financial Relief. In any proceeding for temporary financial relief heard within 45 days of the service of the initial pleading or within any extension of the time for complying with mandatory disclosure granted by the court or agreed to by the parties, the following documents shall be served on the other party:
(1)-(4) [No change]
(de) Parties' Disclosure Requirements for Initial or Supplemental Proceedings. A party shall serve the following documents in any proceeding for an initial or supplemental request for permanent financial relief, including, but not limited to, a request for child support, alimony, equitable distribution of assets or debts, or attorneys' fees, suit money, or costs:
*1075 (1)-(16) [No change]
(ef) Duty to Supplement Disclosure; Amended Financial Affidavit.
(1)-(2) [No change]
(fg) Sanctions. Any document to be produced under this rule that is served on the opposing party fewer than 24 hours before a nonfinal hearing or in violation of the court's pretrial order shall not be admissible in evidence at that hearing unless the court finds good cause for the delay. In addition, the court may impose other sanctions authorized by rule 12.380 as may be equitable under the circumstances. The court may also impose sanctions upon the offending lawyer in lieu of imposing sanctions on a party.
(gh) Extensions of Time for Complying with Mandatory Disclosure. By agreement of the parties, the time for complying with mandatory disclosure may be extended. Either party may also file, at least 5 days before the due date, a motion to enlarge the time for complying with mandatory disclosure. The court shall grant the request for good cause shown.
(hi) Objections to Mandatory Automatic Disclosure. Objections to the mandatory automatic disclosure required by this rule shall be served in writing at least 5 days prior to the due date for the disclosure or the objections shall be deemed waived. The filing of a timely objection, with a notice of hearing on the objection, automatically stays mandatory disclosure for those matters within the scope of the objection. For good cause shown, the court may extend the time for the filing of an objection or permit the filing of an otherwise untimely objection. The court shall impose sanctions for the filing of meritless or frivolous objections.
(ij) Certificate of Compliance. All parties subject to automatic mandatory disclosure shall file with the court a certificate of compliance, Florida Family Law Rules of Procedure Form 12.932, identifying with particularity the documents which have been delivered and certifying the date of service of the financial affidavit and documents by that party. The party shall swear or affirm under oath that the disclosure is complete, accurate, and in compliance with this rule, unless the party indicates otherwise, with specificity, in the certificate of compliance. Except for the financial affidavit and child support guidelines worksheet, no documents produced under this rule shall be filed in the court file without a court order.
(jk) Child Support Guidelines Worksheet. If the case involves child support, the parties shall file with the court at or prior to a hearing to establish or modify child support a Child Support Guidelines Worksheet in substantial conformity with Florida Family Law Rules of Procedure Form 12.902(e). This requirement cannot be waived by the parties.
(kl) Place of Production.
(1)-(2) [No change]
(lm) Failure of Defaulted Party to Comply. Nothing in this rule shall be deemed to preclude the entry of a final judgment when a party in default has failed to comply with this rule.
Any party in an enforcement or contempt proceeding may serve upon any other *1076 party a written request to file and serve a financial affidavit if the other party's financial circumstances are relevant in the proceeding. The party to whom the request is made shall file andserve the requested financial affidavit and file a notice of compliance within 10 days after the service of the written request. The court may allow a shorter or longer time. The financial affidavit shall be in substantial conformity with Florida Family Law Rules of Procedure Form 12.902(b) (Short Form), all sections of which shall be completed.
Interrogatories to parties shall be governed generally by Florida Rule of Civil Procedure 1.340, with the following exceptions.
(a)-(b) [No change]
(c) Serving of Responses. Parties shall serve responses to interrogatories on the requesting party. Responses shall not be filed with the court unless they are admitted into evidence by the court and are in compliance with Florida Rule of Judicial Administration 2.425. The responding party shall file with the court Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of Answers to Standard Family Law Interrogatories.
(a) [No change]
(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 file as provided in subdivision (e).
(2) [No change]
(c)-(d) [No change]
(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. Any report filed in the court file shall be in compliance with Florida Rule of Judicial Administration 2.425. The report shall not be considered by the court before it is properly admitted into evidence. The report shall not be filed in the court file unless or until it is properly admitted into evidence and considered by the court. The court shall consider whether the report *1077 should be sealed as provided by Florida Rule of Judicial Administration 2.420.
Requests for admission shall be governed by Florida Rule of Civil Procedure 1.370, except that
(a) the request and any response to it must comply with Florida Rule of Judicial Administration 2.425; and
(b) documents attached to the request for admission shall not be filed with the court and shall only be attached to the copy served on the party to whom the request for admissions is directed.
Subpoenas shall be governed by Florida Rule of Civil Procedure 1.410, except as follows:
(a) Subpoenas. No subpoena issued under Florida Rule of Civil Procedure 1.410, even if for the purpose of proof of service or nonservice of the subpoena, shall be filed with the court unless in compliance with Florida Rule of Judicial Administration 2.425.
(b) Notice of Issuance of Subpoena. A party issuing a subpoena through an attorney of record or clerk of the court under Florida Rule of Civil Procedure 1.410 shall, on the same day as the subpoena is issued, serve each party to the proceeding with a notice of issuance of subpoena and file this notice with the court. The notice of issuance of subpoena shall identify the person or entity subject to the subpoena, the date the subpoena was issued, and the date and time for appearance or production, and shall recite that all references to account numbers or personal identifying numbers are in compliance with Florida Rule of Judicial Administration 2.425.
(c) Notice to Produce. Any notice to produce issued under Florida Rule of Civil Procedure 1.410 shall comply with Florida Rule of Judicial Administration 2.425.
2008 Amendment. The provisions of Fla. R. Civ. P. Fla. R. Civ. P. 1.410(h) do not alter the requirements of Rulerule 12.407 that a court order must be obtained before a minor child may be subpoenaed to appear at a hearing.
Florida Rule of Civil Procedure 1.440 shall govern general provisions concerning setting an action for trial in family law matters, with the following exceptions and additions.
(a) Setting for Trial. If the court finds the action ready to be set for trial, it shall enter an order setting the action for trial, fixing a date for trial, and setting a pretrial conference, if necessary. In the event a default has been entered, reasonable notice of not less than 10 days shall be given unless otherwise required by law. Trial shall be set within a reasonable time from the service of the notice for trial. At the pretrial conference, the parties should be prepared, consistent with Florida Family Law Rule of Procedure 12.200, to present any matter that will prepare the parties for trial and that can expedite the resolution of the case. The trial court may also direct the parties to reciprocally exchange and file with the court all documents relative to the outcome of the case; a list of all witnesses, all issues to be tried, and all undisposed motions; an estimate of the time needed to try the case; and any other information the court deems appropriate. Any court filings shall be in conformity *1078 with Florida Rule of Judicial Administration 2.425. This information should be served and filed no later than 72 hours before the pretrial conference or 30 days before the trial.
(b) [No change]
Florida Rule of Civil Procedure 1.540 shall govern general provision concerning relief from judgment, decrees, or orders, except:
(a) that there shall be no time limit for motions based on fraudulent financial affidavits in marital or paternity cases; and
(b) the motion and any attachment or exhibit to it shall be in compliance with Florida Rule of Judicial Administration 2.425.
(a)-(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.
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).
Receivers shall be governed by Florida Rule of Civil Procedure 1.620, except that any inventory filed with the court shall be in compliance with Florida Rule of Judicial Administration 2.425.
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 *1079 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 and your spouse have filed financial affidavits with the court or you have waived the filing of financial affidavits and you are satisfied with the financial disclosure received from the other spouse.
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.
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.
If you did not waive the filing of a financial affidavit in the petition, each of you must file a Financial Affidavit. Florida Family Law Rules of Procedure Form 12.902(b) or (c). 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
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 *1080 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.
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.
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.
*1081 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. Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (10/11) *1082 7. [check one only] ( )We have each completed and signed financial affidavits, Florida Family Law Rules of Procedure Forms 12.902(b) or (c), which are attached to this petition. ( ) Each of us is satisfied with the financial disclosure we received from the other spouse and we waive the filing of financial affidavits. 8. [ Check one only ] ( ) yes ( ) no Wife wants to be known by her former name, which was {full legal name} _________________________________________. 9. 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. 10. We each understand that we both must come to the hearing to testify about the things we are asking for in this petition. 11. 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. 12. 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: ________________________ *1083 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 ________________________________ 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: ___________________ 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 _________________________________ *1084 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________, a nonlawyer, located at {street} _______________, {city} _________, {state} ________, {phone} _________, helped {name} __________, [Choose only one] ( ) Husband ( ) Wife or ( ) both, fill out this form.This form should be used when a husband or wife is filing for a dissolution of marriage and you and your spouse have a dependent or minor child(ren) together or the wife is pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You must file this form if the following is true:
You and your spouse have a dependent or minor child(ren) together or the wife is pregnant.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public 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.
For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT. If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED. If your spouse files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED. If your spouse files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle *1086 the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If your spouse files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
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).
With this form, you must also file the following:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that child support be ordered in the final judgment. (If you do not know your spouse's income, you may file this worksheet after his or her financial affidavit has been served on you.)
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you and your spouse have reached an agreement on any or all of the issues.
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed with the petition if the petitioner seeks to establish child support. Otherwise, it must be filed within 45 days of service of the petition on the respondent.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of *1087 service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety Focused Parenting Plan, Form 12.995(b), or Relocation/Long-Distance Parenting Plan 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Parenting Plan and Time-Sharing. If you and your spouse are unable to agree on parenting arrangements and a timesharing schedule, a judge will decide for you as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes.
A parenting course must be completed prior to entry of the final judgment. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you live.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
Shared Parental Responsibility
Sole Parental Responsibility
Supervised Time-Sharing
No contact
Parenting Plan
Parenting Plan Recommendation
Time-Sharing Schedule
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Alimony. Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, *1088 you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities. Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including child support, time-sharing, and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief. If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and timesharing with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Marital Settlement Agreement. If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both of you must sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If you and your spouse have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b), or Relocation/Long-Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c), which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. If the parties are unable to agree, a Parenting Plan will be established by the court.
Final Judgment Form. These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a *1089 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.
IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT, IN AND FOR____________ COUNTY, FLORIDA Case No: ____________ Division: ___________ ________________________, Petitioner, and _________________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name} __________________________________________, the [Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [Choose only one] ( )is( ) is not a member of the military service. The wife [Choose only one] ( )is( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ____________________________________ Date of separation: {month, day, year}____________ (Please indicate if approximate) 4. DEPENDENT OR MINOR CHILD(REN) [Choose all that apply] a. ___ The wife is pregnant. Baby is due on: {date} ____________ b. ___ The minor (under 18) child(ren) common to both parties are: Name Birth date ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with Dependent or Minor Child(ren) (10/11) *1090 c. ___The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Birth date _______________________________________________________________________________ _______________________________________________________________________________ The birth father(s) of the above minor child(ren) is (are) {name and address} _____ ______________________________________________________________________________________ d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical disability are: Name Birth date _________________________________________________________________________ _________________________________________________________________________ 5. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c) ( ) is filed or ( ) will be timely filed. 6. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. (You must complete and attach this form in a dissolution of marriage with minor child(ren)). 7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition. 8. This petition for dissolution of marriage should be granted because: [Choose only one] a. ___ The marriage is irretrievably broken. b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to the filing of this petition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES 1. ___ There are no marital assets or liabilities. 2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 2.902(b) or (c), to be filed in this case. [Choose all that apply] a. ___ All marital assets and liabilities have been divided by a written agreement between the parties, which is attached, to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). b. ___ The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. c. ___ Petitioner should be awarded an interest in Respondent's property because: *1091 ____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [Choose only one] 1. ___ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. 2. ___ Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Respondent has the ability to pay that support. Spousal support (alimony) is requested in the amount of $ ___ every ( )week( ) other week ( ) month, beginning {date} ____ and continuing until {date or event}________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): __________ _____________________________________________________________________________________ _____________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ [Choose if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain} _________________________________________________________________________________________ 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [Choose only one] a. ___ shared by both Father and Mother. b. ___ awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: ________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be ordered to comply with a Parenting Plan that ( ) includes ( ) does not include parental time-sharing with the child(ren). The Petitioner states that it is in the best interests of the child (ren) that: [Choose only one] a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties ( )have( ) have not agreed to the Parenting Plan. b. ___ The court should establish a Parenting Plan with the following provisions: ___ No time-sharing for the ___ Father ___ Mother. *1092 ___ Limited time-sharing with the ___ Father ___ Mother. ___ Supervised Time-Sharing for the ___ Father___ Mother. ___ Supervised or third-party exchange of the child(ren). ___ Time-Sharing Schedule as follows: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 4. Explain why this request is in the best interests of the child(ren): ______________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ SECTION IV. CHILD SUPPORT [Choose all that apply] 1. ___ Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should be ordered retroactive to: a. ___ the date of separation {date} ______________. b. ___ the date of the filing of this petition. c. ___ other {date} ____________ {explain} ____________________________________ 2. ___ Petitioner requests that the Court award child support to be paid beyond the age of 18 years because: a. ___ the following child(ren) {name(s)} ____________________________________ is (are) dependent because of a mental or physical incapacity which began before the age of 18. {explain}________________________________________________________________________ __________________________________________________________________________________________ b. ___ the following child(ren) {name(s)} ______________________ is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. 3. ___ Petitioner requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Petitioner understands that Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be filed before the court will consider this request. 4. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by: [Choose only one] a. ___ Father. b. ___ Mother. 5. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: [Choose only one] a. ___ by Father. b. ___ by Mother. *1093 c. ___by Father and Mother [each pay one-half]. d. ___according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). e. ___Other {explain}: ___________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. Petitioner requests that life insurance to secure child support be provided by: a. ___Father. b. ___Mother. c. ___Both. SECTION V. OTHER 1. [If Petitioner is also the Wife, please indicate by either ( ) yes ( ) or no whether Petitioner/Wife wants to be known by her former name, which was {full legal name} ________________________________________________________________________________ 2. Other relief {specify}: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ SECTION VI. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [Choose all that apply] 1. ___distributing marital assets and liabilities as requested in Section I of this petition; 2. ___awarding spousal support (alimony) as requested in Section II of this petition; 3. ___adopt or establish a Parenting Plan containing provisions for parental responsibility and timesharing for the dependent or minor child(ren) common to both parties, as requested in Section III of this petition; 4. ___establishing child support for the dependent or minor child(ren) common to both parties, as requested in Section IV of this petition; 5. ___restoring Wife's former name as requested in Section V of this petition; 6. ___awarding other relief as requested in Section V of this petition; and any other terms the Court deems necessary. *1094 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ________________ _______________________ Signature of PETITIONER Printed Name: ___________ Address: _________________ City, State, Zip: ________ Telephone Number: ________ Fax Number: _______________ STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on _______ by ___________________ ____________________________ NOTARY PUBLIC or DEPUTY CLERK __________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ____ Personally known ____ Produced identification ____ Type of identification produced __________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________, a nonlawyer, whose address is {street} __________________________, {city} _____________, {state} ____________, {phone} ________, helped {name} ________________, who is the petitioner, fill out this form.This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have marital assets and/or marital liabilities but they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a simplified dissolution of marriage petition, Florida Family Law Rules of Procedure Form 12.901(a). However, you cannot file for a simplified dissolution of marriage if any of the following are true:
You disagree about property, debts, or other matters and wish to have a judge settle them for you.
Either you or your spouse is seeking support (alimony).
You would like to ask questions and get documents concerning your spouse's income, expenses, assets, debts, or other matters before having a trial or settlement.
You would like to reserve your rights to have any matters reconsidered or appeal the judge's decision.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public 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.
For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved *1096 Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
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 a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you and your spouse have reached an agreement on any or all of the issues.
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
*1097 Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition or counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. "Equitable" does not necessarily mean "equal." Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Property But No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). Both husband and wife must sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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 *1098 the last page of every form he or she helps you complete.
IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR __________________ COUNTY, FLORIDA Case No: _________________ Division: _________________ ____________________, Petitioner, and _____________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ________________________________, the [Choose one only] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [Choose one only] ( ) is ( ) is not a member of the military service. The wife [Choose one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year}________________________________ Date of separation: {month, day, year} ________________[Please indicate if approximate] 4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition. 6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: [Choose one only] a. ____ The marriage is irretrievably broken. b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years before the filing of this petition. A copy of the Judgment of Incapacity is attached. Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of Marriage with Property but No Dependent or Minor Child(ren)(10/11) *1099 SECTION I. MARITAL ASSETS AND LIABILITIES [Choose one only] 1. ____ There are no marital assets or liabilities. 2. ____ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c), to be filed in this case. [Choose all that apply] a. ____ All marital assets and debts have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Simplified Dissolution of Marriage, Florida Family Law Rules of Procedure Form 12.902(f)(3) or Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). b. ____ The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. c. ____ Petitioner should be awarded an interest in Respondent's property because: SECTION II. SPOUSAL SUPPORT (ALIMONY) [Choose one only] 1. ____ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. 2. ____ Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Respondent has the ability to pay that support. Spousal support (alimony) is requested in the amount of $ ___ every ( ) week ( ) other week ( ) month, beginning {date} _______ and continuing until {date or event} ____________________________________________________. Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ [Indicate if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION III. OTHER 1. [If Petitioner is also the Wife, choose one only] ( ) yes ( ) no Petitioner/Wife wants to be known by her former name, which was {full legal name} ________________________________________________________________________________. *1100 2. Other relief {specify}: ______________________________________________. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [Choose all that apply] 1. ____ distributing marital assets and liabilities as requested in Section I of this petition; 2. ____ awarding spousal support (alimony) as requested in Section II of this petition; 3. ____ restoring Wife's former name as requested in Section III of this petition; 4. ____ awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _________________ __________________________ Signature of PETITIONER Printed Name: _____________ Address: __________________ City, State, Zip: _________ Telephone Number: _________ Fax Number: _______________ *1101 STATE OF FLORIDA COUNTY OF __________________ Sworn to or affirmed and signed before me on _____ by____________________________________________. ____________________________________________________ NOTARY PUBLIC or DEPUTY CLERK ____________________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced_________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _______________________________________________________, a nonlawyer, whose address is {street} _________________________________________________________________, {city} _____________________________________________,{state} ______,{phone} ____________________________, helped {name} ____________________________________________, who is the petitioner, fill out this form.This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband and wife have no marital assets and/or marital liabilities and they do not have any dependent children nor is the wife is now pregnant. You and/or your spouse must have lived in Florida for at least 6 months before filing for a dissolution in Florida. If you and your spouse agree on all issues and both can attend the hearing, you may want to file a petition for simplified dissolution of marriage, Florida Family Law Rules of Procedure Form 12.901(a). However, you may file this form if all of the following are true:
You have no marital assets or marital debts.
Neither you nor your spouse is seeking support (alimony).
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public 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.
For your case to proceed, you must properly notify your spouse of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if your spouse resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family *1103 law intake staff, or judicial assistant to set a final hearing. You must notify your spouse of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
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 a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).
With this form, you must also file the following:
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and your spouse have agreed not to exchange these documents.)
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with No Property or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or *1104 judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1105 IN THE CIRCUIT COURT OF THE_______________ JUDICIAL CIRCUIT, IN AND FOR _________________________ COUNTY, FLORIDA Case No: _________________ Division: ________________ _______________________________, Petitioner, and _______________________________, Respondent. PETITION FOR DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY I, {full legal name} ____________________________________, the [Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. The husband [Choose only one] ( ) is ( ) is not a member of the military service. The wife [Choose only one] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ____________________________________________ 4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition. 6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: [Choose only one] a. ____ The marriage is irretrievably broken. b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years before the filing of this petition. A copy of the Judgment of Incapacity is attached. 7. THERE ARE NO MARITAL ASSETS OR LIABILITIES. 8. PETITIONER FOREVER GIVES UP HIS/HER RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM RESPONDENT. *1106 9. [If Petitioner is also the Wife, Choose only one] ( ) yes ( ) no Petitioner/Wife wants to be known by her former name, which was {full legal name}___________________________________________________. 10. Other relief {specify}: __________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Petitioner requests that the Court enter an order dissolving the marriage and: [Choose all that apply] 1. ____ restoring Wife's former name as specified in paragraph 9 of this petition; 2. ____ awarding other relief as specified in paragraph 10 of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated:_____________ _________________________________ Signature of PETITIONER Printed Name: ___________________ Address: ________________________ City, State, Zip: _______________ Telephone Number: _______________ Fax Number: _____________________ *1107 STATE OF FLORIDA COUNTY OF ________________ Sworn to or affirmed and signed before me on __________ by____________________________________. __________________________________________________ NOTARY PUBLIC or DEPUTY CLERK __________________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced _____________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} __________________________________________, a nonlawyer, whose address is {street} _____________________, {city} ______________________, {state} _____________, {phone} ___________, helped {name} ______________________, who is the petitioner, fill out this form.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.
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition.
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 rule 12.285, Florida Family Law Rules of Procedure.
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.
HourlyIf you are paid by the hour, you may convert your income to monthly as follows:
Hourly amount × Hours worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
DailyIf you are paid by the day, you may convert your income to monthly as follows:
Daily amount × Days worked per week = Weekly amount
Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
WeeklyIf you are paid by the week, you may convert your income to monthly as follows:
*1109 Weekly amount × 52 Weeks per year = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Bi-weeklyIf you are paid every two weeks, you may convert your income to monthly as follows:
Bi-weekly amount × 26 = Yearly amount
Yearly amount ÷ 12 Months per year = Monthly Amount
Semi-monthlyIf you are paid twice per month, you may convert your income to monthly as follows:
Semi-monthly amount × 2 = Monthly Amount
Expenses may be converted in the same manner.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1110 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) a. From this case: $ _______ b. From other case(s): $____ 10. ____ Monthly interest and dividends *1111 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) a. from this case: $ _____ b. 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 A. HOUSEHOLD: C. CHILD(REN)'S EXPENSES Mortgage or rent $____ Day care $____ Property taxes $____ Lunch money $____ Utilities $____ Clothing $____ Telephone $____ Grooming $____ Food $____ Gifts for holidays $____ Meals outside home $____ Medical/Dental (uninsured) $____ Maintenance/Repairs $____ Other: $____ Other:___________ $____ B. AUTOMOBILE D. INSURANCE Medical/Dental $____ Gasoline $____ Child(ren)'s medical/dental $____ Repairs $____ Life $____ Insurance $____ Other: _________________ $____ *1112 E. OTHER EXPENSES NOT LISTED ABOVE F. PAYMENTS TO CREDITORS Clothing $_____ CREDITOR: MONTHLY Medical/Dental (uninsured) $____ PAYMENT Grooming $____ Entertainment $____ ___________________ $______ Gifts $____ ___________________ $______ Religious organizations $____ ___________________ $______ Miscellaneous $____ ___________________ $______ Other:________________ $____ ___________________ $______ ______________________ $____ ___________________ $______ ______________________ $____ ___________________ $______ ______________________ $____ ___________________ $______ ______________________ $____ ___________________ $______ ______________________ $____ ___________________ $______ 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.)
*1113
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). | Current | (Check correct |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box 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) | $ | | |
-----------------------------------------------------------------------------------------------------------
B. LIABILITIES:
-----------------------------------------------------------------------------------------------------------
|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). | Current | (Check correct |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box next to any | Amount | column) |
|bebt(s) which you believe you should be responsible. | Owed |-----------------|
| | | husband | wife |
|-----------------------------------------------------------------------------|----------|---------|-------|
| | Mortgages on real estate: First mortgage on home | $ | | |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
| | Second mortgage on home | | | |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
| | Other mortgages | | | |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
| | Auto loans | | | |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
| | Charge/credit card accounts | | | |
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
|-----|-----------------------------------------------------------------------|----------|---------|-------|
| | Other | | | |
-----------------------------------------------------------------------------------------------------------
*1114
-----------------------------------------------------------------------------------------------------------
|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). | Current | (Check correct |
|LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check the box next to any | Amount | column) |
|debt(s) for which you believe you should be responsible. | Owed |------------------|
| | | husband | wife |
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
|-----|-----------------------------------------------------------------------|----------|----------|-------|
| | 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 box 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 box next to any contingent debt(s) for which you believe you | Amount | column) | |should be responsible. | Owed |-----------------| | | | husband | wife | | | | | | |-----|----------------------------------------------------------------------|-----------|----------|------| | | $ | | | |-----|----------------------------------------------------------------------|-----------|----------|------| |Total Contingent Liabilities | $ | | | |----------------------------------------------------------------------------|------------------------------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. *1115 I certify that a copy of this document was [choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _____________________________________. Other party or his/her attorney: Name: ____________________________________ Address: _________________________________ City, State, Zip: ________________________ Fax Number: ______________________________ Date: ____________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________ ________________________________________ Signature of Party Printed Name: __________________________ Address: _______________________________ City, State, Zip: ______________________ Telephone Number: ______________________ Fax Number: ____________________________ STATE OF FLORIDA COUNTY OF _________________________ Sworn to or affirmed and signed before me on ___________ by __________________________________. ___________________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification Type of identification produced _________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________________________, a nonlawyer, located at {street} ___________________________, {city} _______________________, {state} ___________________________, {phone} _________, helped {name} ______________________, who is the [choose only one] ___ petitioner or ___ respondent, fill out this form. *1116 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (10/11) 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 mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. This must be accomplished within 45 days of service of the petition. Where can I look for more information? Before proceeding, you should read "General Information for 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 rule 12.285, Florida Family Law Rules of Procedure. 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. Hourly If you are paid by the hour, you may convert your income to monthly as follows: Hourly amount × Hours worked per week = Weekly amount Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Daily If you are paid by the day, you may convert your income to monthly as follows: Daily amount × Days worked per week = Weekly amount *1117 Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Weekly If you are paid by the week, you may convert your income to monthly as follows: Weekly amount × 52 Weeks per year = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Bi-weekly If you are paid every two weeks, you may convert your income to monthly as follows: Bi-weekly amount × 26 = Yearly amount Yearly amount ÷ 12 Months per year = Monthly Amount Semi-monthly If you are paid twice per month, you may convert your income to monthly as follows: Semi-monthly amount × 2 = Monthly Amount Expenses may be converted in the same manner. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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. *1118 IN THE CIRCUIT COURT OF THE _____________ JUDICIAL CIRCUIT, IN AND FOR ______________ COUNTY, FLORIDA Case No.: __________________________ Division: __________________________ _____________________________, Petitioner, and _____________________________, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT ($50,000 or more Individual Gross Annual Income) I, {full legal name} ____________________________________________________, being sworn, certify that the following information is true: ----------------------------------------------------------------------------------------- |SECTION I. INCOME | ----------------------------------------------------------------------------------------- 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. *1119 c. ___ Retired. Date of retirement: _______________________________________________________ Employer from whom retired: ____________________________________________________________ Address: _______________________________________________________________________________ City, State, Zip code: __________________________ Telephone Number: ______________ LAST YEAR'S GROSS INCOME: Your Income Other Party's Income (if known) YEAR_____ $______ $ ______ PRESENT MONTHLY GROSS INCOME: All amounts must be MONTHLY. See the instructions with this form to figure out money amounts for anything that is NOT paid monthly. Attach more paper, if needed. Items included under "other" should be listed separately with separate dollar amounts. 1. _____ Monthly gross salary or wages 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 a a. From this case: $_________ b. 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 1-16). 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. $____ Monthly federal, state, and local income tax (corrected for filing status and allowable dependents and income tax liabilities a. Filing Status___________ b. Number of dependents claimed_______ 19. _____ Monthly FICA or self-employment taxes *1120 20. _____ Monthly Medicare payments 21. _____ Monthly mandatory union dues 22. _____ Monthly mandatory retirement payments 23. _____ Monthly health insurance payments (including dental insurance), excluding portion paid for any minor children of this relationship 24. _____ Monthly court-ordered child support actually paid for children from another relationship 25. _____ Monthly court-ordered alimony actually paid (Add 25a and 2 a. From this case:$________ b. 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). *1121 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) *1122 MONTHLY INSURANCE: 64. $_____ Health insurance, excluding portion paid for any minor child(ren) of this relationship 65. ______ Life insurance 66. ______ Dental insurance Other: 67. ___________________________________________________________________________________________ 68. ___________________________________________________________________________________________ 69. $_______ SUBTOTAL (add lines 64 through 68) 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 Other: (include any usual and customary expenses not otherwise mentioned in the items listed above) 86. ___________________________________________________________________________________________ 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. ____________________________________________________________________________________ *1123 102. _____________________________________________________________________________________ 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 box in Column A next to any item that you are requesting the judge award to you. STEP 3: In column B, write what you believe to be the current fair market value of all items listed. STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item is "nonmarital," meaning it belongs to only one of you and should not be divided. You should indicate to whom you believe the item belongs. (Typically, you will only use Column C if property was owned by one spouse before the marriage. See the "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 | B | C | | ASSETS: DESCRIPTION OF ITEM(S) | Current | Nonmarital | | | Fair | Check correct | |LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. | Market | column) | |Check the box 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) | | | | |------|---------------------------------------------------------------------|---------|---------|-------| | | | | | | --------------------------------------------------------------------------------------------------------
*1124
--------------------------------------------------------------------------------------------------------
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Money owed to you (not evidenced by a note) | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Real estate: (Home) | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
| | (Other) | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Business Interests | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Automobiles | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Boats | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Other vehicles | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Retirement plans (Profit Sharing. Pension, IRA, 401(k)s, etc.) | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Furniture & furnishings in home | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Furniture & furnishings elsewhere | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Collectibles | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Jewelry | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
--------------------------------------------------------------------------------------------------------
*1125
--------------------------------------------------------------------------------------------------------
| | Life Insurance (cash surrender value) | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Sporting and entertainment (T.V., stereo, etc.) equipment | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
| | Other assets | | | |
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|------|---------------------------------------------------------------------|---------|---------|-------|
|Total Assets (add column B) |$ | | |
--------------------------------------------------------------------------------------------------------
B. LIABILITIES/DEBTS (This is where you list what you OWE.)
INSTRUCTIONS:
STEP 1: In column A, list a description of each separate debt owed by you (and/or your spouse, if
this is a petition for dissolution of marriage). Blank spaces are provided if you need to list more than
one of an item.
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any debt(s)
for which you believe you should be responsible.
STEP 3: In column B, write what you believe to be the current amount owed for all items listed.
STEP 4: Use column C only if this is a petition for dissolution of marriage and you believe an item
is "nonmarital," meaning the debt belongs to only one of you and should not be divided. You
should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the
debt was owed by one spouse before the marriage. See the "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.)
*1126
----------------------------------------------------------------------------------------------------
| A | B | C |
| LIABILITIES DESCRIPTION OF ITEM(S) | Current | Nonmarital |
| | Amount | (Check correct |
|LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. | Owed | coloumn) |
|Check the box next to any 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 | | | |
|-----|-----------------------------------------------------------------|----------|----------|------|
|-----|-----------------------------------------------------------------|----------|----------|------|
| | 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) | $ | | |
----------------------------------------------------------------------------------------------------
*1127
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 box 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 box next to any contingent debt(s) for which you believe you | Owed |-----------------| |should be responsible. | | husband | wife | |----------------------------------------------------------------------------|------------|----------|------| | | | $ | | | |------|---------------------------------------------------------------------|------------|----------|------| |------|---------------------------------------------------------------------|------------|----------|------| |------|---------------------------------------------------------------------|------------|----------|------| |------|---------------------------------------------------------------------|------------|----------|------| |------|---------------------------------------------------------------------|------------|----------|------| |------|---------------------------------------------------------------------|------------|----------|------| | Total Contingent Liabilities | $ | | | -----------------------------------------------------------------------------------------------------------*1128 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] ______ 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: ( ) mailed, ( ) faxed and mailed, or ( ) hand delivered to the person(s) listed below on {date} _______________________. Other party or his/her attorney: Name: _______________________________ Address: ____________________________ City, State, Zip: ___________________ Fax Number: _________________________ Date: _______________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _________________________ ______________________________________________ Signature of Party Printed Name: ________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Telephone Number: ____________________________ Fax Number: __________________________________ STATE OF FLORIDA COUNTY OF __________________________________________________ Sworn to or affirmed and signed before me on ____________ by _________________________________. ___________________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification Type of identification produced________________________ *1129 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} __________________________________________, a nonlawyer, located at {street} _____________________________, {city} ____________________, {state} ________________, {phone} _____________________, helped {name}_____________________, who is the [check only one] ___ petitioner or ___ respondent, fill out this form. *1130 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(e), CHILD SUPPORT GUIDELINES WORKSHEET (10/11) When should this form be used? You should complete this worksheet if child support is being requested in your case. If you know the income of the other party, this worksheet should accompany your financial affidavit. If you do not know the other party's income, this form must be completed after the other party files his or her financial affidavit, and serves a copy on you. This form should be typed or printed in black ink. You should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. What should I do next? A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. Where can I look for more information? Before proceeding, you should read "General Information for 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 section 61.30, Florida Statutes. 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 a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h). The chart below contains the guideline amounts that you should use when calculating child support. This amount is based on the number of children and the combined income of the parents, and it is divided between the parents in direct proportion to their income or earning capacity. From time to time, some of the amounts in the child support guidelines chart will change. Be sure you have the most recent version of the chart before using it. Because the guidelines are based on monthly amounts, it may be necessary to convert some income and expense figures from other frequencies to monthly. You should do this as follows: If payment is twice per month Payment amount × 2 = Monthly amount If payment is every two weeks Payment amount × 26 = Yearly amount due Yearly amount ÷ 12 = Monthly amount *1131 If payment is weekly Weekly amount × 52 = Yearly amount due Yearly amount ÷ 12 = Monthly amount If you or the other parent request that the court award an amount that is different than the guideline amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1132
CHILD SUPPORT GUIDELINES CHART
Combined One Two Three Four Five Six
Monthly Child Children Children Children Children Children
Available
Income
800.00 190 211 213 216 218 220
850.00 202 257 259 262 265 268
900.00 213 302 305 309 312 315
950.00 224 347 351 355 359 363
1000.00 235 365 397 402 406 410
1050.00 246 382 443 448 453 458
1100.00 258 400 489 495 500 505
1150.00 269 417 522 541 547 553
1200.00 280 435 544 588 594 600
1250.00 290 451 565 634 641 648
1300.00 300 467 584 659 688 695
1350.00 310 482 603 681 735 743
1400.00 320 498 623 702 765 790
1450.00 330 513 642 724 789 838
1500.00 340 529 662 746 813 869
1550.00 350 544 681 768 836 895
1600.00 360 560 701 790 860 920
1650.00 370 575 720 812 884 945
1700.00 380 591 740 833 907 971
1750.00 390 606 759 855 931 996
1800.00 400 622 779 877 955 1022
1850.00 410 638 798 900 979 1048
1900.00 421 654 818 923 1004 1074
1950.00 431 670 839 946 1029 1101
2000.00 442 686 859 968 1054 1128
2050.00 452 702 879 991 1079 1154
2100.00 463 718 899 1014 1104 1181
2150.00 473 734 919 1037 1129 1207
2200.00 484 751 940 1060 1154 1234
2250.00 494 767 960 1082 1179 1261
2300.00 505 783 980 1105 1204 1287
2350.00 515 799 1000 1128 1229 1314
2400.00 526 815 1020 1151 1254 1340
2450.00 536 831 1041 1174 1279 1367
2500.00 547 847 1061 1196 1304 1394
*1133
2550.00 557 864 1081 1219 1329 1420
2850.00 616 956 1197 1349 1471 1573
2900.00 626 971 1215 1370 1494 1598
2950.00 635 986 1234 1391 1517 1622
3000.00 644 1001 1252 1412 1540 1647
3050.00 654 1016 1271 1433 1563 1671
3100.00 663 1031 1289 1453 1586 1695
3150.00 673 1045 1308 1474 1608 1720
3200.00 682 1060 1327 1495 1631 1744
3250.00 691 1075 1345 1516 1654 1769
3300.00 701 1090 1364 1537 1677 1793
3350.00 710 1105 1382 1558 1700 1818
3400.00 720 1120 1401 1579 1723 1842
3450.00 729 1135 1419 1599 1745 1867
3500.00 738 1149 1438 1620 1768 1891
3550.00 748 1164 1456 1641 1791 1915
3600.00 757 1179 1475 1662 1814 1940
3650.00 767 1194 1493 1683 1837 1964
3700.00 776 1208 1503 1702 1857 1987
3750.00 784 1221 1520 1721 1878 2009
3800.00 793 1234 1536 1740 1899 2031
3850.00 802 1248 1553 1759 1920 2053
3900.00 811 1261 1570 1778 1940 2075
3950.00 819 1275 1587 1797 1961 2097
4000.00 828 1288 1603 1816 1982 2119
4050.00 837 1302 1620 1835 2002 2141
4100.00 846 1315 1637 1854 2023 2163
4150.00 854 1329 1654 1873 2044 2185
4200.00 863 1342 1670 1892 2064 2207
4250.00 872 1355 1687 1911 2085 2229
4300.00 881 1369 1704 1930 2106 2251
4350.00 889 1382 1721 1949 2127 2273
4400.00 898 1396 1737 1968 2147 2295
4450.00 907 1409 1754 1987 2168 2317
4500.00 916 1423 1771 2006 2189 2339
4550.00 924 1436 1788 2024 2209 2361
4600.00 933 1450 1804 2043 2230 2384
*1134
4650.00 942 1463 1821 2062 2251 2406
4700.00 951 1477 1838 2081 2271 2428
4750.00 959 1490 1855 2100 2292 2450
4800.00 968 1503 1871 2119 2313 2472
4850.00 977 1517 1888 2138 2334 2494
4900.00 986 1530 1905 2157 2354 2516
4950.00 993 1542 1927 2174 2372 2535
5000.00 1000 1551 1939 2188 2387 2551
5050.00 1006 1561 1952 2202 2402 2567
5100.00 1013 1571 1964 2215 2417 2583
5150.00 1019 1580 1976 2229 2432 2599
5200.00 1025 1590 1988 2243 2447 2615
5250.00 1032 1599 2000 2256 2462 2631
5300.00 1038 1609 2012 2270 2477 2647
5350.00 1045 1619 2024 2283 2492 2663
5400.00 1051 1628 2037 2297 2507 2679
5450.00 1057 1638 2049 2311 2522 2695
5500.00 1064 1647 2061 2324 2537 2711
5550.00 1070 1657 2073 2338 2552 2727
5600.00 1077 1667 2085 2352 2567 2743
5650.00 1083 1676 2097 2365 2582 2759
5700.00 1089 1686 2109 2379 2597 2775
5750.00 1096 1695 2122 2393 2612 2791
5800.00 1102 1705 2134 2406 2627 2807
5850.00 1107 1713 2144 2418 2639 2820
5900.00 1111 1721 2155 2429 2651 2833
5950.00 1116 1729 2165 2440 2663 2847
6000.00 1121 1737 2175 2451 2676 2860
6050.00 1126 1746 2185 2462 2688 2874
6100.00 1131 1754 2196 2473 2700 2887
6150.00 1136 1762 2206 2484 2712 2900
6200.00 1141 1770 2216 2495 2724 2914
6250.00 1145 1778 2227 2506 2737 2927
6300.00 1150 1786 2237 2517 2749 2941
6350.00 1155 1795 2247 2529 2761 2954
6400.00 1160 1803 2258 2540 2773 2967
6450.00 1165 1811 2268 2551 2785 2981
*1135
6500.00 1170 1819 2278 2562 2798 2994
6550.00 1175 1827 2288 2573 2810 3008
6600.00 1179 1835 2299 2584 2822 3021
6650.00 1184 1843 2309 2595 2834 3034
6700.00 1189 1850 2317 2604 2845 3045
6750.00 1193 1856 2325 2613 2854 3055
6800.00 1196 1862 2332 2621 2863 3064
6850.00 1200 1868 2340 2630 2872 3074
6900.00 1204 1873 2347 2639 2882 3084
6950.00 1208 1879 2355 2647 2891 3094
7000.00 1212 1885 2362 2656 2900 3103
7050.00 1216 1891 2370 2664 2909 3113
7100.00 1220 1897 2378 2673 2919 3123
7150.00 1224 1903 2385 2681 2928 3133
7200.00 1228 1909 2393 2690 2937 3142
7250.00 1232 1915 2400 2698 2946 3152
7300.00 1235 1921 2408 2707 2956 3162
7350.00 1239 1927 2415 2716 2965 3172
7400.00 1243 1933 2423 2724 2974 3181
7450.00 1247 1939 2430 2733 2983 3191
7500.00 1251 1945 2438 2741 2993 3201
7550.00 1255 1951 2446 2750 3002 3211
7600.00 1259 1957 2453 2758 3011 3220
7650.00 1263 1963 2461 2767 3020 3230
7700.00 1267 1969 2468 2775 3030 3240
7750.00 1271 1975 2476 2784 3039 3250
7800.00 1274 1981 2483 2792 3048 3259
7850.00 1278 1987 2491 2801 3057 3269
7900.00 1282 1992 2498 2810 3067 3279
7950.00 1286 1998 2506 2818 3076 3289
8000.00 1290 2004 2513 2827 3085 3298
8050.00 1294 2010 2521 2835 3094 3308
8100.00 1298 2016 2529 2844 3104 3318
8150.00 1302 2022 2536 2852 3113 3328
8200.00 1306 2028 2544 2861 3122 3337
8250.00 1310 2034 2551 2869 3131 3347
8300.00 1313 2040 2559 2878 3141 3357
*1136
8350.00 1317 2046 2566 2887 3150 3367
8400.00 1321 2052 2574 2895 3159 3376
8450.00 1325 2058 2581 2904 3168 3386
8500.00 1329 2064 2589 2912 3178 3396
8550.00 1333 2070 2597 2921 3187 3406
8600.00 1337 2076 2604 2929 3196 3415
8650.00 1341 2082 2612 2938 3205 3425
8700.00 1345 2088 2619 2946 3215 3435
8750.00 1349 2094 2627 2955 3224 3445
8800.00 1352 2100 2634 2963 3233 3454
8850.00 1356 2106 2642 2972 3242 3464
8900.00 1360 2111 2649 2981 3252 3474
8950.00 1364 2117 2657 2989 3261 3484
9000.00 1368 2123 2664 2998 3270 3493
9050.00 1372 2129 2672 3006 3279 3503
9100.00 1376 2135 2680 3015 3289 3513
9150.00 1380 2141 2687 3023 3298 3523
9200.00 1384 2147 2695 3032 3307 3532
9250.00 1388 2153 2702 3040 3316 3542
9300.00 1391 2159 2710 3049 3326 3552
9350.00 1395 2165 2717 3058 3335 3562
9400.00 1399 2171 2725 3066 3344 3571
9450.00 1403 2177 2732 3075 3353 3581
9500.00 1407 2183 2740 3083 3363 3591
9550.00 1411 2189 2748 3092 3372 3601
9600.00 1415 2195 2755 3100 3381 3610
9650.00 1419 2201 2763 3109 3390 3620
9700.00 1422 2206 2767 3115 3396 3628
9750.00 1425 2210 2772 3121 3402 3634
9800.00 1427 2213 2776 3126 3408 3641
9850.00 1430 2217 2781 3132 3414 3647
9900.00 1432 2221 2786 3137 3420 3653
9950.00 1435 2225 2791 3143 3426 3659
10000.00 1437 2228 2795 3148 3432 3666
*1137
IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT,
IN AND FOR ______________ COUNTY, FLORIDA
Case No.: ____________________________
Division: ____________________________
__________________________________,
Petitioner,
and
__________________________________,
Respondent.
NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET
PLEASE TAKE NOTICE, that {name}__________________, is filing his/her Child
Support Guidelines Worksheet attached and labeled Exhibit 1.
CERTIFICATE OF SERVICE
I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was
[check one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on
{date} ________.
Other party or his/her attorney:
Name: _______________________________
Address: ____________________________
City, State, Zip: ___________________
Fax Number: _________________________
Date: _______________________________
________________________________________
Signature of Party
Printed Name: __________________________
Address: _______________________________
City, State, Zip: ______________________
Telephone Number: ______________________
Fax Number: ____________________________
*1138
-------------------------------------------------------------------------------------------
| CHILD SUPPORT GUIDELINES WORKSHEET |
|-------------------------------------------------------------------------------------------|
| | A. FATHER | B. MOTHER | TOTAL |
|-------------------------------------------|----------------|---------------|--------------|
| 1. Present Net Monthly Income | | | |
| Enter the amount from line number | | | |
| 27, Section I of Florida Family Law | | | |
| Rules of Procedure Form 12.902(b) | | | |
| or (c), Financial Affidavit. | | | |
|-------------------------------------------|--------------------------------|--------------|
| 2. Basic Monthly Obligation | | |
| There is (are) {number} ____ minor | | |
| child(ren) common to the parties. | | |
| Using the total amount from line 1, | | |
| enter the appropriate amount from | | |
| the child support guidelines chart. | | |
|-------------------------------------------|-----------------------------------------------|
| 3. Percent of Financial Responsibility | % | % |
| Divide the amount on line 1A by the | | |
| total amount on line 1 to get | | |
| Father's percentage financial | | |
| responsibility. Enter answer on line | | |
| 3A. Divide the amount on line 1B by | | |
| the total amount on line 1 to get | | |
| Mother's percentage financial | | |
| responsibility. Enter answer on line | | |
| 3B. | | |
|-------------------------------------------|-----------------------------------------------|
| 4. Share of Basic Monthly Obligation | | |
| Multiply the number on line 2 by the | | |
| percentage on line 3A to get | | |
| Father's share of basic obligation. | | |
| Enter answer on line 4A. | | |
| Multiply the number on line 2 by the | | |
| percentage on line 3B to get | | |
| Mother's share of basic obligation. | | |
| Enter answer on line 4B. | | |
|-------------------------------------------------------------------------------------------|
| Additional Support Health Insurance, Child Care & Other |
|-------------------------------------------------------------------------------------------|
| 5. | | |
| a. 100% of Monthly Child Care | | |
| Costs | | |
| [Child care costs should not exceed | | |
| the level required to provide quality | | |
| care from a licensed source. See | | |
| section 61.30(7), Fla. Stat. for more | | |
| information.] | | |
-------------------------------------------------------------------------------------------
*1139
-------------------------------------------------------------------------------------------
| b. Total Monthly Child(ren)'s | | |
| Health Insurance Cost | | |
| [This is only amounts actually | | |
| paid for health insurance on the | | |
| child(ren).] | | |
|-------------------------------------------|--------------------------------|--------------|
| c. Total Monthly Child(ren)'s | | |
| Noncovered Medical, Dental and | | |
| Prescription Medication Costs | | |
|-------------------------------------------|--------------------------------|--------------|
| d. Total Monthly Child Care & | | |
| Health Costs [Add lines | | |
| 5a+5b+5c] | | |
|-------------------------------------------------------------------------------------------|
| 6. Additional Support Payments | | | |
| Multiply the number on line 5d by | | | |
| the percentage on line 3A to | | | |
| determine the Father's share. | | | |
| Enter answer on line 6A. | | | |
| Multiply the number on line 5d by | | | |
| the percentage on line 3B to | | | |
| determine the Mother's share. | | | |
| Enter answer on line 6B. | | | |
|-------------------------------------------------------------------------------------------|
| Statutory Adjustments/Credits |
|-------------------------------------------------------------------------------------------|
| 7. | | | |
| a. Monthly child care payments | | | |
| actually made | | | |
|-------------------------------------------|----------------|---------------|--------------|
| b. Monthly health insurance | | | |
| payments actually made | | | |
|-------------------------------------------|----------------|---------------|--------------|
| c. Other payments/credits actually | | | |
| made for any noncovered | | | |
| medical, dental and prescription | | | |
| medication expenses of the | | | |
| child(ren) not ordered to be | | | |
| separately paid on a percentage | | | |
| basis. [See § 61.30 (8), Florida | | | |
| Statutes] | | | |
|-------------------------------------------|----------------|---------------|--------------|
| 8. Total Support Payments actually made | | | |
| [Add 7a through 7c] | | | |
|-------------------------------------------|----------------|---------------|--------------|
| 9. MINIMUM CHILD SUPPORT | | | |
| OBLIGATION FOR EACH PARENT | | | |
| [Line 4 plus line 6; minus line 8] | | | |
-------------------------------------------------------------------------------------------
*1140
------------------------------------------------------------------------------------------------------
| CHILD SUPPORT GUIDELINES WORKSHEET |
|------------------------------------------------------------------------------------------------------|
| | A. FATHER | B. MOTHER | TOTAL |
|------------------------------------------------------------------------------------------------------|
| Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20 |
| percent of the overnights in the year (73 overnights in the year), complete Nos. 10 through 21 |
|------------------------------------------------------------------------------------------------------|
| 10. Basic Monthly Obligation × 150% | |
| [Multiply line 2 by 1.5] | |
|-------------------------------------------|----------------------------------------------------------|
| 11. Increased Basic Obligation for each | | | |
| parent | | | |
| Multiply the number on line 10 by | | | |
| the percentage on line 3A to | | | |
| determine the Father's share. | | | |
| Enter answer on line 11A. | | | |
| Multiply the number on line 10 by | | | |
| the percentage on line 3B to | | | |
| determine the Mother's share. | | | |
| Enter answer on line 11B. | | | |
|-------------------------------------------|----------------|---------------|-------------------------|
| 12. Percentage of overnight stays with | % | % | |
| each parent | | | |
| The child(ren) spend(s) ______ | | | |
| overnight stays with the Father each | | | |
| year. Using the number on the | | | |
| above line, multiply it by 100 and | | | |
| divide by 365. Enter this number on | | | |
| line 12A. | | | |
| The child(ren) spend(s) ______ | | | |
| overnight stays with the Mother | | | |
| each year. Using the number on the | | | |
| above line, multiply it by 100 and | | | |
| divide by 365. Enter this number on | | | |
| line 12B. | | | |
|-------------------------------------------|----------------|---------------|-------------------------|
| 13. Parent's support multiplied by other | | | |
| Parent's percentage of overnights | | | |
| [Multiply line 11A by line 12B. Enter | | | |
| this number in 13A. Multiply line | | | |
| 11B by line 12A. Enter this number | | | |
| in 13B.] | | | |
|------------------------------------------------------------------------------------------------------|
| Additional Support Health Insurance, Child Care & Other |
------------------------------------------------------------------------------------------------------
*1141
---------------------------------------------------------------------------------------
| CHILD SUPPORT GUIDELINES WORKSHEET |
|--------------------------------------------------------------------------------------|
| | A. FATHER | B. MOTHER | TOTAL |
|------------------------------------------------|---------------------------|---------|
| 14. | | |
| a. Total Monthly Child Care Costs | | |
| [Child care costs should not exceed the | | |
| level required to provide quality care | | |
| from a licensed source. See section | | |
| 61.30(7), Fla. Stat. for more | | |
| information.] | | |
|------------------------------------------------| |---------|
| b. Total Monthly Child(ren)'s | | |
| Health Insurance Cost. [This is | | |
| only amounts actually paid for | | |
| health insurance on the | | |
| child(ren).] | | |
|------------------------------------------------| |---------|
| c. Total Monthly Child(ren)'s | | |
| Noncovered Medical, Dental and | | |
| Prescription Costs. | | |
|------------------------------------------------| |---------|
| d. Total Monthly Child Care & | | |
| Health Costs [Add lines | | |
| 14a+14b+14c] | | |
|------------------------------------------------|---------------------------|---------|
| 15. Additional Support Payments | | | |
| Multiply the number on line 14d by | | | |
| the percentage on line 3A to | | | |
| determine the Father's share. | | | |
| Enter answer on line 15A. | | | |
| Multiply the number on line 14d by | | | |
| the percentage on line 3B to | | | |
| determine the Mother's share. | | | |
| Enter answer on line 15B. | | | |
|--------------------------------------------------------------------------------------|
| Statutory Adjustments/Credits |
|--------------------------------------------------------------------------------------|
| 16. | | | |
| a. Monthly child care payments | | | |
| actually made | | | |
|--------------------------------------------------------------------------------------|
| b. Monthly health insurance | | | |
| payments actually made | | | |
----------------------------------------------------------------------------------------
*1142
----------------------------------------------------------------------------------------
| | | | |
| c. Other payments/credits actually | | | |
| made for any noncovered | | | |
| medical, dental and prescription | | | |
| medication expenses of the | | | |
| child(ren) not ordered to be | | | |
| separately paid on a percentage | | | |
| basis. [See Section 61.30 (8), | | | |
| Florida Statutes] | | | |
|------------------------------------------------|-------------|-------------| |
| 17. Total Support Payments actually | | | |
| made [Add 16a through 16c] | | | |
|------------------------------------------------|-------------|-------------| |
| 18. Total Additional Support Transfer | | | |
| Amount [Line 15 minus line 17; Enter | | | |
| any negative number as zero] | | | |
|------------------------------------------------|-------------|-------------| |
| 19. Total Child Support Owed from | | | |
| Father to Mother [Add line 13A+18A] | | | |
| | | | |
|------------------------------------------------|-------------|-------------| |
| 20. Total Child Support Owed from | | | |
| Mother to Father [Add line 13B+18B] | | | |
|------------------------------------------------|-------------|-------------| |
| 21. Actual Child Support to Be Paid. | $ | $ | |
| [Comparing lines 19 and 20, Subtract | | | |
| the smaller amount owed from the | | | |
| larger amount owed and enter the | | | |
| result in the column for the parent | | | |
| that owes the larger amount of | | | |
| support] | | | |
---------------------------------------------------------------------------------------|
ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a
child support amount that is more or less than the child support guidelines, you must complete and file
Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form
12.943.
[check one only]
a. ___ Deviation from the guidelines amount is requested. The Motion to Deviate from Child
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached.
b. ___ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached.
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in
all blanks]
I, {full legal name and trade name of nonlawyer} _________________________________________,
a nonlawyer, located at {street} ____________________, {city} ___________________,
{state} ________________, {phone} ___________, helped {name} ___________,
who is the [check one only] ___ petitioner or ___ respondent, fill out this form.
This form should be used when you are responding to a petition for dissolution of marriage with dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you.
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.
You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows:
The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing).
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.
With this form, you must also file the following:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d)
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the *1144 other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you have reached an agreement on any or all of the issues.
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), Safety-Focused Parenting Plan, Form 12.995(b), or Relocation-Long-Distance Parenting Plan, Form 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.)
Parenting Plan and Time-Sharing ... If you and your spouse are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide for you as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing schedule based on the child(ren)'s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes.
A parenting course must be completed prior to entry of the final judgment. You should contact the clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation where you live.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
Shared Parental Responsibility
Sole Parental Responsibility
Supervised Time-Sharing
No contact
Parenting Plan
Parenting Plan Recommendation
Time-Sharing Schedule
Child Support ... The court may order one parent to pay child support to assist *1145 the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. Equitable does not necessarily mean equal. Many factors, including child support, time-sharing and alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Parenting Plan ... In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If you and your spouse have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or 12.995(c) which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. A Parenting Plan will be established by the court.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, parental responsibility and time-sharing with child(ren), temporary child support, or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both parties must sign this agreement before a notary public or deputy clerk. Any issues on which you *1146 are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Form ... These family law forms contain a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1147 IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR _________________________ COUNTY, FLORIDA Case No: __________________ Division: _________________ ______________________________, Petitioner, and ______________________________, Respondent. ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ____________________ Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ________________________________________________________________ ___________________________________________________________________________________________________ COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. Florida Supreme Court Approved Family Law Form 12.903(c)(1) Answer to Petition and Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren) (10/11)LAKSHMI
*1148 2. Petitioner [one only] ( ) is ( ) is not a member of the military service. Respondent [one only] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} _______________________________________________ Date of separation: {month, day, year} _____________________ (indicate if approximate) 4. DEPENDENT OR MINOR CHILD(REN) [Choose all that apply] a. ___ The wife is pregnant. Baby is due on: {date} _____________ b. ___ The minor (under 18) child(ren) common to both parties are: Name Birth date ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ c. ___ The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Birth date ____________________________________________________________________________________________ ____________________________________________________________________________________________ The birth father(s) of the above minor child(ren) is (are) {name and address} ___ ____________________________________________________________________________________________ d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical disability are: Name Birth date ________________________________________________________________________________________ ________________________________________________________________________________________ 5. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition. You must complete and attach this form in a dissolution of marriage with minor child(ren). 6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this counterpetition. 7. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c) ( ) is filed or ( ) will be timely filed. *1149 8. This counterpetition for dissolution of marriage should be granted because: [Choose only one] a. ___ The marriage is irretrievably broken. b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [Choose only one] 1. ___ There are no marital assets or liabilities. 2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c), to be filed in this case. [Choose all that apply] a. ___ All marital assets and liabilities have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). b. ___ The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. c. ___ Respondent should be awarded an interest in Petitioner's property because: __________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [Choose only one] 1. ___ Respondent forever gives up his/her right to spousal support (alimony) from Petitioner. 2. ___ Respondent requests that the Court order Petitioner to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and that Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the amount of $______ every ( ) week ( ) other week ( ) month, beginning {date} _____________ and continuing until {date or event} __________. Explain why the Court should order Petitioner to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): __________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ *1150 [Please indicate if applicable] ( ) Respondent requests life insurance on Petitioner's life, provided by Petitioner, to secure such support. SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING 1. The minor child(ren) currently reside(s) with ( ) Mother ( ) Father ( ) Other: {explain} __________________________________________________________________________________ 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [Choose only one] a. ___ shared by both Father and Mother. b. ___ awarded solely to ( ) Father ( ) Mother. Shared parental responsibility would be detrimental to the child(ren) because: _______________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be ordered to comply with a Parenting Plan that ( ) includes ( ) does not include parental time-sharing with the child(ren). The Respondent states that it is in the best interests of the child(ren) that: [Choose only one] a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties ( ) have ( ) have not agreed to the Parenting Plan. b. ___ The court should establish a Parenting Plan with the following provisions: ( ) No time-sharing for the ___ Father___ Mother ( ) Limited time-sharing with the ___ Father___ Mother ( ) Supervised time-sharing for the ___ Father___ Mother. ( ) Supervised or third-party exchange of the child(ren). ( ) Time-sharing as follows: __________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Explain why this request is in the best interests of the child(ren): ______________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ SECTION IV. CHILD SUPPORT [Choose all that apply] 1. Respondent requests that the Court award child support as determined by Florida's child support *1151 guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should be ordered retroactive to: a. ___ the date of separation {date} ______________. b. ___ the date of the filing of this petition. c. ___ other {date} ______________{explain} ______________________________________ _______________________________________________________________________________________ 2. ___ Respondent requests that the Court award child support to be paid beyond the age of 18 years because: a. ___ the following child(ren) {name(s)} _______________________________________________ _______________________________________________________________________________________________ is (are) dependent because of a mental or physical incapacity which began before the age of 18. {explain} _____________________________________________________________________________ b. the following child(ren) {name(s)} _____________________ is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. 3. ___ Respondent requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Respondent understands that Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be filed before the court will consider this request. 4. Respondent requests that medical/dental insurance coverage for the minor child(ren) be provided by: [Choose only one] a. ___ Father. b. ___ Mother. 5. ___ Respondent requests that uninsured medical/dental expenses for the child(ren) be paid: [Choose only one] a. ___ by Father. b. ___ by Mother. c. ___ by Father and Mother each paying one-half. d. ___ according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). e. ___ Other {explain}: ___________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 6. ___ Respondent requests that life insurance to secure child support be provided by: a. ___ Father. b. ___ Mother. c. ___ Both. *1152 SECTION V. OTHER 1. If Respondent is also the Wife, please indicate by either ( ) yes OR ( ) no whether Respondent/Wife wants to be known by her former name, which was {full legal name}: _________________________________________________________________________________ 2. Other relief {specify}: _________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SECTION VI. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Respondent requests that the Court enter an order dissolving the marriage and: [Choose all that apply] 1. ___ distributing marital assets and liabilities as requested in Section I of this petition; 2. ___ awarding spousal support (alimony) as requested in Section II of this petition; 3. ___ adopt or establish a Parenting Plan containing provisions for parental responsibility and time-sharing for the dependent or minor child(ren) common to both parties, as requested in Section III of this petition; 4. ___ establishing child support for the dependent or minor child(ren) common to both parties, as requested in Section IV of this petition; 5. ___ restoring Wife's former name as requested in Section V of this petition; 6. ___ awarding other relief as requested in Section V of this petition; and any other terms the Court deems necessary. I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______. Petitioner or his/her attorney: Printed Name: _________________ Address: ______________________ City, State, Zip: _____________ Fax Number: ___________________ *1153 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________ _____________________________________________ Signature of Respondent/Counterpetitioner Printed Name: _______________________________ Address: ____________________________________ City, State, Zip: ___________________________ Telephone Number: ___________________________ Fax Number: _________________________________ STATE OF FLORIDA COUNTY OF ____________ Sworn to or affirmed and signed before me on ____________ by _________________________. ___________________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced ________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________________________, a nonlawyer, whose address is {street} ______________________________________________________, {city} __________________, {state} ______________, {phone} ___________________________, helped {name} _______________________, who is the petitioner, fill out this form.This form should be used when you are responding to a petition for dissolution of marriage with property but no dependent or minor child(ren) and you are asking the court for something not contained in the petition. The answer portion of this form is used to admit or deny the allegations contained in the petition, and the counterpetition portion of this form is used to ask for whatever you want the court to do for you.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public 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.
You have 20 days to answer after being served with the other party's petition. A copy of this form must be mailed or hand delivered to the other party. After you file an answer and counterpetition your case will then generally proceed as follows:
The other party is required to answer your counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
UNCONTESTED ... Your dissolution is uncontested if you and your spouse agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED ... Your dissolution is contested if you and your spouse disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing).
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.
With this form, you must also file the following:
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) OR photocopy of current Florida driver's license, Florida identification card, or voter's registration card *1155 (issue date of copied document must be at least six months before date case is actually filed with the clerk of the circuit court).
Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you have reached an agreement on any or all of the issues.
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at the time you file this answer, unless you and the other party have agreed not to exchange these documents.)
Alimony ... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in your counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital assets and marital liabilities. Equitable does not necessarily mean equal. Many factors, including alimony awards, may lead the court to make an unequal (but still equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree or the court determines belong to, or are the responsibility of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when distributing marital assets and liabilities.
Temporary Relief ... If you need temporary relief regarding temporary use of assets, temporary responsibility for liabilities, or temporary alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form.
Marital Settlement Agreement ... If you and your spouse are able to reach an agreement on any or all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). Both parties must sign this agreement before a notary public. Any issues on which you are unable to agree will be considered contested and settled by the judge at the final hearing.
Final Judgment Forms ... These family law forms contain a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(2), which the judge may use if your case is contested. If you and your spouse reach an agreement on all of the issues, the judge may use a Final Judgment of Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(2). You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a *1156 final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer ... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1157 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR ______________________ COUNTY, FLORIDA Case No: ________________________ Division: _______________________ _______________________, Petitioner, and _______________________, Respondent. ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} _________________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} _______ ________________________________________________________________________________________________ 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those allegations: {indicate section and paragraph number} ______ _________________________________________________________________________________ 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} ________________________________________________________________ ______________________________________________________________________________________________ COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) 1. JURISDICTION/RESIDENCE ( ) Husband ( ) Wife ( ) Both has (have) lived in Florida for at least 6 months before the filing of this Petition for Dissolution of Marriage. 2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service. Respondent [Choose only one] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for Dissolution of Marriage with Property but No Dependent or Minor Children (10/11) LAKSHMI *1158 Date of marriage: {month, day, year} _______________________________ 4. THERE ARE NO MINOR (UNDER 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND THE WIFE IS NOT PREGNANT. 5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this counterpetition. 6. This counterpetition for dissolution of marriage should be granted because: [Choose only one] a. ___ The marriage is irretrievably broken. b. ___ One of the parties has been adjudged mentally incapacitated for a period of 3 years prior to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. SECTION I. MARITAL ASSETS AND LIABILITIES [Choose only one] 1. ___ There are no marital assets or liabilities. 2. ___ There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c), to be filed in this case. [Choose all that apply] a. ___ All marital assets and liabilities have been divided by a written agreement between the parties, which is attached to be incorporated into the final judgment of dissolution of marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). b. ___ The Court should determine how the assets and liabilities of this marriage are to be distributed, under section 61.075, Florida Statutes. c. ___ Respondent should be awarded an interest in Petitioner's property because: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ SECTION II. SPOUSAL SUPPORT (ALIMONY) [Choose only one] 1. ___ Respondent forever gives up his/her right to spousal support (alimony) from Petitioner. 2. ___ Respondent requests that the Court order Petitioner to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting and Petitioner has the ability to pay that support. Spousal support (alimony) is requested in the amount of $___ every ( ) week ( ) other week ( ) month, beginning {date} __________ and continuing until {date or event} __________. *1159 Explain why the Court should order Petitioner to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): ___________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ [Choose if applies] ( ) Respondent requests life insurance on Petitioner's life, provided by Petitioner, to secure such support. SECTION III. OTHER 1. [If Respondent is also the Wife, Choose one only] ( ) yes ( ) no Respondent/Wife wants to be known by her former name, which was {full legal name} _________________________. 2. Other relief {specify}: ________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ SECTION IV. RESPONDENT'S/COUNTERPETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the final judgment of dissolution of marriage.) Respondent requests that the Court enter an order dissolving the marriage and: [Choose all that apply] 1. ___ distributing marital assets and liabilities as requested in Section I of this petition; 2. ___ awarding spousal support (alimony) as requested in Section II of this petition; 3. ___ restoring Wife's former name as requested in Section III of this petition; 4. ___ awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. *1160 I certify that a copy of this document was [Choose one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ___________. Petitioner or his/her attorney: Printed Name: _________________ Address: ______________________ City, State, Zip: _____________ Fax Number: ___________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: __________________ _____________________________________________ Signature of Respondent/Counterpetitioner Printed Name: _______________________________ Address: ____________________________________ City, State, Zip: ___________________________ Telephone Number: ___________________________ Fax Number: _________________________________ STATE OF FLORIDA COUNTY OF ______________ Sworn to or affirmed and signed before me on ____________ by ____________________. _____________________________________ NOTARY PUBLIC or DEPUTY CLERK ______________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced ____________________ *1161 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________, a nonlawyer, whose address is {street} ______________________________________, {city} ______________, {state} ___________,{phone} _________________, helped {name} ______________________, who is the petitioner, fill out this form.This form may be used to ask the court to enter a support order if you and your spouse are separated, and your spouse has the ability to contribute to you and your minor child(ren), but has failed to do so. You can only use this form if a dissolution of marriage has not been filed and based upon the time-sharing schedule, you are entitled to support. If a petition for dissolution of marriage has been filed, you should file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form.
This petition cannot address the issues of property, debts, or parental responsibility and time-sharing with child(ren). It only deals with alimony and child support.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public 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.
For your case to proceed, you must properly notify the other party in your case of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT. If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by *1163 using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED. If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED. If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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 section 61.09, Florida Statutes.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form you must also file the following:
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), if the case involves minor or dependent child(ren).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.)
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that child support be ordered in the final judgment. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion *1164 of his or her support for the child(ren) to the other parent. Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents and the number of overnights the child(ren) spend with each parent. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Temporary Relief. If you need temporary relief regarding child support or temporary alimony, you may file a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, see the instructions for that form.
Final Judgment Form. These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.994(a), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1165 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR _______________________ COUNTY, FLORIDA Case No: _____________ Division: ____________ _____________________, Petitioner, and _____________________, Respondent. PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ___________________________________________, the ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes. 2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service. Respondent [Choose only one] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY a. Date of marriage: {month, day, year} _____________ b. Date of separation: {month, day, year} _______________ (___ Please indicate if approximate) 4. MINOR CHILD(REN) [Choose all that apply] a. ___ The wife is pregnant. The baby is due on: {date} ___________. b. ___ The minor (under 18) child(ren) common to both parties are: Name Birth date __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren) (10/11) LAKSHMI *1166 c. ___ The minor child(ren) born or conceived during the marriage who are not common to both parties are: Name Birth date __________________________________________________________________ __________________________________________________________________ The birth father(s) of the above minor child(ren) is (are) {name and address} ______ __________________________________________________________________ d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon the parties due to a mental or physical incapacity are: Name Birth date __________________________________________________________________ __________________________________________________________________ 5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if required, is filed with this petition. 6. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), is, or will be, filed. 7. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. 8. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. SECTION I. SPOUSAL SUPPORT (ALIMONY) [Choose only one] 1. ___ Petitioner does not request spousal support (alimony) from Respondent at this time. 2. ___ Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do so. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting. Spousal support (alimony) is requested in the amount of $ ______ every ( ) week ( ) other week ( ) month, beginning {date} _______________, and continuing until {date or event} _______________________________________________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): ______________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ *1167 _______________________________________________________________________________________________ _______________________________________________________________________________________________ [Choose if applies] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION II. CHILD SUPPORT Respondent has the ability to contribute to the maintenance of his or her minor child(ren) and has failed to do so. Based upon the time-sharing schedule, the Petitioner is entitled to child support. [Choose all that apply] 1. ___ Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. 2. ___ Petitioner requests that the Court award child support to be paid beyond the age of 18 years because: a. ___ the following child(ren), {name(s)} ________________________________________, is (are) dependent because of a mental or physical incapacity which began prior to the age of 18 {explain}: ________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ b. ___ the following child(ren), {name(s)} ____________________________________________, is (are) dependent in fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation of graduation before the age of 19. 3. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by: [Choose only one] a. ___ Father. b. ___ Mother. 4. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: [Choose only one] a. ___ by father. b. ___ by mother. c. ___ by Father and Mother each paying one-half. d. ___ according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). e. ___ Other {explain}: ___________________________________ _________________________________________________________________ _________________________________________________________________ 5. ___ Petitioner requests that life insurance to secure child support be provided by: a. ___ Father. b. ___ Mother. c. ___ Both. SECTION III. OTHER RELIEF _______________________________________________________________________________________________ _______________________________________________________________________________________________ *1168 _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ SECTION IV. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the order for support.) Petitioner requests that the Court enter an order establishing support and: [Choose all that apply] a. ___ awarding spousal support (alimony) as requested in Section I of this petition; b. ___ establishing child support for the minor child(ren) common to both parties, as requested in Section II of this petition; c. ___ awarding other relief as requested in Section III of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ____________________ ________________________________ Signature of PETITIONER Printed Name: ___________________ Address: ________________________ City, State, Zip: _______________ Telephone Number: _______________ Fax Number: _____________________ STATE OF FLORIDA COUNTY OF ____________ Sworn to or affirmed and signed before me on ____________ by ________________. ________________________________ NOTARY PUBLIC or DEPUTY CLERK _________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ___ Personally known ___ Produced identification ___ Type of identification produced ________________________ *1169 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________, a nonlawyer, whose address is {street} _______________________________________, {city} _______________, {state} _________, {phone} __________________, helped {name} ____________________, who is the petitioner, fill out this form.This form may be used if you and your spouse are separated, but a dissolution of marriage has not been filed, and you are requesting alimony. If a petition for dissolution has been filed, you should file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c), instead of using this petition. Also, if you are requesting that an order be entered for you to pay support to your spouse, you should not file this form.
This petition does not address the issues of property or debts. It only deals with alimony.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records.
For your case to proceed, you must properly notify the other party in your case of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting a divorce, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a)(1), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), after striking through "for Dissolution of Marriage" and inserting "for Support Unconnected with Dissolution for Marriage with No Dependent or Minor Child(ren)." If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. UNCONTESTED... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied ------- with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. *1171 with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED . . . If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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 section 61.09, Florida Statutes.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form you must also file the following:
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition.)
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if not filed at the time of the petition, unless you and the other party have agreed not to exchange these documents.)
Alimony . . . Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original petition. If you do not request alimony in writing before the final hearing, it is waived (you may not request it later). You may request either permanent alimony, lump sum alimony, or rehabilitative alimony.
Temporary Relief . . . If you need temporary relief regarding alimony, you may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For more information, see the instructions for that form. Final Judgment Form . . . These family law forms contain a Final Judgment of Support Unconnected with Dissolution of Marriage with No Dependent or Minor *1172 Child(ren), Florida Supreme Court Approved Family Law Form 12.994(b), which the judge may use if your case is contested. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final judgment with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer . . . Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1173 IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT, IN AND FOR _________________________ COUNTY, FLORIDA Case No: _____________________ Division: ____________________ ______________________________, Petitioner, and _____________________________, Respondent. PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR CHILD(REN) I, {full legal name} ______________________________________, the [Choose only one] ( ) Husband ( ) Wife, being sworn, certify that the following statements are true: 1. JURISDICTION ( ) Husband ( ) Wife ( ) Both live in Florida at the filing of this Petition for Support Unconnected with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida Statutes. 2. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service. Respondent [Choose only one] ( ) is ( ) is not a member of the military service. 3. MARRIAGE HISTORY Date of marriage: {month, day, year} ____________________ Date of separation: {month, day, year} ___________________ (___Indicate if approximate) 4. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), is, or will be, filed. 5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if required, is, or will be filed. SECTION I. SPOUSAL SUPPORT (ALIMONY) 1. ____ Respondent has the ability to contribute to the maintenance of Petitioner and has failed to do so. Petitioner requests that the Court order Respondent to pay the following spousal support (alimony) and claims that he or she has a need for the support that he or she is requesting. Spousal support (alimony) is requested in the amount of $__________ every ( ) week ( ) other week ( ) month, beginning {date} __________, and continuing until {date or event} __________ Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of Marriage with No Dependent or Minor Child(ren) (10/11) *1174 ________________________________________________________________________________________________ Explain why the Court should order Respondent to pay and any specific request(s) for type of alimony (temporary, permanent, rehabilitative, and/or lump sum): _______________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ [indicate if applicable] ( ) Petitioner requests life insurance on Respondent's life, provided by Respondent, to secure such support. SECTION II. OTHER RELIEF ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ SECTION III. PETITIONER'S REQUEST (This section summarizes what you are asking the Court to include in the order for support.) Petitioner requests that the Court enter an order establishing support and: Choose all that apply] a. ____ awarding spousal support (alimony) pursuant to Section I of this petition; b. ____ awarding other relief as specified in Section II of this petition; and any other terms the Court deems necessary. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _________________________ _______________________________________________________ Signature of PETITIONER Printed Name: _________________________________________ Address: ______________________________________________ City, State, Zip: _____________________________________ Telephone Number: _____________________________________ Fax Number: ___________________________________________ *1175 STATE OF FLORIDA COUNTY OF __________________________ Sworn to or affirmed and signed before me on _________________ by __________________________________. _______________________________________________________ NOTARY PUBLIC or DEPUTY CLERK ________________________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ____ Personally known ____ Produced identification ____ Type of identification produced _________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________________________________, a nonlawyer, whose address is {street} __________________, {city} __________________________________, {state} _________________, {phone} ___________, helped {name} ______________________________________, who is the petitioner, fill out this form.*1176 INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.905(d), SUPPLEMENTAL PETITION FOR TEMPORARY MODIFICATION OF PARENTING ISSUES FOR CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR TEMPORARILY ASSIGNED TO MILITARY SERVICE (10/11)
This form should be used when a parent seeks a temporary modification of an order establishing custody, visitation, a parenting plan, or time-sharing schedule because the parent is activated, deployed, or temporarily assigned to military service and the parent's ability to comply with the prior order (s) and time-sharing schedule is materially affected.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. This form and these instructions do not apply to modification of temporary orders.
For your case to proceed, you must properly notify the other party in your case of the supplemental petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. You may also be able to use constructive service if the other party resides in another state or country. However, if constructive service is used, other than granting dissolution of marriage, the court may only grant limited relief. For more information on constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If the other party is in the military service of the United States, additional steps for service may be required. See, for example, Memorandum for Certificate of Military Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding constructive service and service on an individual in the military service is very complex and you may wish to consult an attorney regarding these issues.
If personal service is used, the other party has 20 days to answer after being served with your supplemental petition. Your case will then generally proceed in one of the following three ways:
DEFAULT . . . If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED . . . If the respondent files an answer that agrees with everything in your supplemental petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family *1177 Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED . . . If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d).
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 section 61.13002, Florida Statutes.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
With this form, you must also file the following:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are seeking modification of the child support obligation. (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been served on you.)
Settlement Agreement, if you have reached an agreement on any or all of the issues. Although there is no form for this in these Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1).
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if not previously filed.
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), if you are seeking modification of the child support obligation.
Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a), (b), or (c). If the parties have reached an agreement, a signed and notarized Parenting Plan should be attached. If you have not reached an agreement, a proposed Parenting Plan may be filed.
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932, if you are seeking modification of the child support obligation. (This must be filed within 45 days of service of the supplemental petition on the respondent, if not filed at the time of the supplemental *1178 petition, unless you and the other party have agreed not to exchange these documents.)
Temporary Judgment Form . . . These family law forms contain a Supplemental Temporary Judgment Modifying Parenting Issues for Children of a Parent Activated, Deployed or Temporarily Assigned to Military Service Florida Supreme Court Approved Family Law Form 12.993(d), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Nonlawyer . . . Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 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.
*1179 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: ________________________ Division: _______________________ _________________________________, Petitioner, and _________________________________, Respondent. SUPPLEMENTAL PETITION FOR TEMPORARY MODIFICATION OF PARENTING ISSUES FOR CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR TEMPORARILY ASSIGNED TO MILITARY SERVICE I, {full legal name} ________________________________________, being sworn, certify that the following information is true: 1. The parties to the action, {names} ____________________________________, were granted a final judgment of [Choose one only] ( ) dissolution of marriage ( ) paternity on {date} ______________, ( ) other {describe} __________________________________________________________________. A copy/copies of the final judgment or any modification(s) is/are attached. 2. Paragraph(s) _____ of the [Choose one only] ( ) final judgment or ( ) most recent modification of it grants custody, primary care, or time-sharing of the minor child(ren), {name(s)} ____________________________, with {name of parent} __________________________________. 3. The parent, {name} ____________________, is [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned to military service. 4. The parent, {name} _____________________________, is temporarily unable to continue the current parenting plan and time-sharing schedule with the minor child(ren) during the period of time that the parent is [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned to military service. 5. I ask the court to temporarily modify/amend the parental responsibility and time-sharing schedule of the minor child(ren) during the period of time that the parent, {name} ___________________, is Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition for Temporary Modification of Parenting issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to Military Service (10/11) *1180 [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned to military service as follows: {explain}___________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 6. This temporary modification/amendment is in the best interests of the child(ren). 7. I ask that the court adopt ( ) the attached temporary Parenting Plan ( ) time-sharing schedule set forth below during the time that the parent is [Choose all that apply] ( ) activated ( ) deployed ( ) temporarily assigned to military service: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 8. If the requested modification/amendment is granted, Petitioner requests that child support be temporarily modified/amended, consistent with the temporary modification/amendment of the Parenting Plan and time-sharing schedule. A Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e) is, or will be, filed if a modification of child support is requested. 9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c) is filed with this Petition if a modification of child support is requested. 10. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 11. Other: ________________________________________________________________________________________ a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ 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: ___________________________________________ *1181 STATE OF FLORIDA COUNTY OF _______________________ Sworn to or affirmed and signed before me on ________________ by __________________________________. ______________________________________________________ NOTARY PUBLIC or DEPUTY CLERK ______________________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ____ Personally known ____ Produced identification ____ Type of identification produced ________________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _________________________________________________, a nonlawyer, whose address is {street} ___________________________________________________________, {city} __________________________________________, {state} ______________, {phone} __________, helped {name} _________________________________________, who is the petitioner, fill out this form.*1182 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(b), STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS (10/11)
This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.)
The questions in this form should be used in original proceedings or enforcement proceedings and are meant to supplement the information provided in the Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them.
This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send an original and one copy of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to the other party. You should also keep a copy for your records. You shall not file this form with the clerk of the circuit court unless the answers are admitted into evidence by the court and are in compliance with Florida Rule of Judicial Administration 2.425. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to tell the court that you have sent this form to the other party.
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure, and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure.
In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print legibly your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge.
You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided *1183 in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The original of the answers to the interrogatories is to be provided to the requesting party. DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE COURT EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE 1.340(e) AND IN ACCORDANCE WITH THE REQUIREMENTS OF FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law 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.
*1184 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR __________________ COUNTY, FLORIDA Case No.: ______________________ Division: ______________________ __________________________________, Petitioner, and __________________________________, Respondent. STANDARD FAMILY LAW INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS ________________________________________________________________________________ TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES I am requesting that the following standard questions be answered: [check all that apply] ____1 ____2 ____3 ____4 ____5 ____6 ____7 Background Education Employment Assets Liabilities Miscellaneous Long Form Information Affidavit In addition, I am requesting that the attached {#} _________________ questions be answered. The answers to the following questions are intended to supplement the information provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should answer the group of questions indicated in the above shaded box. The questions should be answered in the blank space provided below each separately numbered question. If sufficient space is not provided, you may attach additional papers with the answers and refer to them in the space provided in the interrogatories. You should be sure to make a copy for yourself. Each question must be answered separately and as completely as the available information permits. All answers are to be made under oath or affirmation as to their truthfulness. AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF THE COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC RECORD. INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE OTHER PARTY AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO INTERROGATORIES, WITH THE CLERK. Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law interrogatories for Original or Enforcement Proceedings (10/11) *1185 I, {name of person answering interrogatories} __________________________ being sworn, certify that the following information is true: 1. BACKGROUND INFORMATION: a. State your full legal name and any other name by which you have been known. b. State your present residence and telephone numbers. 2. EDUCATION: a. List all business, commercial, and professional licenses that you have obtained. b. List all of your education including, but not limited to, vocational or specialized training, including the following: (1) name and address of each educational institution. (2) dates of attendance. (3) degrees or certificates obtained or anticipated dates of same. 3. EMPLOYMENT: a. For each place of your employment or self-employment during the last 3 years, state the following: (1) name, address, and telephone number of your employer. (2) dates of employment. (3) job title and brief description of job duties. (4) starting and ending salaries. (5) name of your direct supervisor. (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. *1186 b. Other than as an employee, if you have been engaged in or associated with any business, commercial, or professional activity within the last 3 years that was not detailed above, state for each such activity the following: (1) name, address, and telephone number of each activity. (2) dates you were connected with such activity. (3) position title and brief description of activities. (4) starting and ending compensation. (5) name of all persons involved in the business, commercial, or professional activity with you. (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. c. If you have been unemployed at any time during the last 3 years, state the dates of unemployment. If you have not been employed at any time in the last 3 years, give the information requested above in question 3.a for your last period of employment. 4. ASSETS: a. Real Estate. State the street address, if any, and if not, the legal description of all real property that you own or owned during the last 3 years. For each property, state the following: (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest. (2) the purchase price, the cost of any improvements made since it was purchased, and the amount of any depreciation taken. (3) the fair market value on the date of your separation from your spouse. (4) the fair market value on the date of the filing of the petition for dissolution of marriage. *1187 b. Tangible Personal Property. List all items of tangible personal property that are owned by you or in which you have had any interest during the last 3 years including, but not limited to, motor vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose fair market value exceeds $100. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest. (3) the date you acquired your interest. (4) the purchase price. (5) the present fair market value. (6) the fair market value on the date of your separation from your spouse. (7) the fair market value on the date of the filing of the petition for dissolution of marriage. c. Intangible Personal Property. Other than the financial accounts (checking, savings, money market, credit union accounts, retirement accounts, or other such cash management accounts) listed in the answers to interrogatories 4.d and 4.e below, list all items of intangible personal property that are owned by you or in which you have had any ownership interest (including closed accounts) within the last 3 years, including but not limited to, partnership and business interests (including good will), deferred compensation accounts unconnected with retirement, including but not limited to stock options, sick leave, and vacation pay, stocks, stock funds, mutual funds, bonds, bond funds, real estate investment trust, receivables, certificates of deposit, notes, mortgages, and debts owed to you by another entity or person. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest and the names and addresses of the persons and entities who are indebted to you. (3) the date you acquired your interest. (4) the purchase price, acquisition cost, or loaned amount. (5) the fair market value or the amounts you claim are owned by or owed to you: (a) presently, at the time of answering these interrogatories. (b) on the date of your separation from your spouse. (c) on the date of the filing of the petition for dissolution of marriage. You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. However, if the date of acquisition, the purchase price and the market valuations are not clearly reflected in the periodic statements which are furnished then these questions must be answered separately. You do not have to resubmit any periodic statements previously furnished under rule 12.285 (Mandatory Disclosure). *1188 d. Retirement Accounts: List all information regarding each retirement account/plan, including but not limited to defined benefit plans, 401k, 403B, IRA accounts, pension plans, Florida Retirement System plans (FRS), Federal Government plans, money purchase plans, HR10 (Keogh) plans, profit sharing plans, annuities, employee savings plans, etc. that you have established and/or that have been established for you by you, your employer, or any previous employer. For each account, state the following: (1) the name and last 4 digits of the account number of each account/plan and where it is located. (2) the type of account/plan. (3) the name and address of the fiduciary plan administrator/service representative. (4) the fair market value of your interest in each account/plan. (a) present value. (b) value on the date of separation. (c) value on the date of filing of the petition for dissolution of marriage (5) whether you are vested or not vested; and if vested, in what amount, as of a certain date and the schedule of future vesting. (6) the date at which you became/become eligible to receive some funds in this account/plan. (7) monthly benefits of the account/plan if no fair market value is ascertained. (8) beneficiary(ies) and/or alternate payee(s). e. Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) the last 4 digits of account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) highest balance within each of the preceding 3 years. (6) lowest balance within each of the preceding 3 years. You may comply with this interrogatory (4.e) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished pursuant to rule 12.285 (Mandatory Disclosure). f. Closed Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) closed within the last 3 years, in *1189 which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) the last 4 digits of account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) date account was closed. g. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the following: (1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one the following: (a) identification of the estate, trust, insurance policy, or annuity. (b) the nature, amount, and frequency of any distributions of benefits. (c) the total value of the beneficiaries' interest in the benefit. (d) whether the benefit is vested or contingent. (2) If you have established any trust or are the trustee of a trust, state the following: (a) the date the trust was established. (b) the names and addresses of the trustees. (c) the names and addresses of the beneficiaries. (d) the names and addresses of the persons or entities who possess the trust documents. (e) each asset that is held in each trust, with its fair market value. h. Canceled Life Insurance Policies. For all policies of life insurance within the preceding 3 years that you no longer hold, own, or have any interest in, state the following: (1) name of company that issued the policy and last 4 digits of policy number. (2) name, address, and telephone number of agent who issued the policy. (3) amount of coverage. (4) name of insured. (5) name of owner of policy. (6) name of beneficiaries. (7) premium amount. (8) date the policy was surrendered. (9) amount, if any, of monies distributed to the owner. *1190 i. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and telephone numbers of your accountant, bookkeeper, and any other persons who possess your financial records, and state which records each possesses. j. Safe Deposit Boxes, Lock Boxes, Vaults, Etc. For all safe deposit boxes, lock boxes, vaults, or similar types of depositories, state the following: (1) The names and addresses of all banks, depositories, or other places where, at any time during the period beginning 3 years before the initiation of the action, until the date of your answering this interrogatory, you did any of the following: (a) had a safe deposit box, lock box, or vault. (b) were a signatory or co-signatory on a safe deposit box, lock box, or vault. (c) had access to a safe deposit box, lock box, or vault. (d) maintained property. (2) The box or identification numbers and the name and address of each person who has had access to any such depository during the same time period. (3) All persons who have possession of the keys or combination to the safe deposit box, lock box, or vault. (4) Any items removed from any safe deposit boxes, lock boxes, vaults, or similar types of depositories by you or your agent during that time, together with the present location and fair market value of each item. (5) All items in any safe deposit boxes, lock boxes, vaults, or similar types of depositories and fair market value of each item. 5. LIABILITIES: a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and other obligations (other than credit cards and charge accounts) listed in your Financial Affidavit, indicate for each the following: (1) name and address of the creditor. (2) name in which the obligation is or was incurred. (3) last 4 digits of loan or account number, if any. (4) nature of the security, if any. (5) payment schedule. (6) present balance and current status of your payments. (7) total amount of arrearage, if any. (8) balance on the date of your separation from your spouse. *1191 (9) balance on the date of the filing of the petition for dissolution of marriage. You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of the creditor. (2) name in which the account is or was maintained. (3) names of each person authorized to sign on the accounts. (4) last 4 digits of account numbers. (5) present balance and current status of your payments. (6) total amount of arrearage, if any. (7) balance on the date of your separation from your spouse. (8) balance on the date of the filing of the petition for dissolution of marriage. (9) highest and lowest balance within each of the preceding 3 years. You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). c. Closed Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) closed with no remaining balance, within the last 3 years, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each creditor. (2) name in which the account is or was maintained. (3) last 4 digits of account numbers. (4) names of each person authorized to sign on the accounts. (5) date the balance was paid off. *1192 (6) amount of final balance paid off. You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). 6. MISCELLANEOUS: a. If you are claiming an unequal distribution of marital property or enhancement or appreciation of nonmarital property, state the amount claimed and all facts upon which you rely in your claim. b. If you are claiming an asset or liability is nonmarital, list the asset or liability and all facts upon which you rely in your claim. c. If the mental or physical condition of a spouse or child is an issue, identify the person and state the name and address of all health care providers involved in the treatment of that person for said mental or physical condition. d. Detail your proposed parenting plan for the minor child(ren), including your proposed time-sharing schedule. Alternatively, attach a copy of your proposed parenting plan. e. If you are claiming that the other parent's time-sharing with the minor child(ren) should be limited, supervised, or otherwise restricted, or that you should have sole parental responsibility for the minor child(ren), with or without time-sharing with the other parent, or that you should have ultimate responsibility over specific aspects of the child(ren)'s welfare or that these responsibilities should be divided between you and the other parent, state your reasons and all facts which you rely upon to support your claim. 7. LONG FORM AFFIDAVIT: If you filed the short form affidavit, Florida Family Law Rules of Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), you must do so within the time to serve the answers to these interrogatories. *1193 I certify that a copy of this document was [check one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ______________. Other party or his/her attorney: Name: ____________________________ Address: _________________________ City, State, Zip: ________________ Fax Number: ______________________ I understand that I am swearing or affirming under oath to the truthfulness of the answers to these interrogatories and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _____________________ _____________________________________ Signature of Party Printed Name: ________________________ Address: _____________________________ City, State, Zip: ____________________ Telephone Number: ____________________ Fax Number: __________________________ STATE OF FLORIDA COUNTY OF __________________________ Sworn to or affirmed and signed before me on ______________ by ___________________. ______________________________________ NOTARY PUBLIC or DEPUTY CLERK ______________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ____ Personally known ____ Produced identification Type of identification produced ______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________________, a nonlawyer, located at {street} ____________________, {city} _____________, {state} ______, {phone} _______, helped {name} ___________________, who is the [choose one only] ___ petitioner or ___ respondent, fill out this form.*1194 INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.930(c), STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEDINGS (10/11)
This form should be used to ask the other party in your case to answer certain standard questions in writing. These questions are called interrogatories, and they must relate to your case. If the other party fails to answer the questions, you may ask the judge to order the other party to answer the questions. (You cannot ask these questions before the petition has been filed.)
The questions in this form should be used in modification proceedings and are meant to supplement the information provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should read all of the questions in this form to determine which questions, if any, the other party needs to answer in order to provide you with information not covered in the financial affidavit forms. If there are questions to which you already know the answer, you may choose not to ask them.
This form should be typed or printed in black ink. You must complete the box at the beginning of this form to indicate which questions you are requesting that the other party answer. You should send an original and one copy of this form and the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to the other party. You should also keep a copy for your records. You do not need to file this form with the clerk of the circuit court. However, you must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to tell the court that you have sent this form to the other party.
After you receive the completed answers to the interrogatories, DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE COURT UNLESS THE ANSWERS ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425.
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see the instructions for Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure and rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure.
In addition to the standard questions in this form, you may ask up to 10 additional questions. You should type or print your additional questions on a separate sheet of paper and attach it to this form. If you want to ask more than 10 additional questions, you will need to get permission from the judge.
You may want to inform the other party of the following information: As a general rule, within 30 days after service of interrogatories, the other party must answer the questions in writing and mail (have postmarked) the answers to you. His or her answers shall be written in the *1195 blank space provided after each separately numbered interrogatory. If sufficient space is not provided, the answering party may attach additional papers with the answers and refer to them in the space provided in the interrogatories. He or she should be sure to make a copy for him/herself. All answers to these questions are made under oath or affirmation as to their truthfulness. Each question must be answered separately and as completely as the available information permits. The original of the answers to the interrogatories is to be provided to the requesting party. DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE CIRCUIT COURT UNLESS THE ANSWERS ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The other party may object to a question by writing the legal reason for the objection in the space provided. He or she may also ask the court for a protective order granting him or her permission not to answer certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue burden or expense. If the other party fails to either answer or object to the questions within 30 days, he or she may be subject to court sanctions.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law 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.
*1196 IN THE CIRCUIT COURT OF THE _________________ JUDICIAL CIRCUIT, IN AND FOR ________________ COUNTY, FLORIDA Case No.: _____________________ Division: _____________________ ___________________________, Petitioner and ____________________________, Respondent. STANDARD FAMILY LAW INTERROGATORIES FOR MODIFICATION PROCEEDINGS ------------------------------------------------------------------------------------------------ TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES I am requesting that the following standard questions be answered: [check all that apply] ____1 ____2 ____3 ____4 ____ 5 ____6 ____7 Background Education Employment Assets Liabilities Miscellaneous Long Form Information Affidavit In addition, I am requesting that the attached {#} _________________ questions be answered. ------------------------------------------------------------------------------------------------ The answers to the following questions are intended to supplement the information provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should answer the group of questions indicated in the above shaded box. The questions should be answered in the blank space provided below each separately numbered question. If sufficient space is not provided, you may attach additional papers with the answers and refer to them in the space provided in the interrogatories. You should be sure to make a copy for yourself. Each question must be answered separately and as completely as the available information permits. All answers are to be made under oath or affirmation as to their truthfulness. AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF THE COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC RECORD. INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE OTHER PARTY AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO INTERROGATORIES, WITH THE CLERK. *1197 I, {name of person answering interrogatories} _______________________________, being sworn, certify that the following information is true: 1. BACKGROUND INFORMATION: a. State your full legal name and any other name by which you have been known. b. State your present residence and telephone numbers. 2. EDUCATION: a. List all business, commercial, and professional licenses that you have obtained since the entry of the Final Judgment sought to be modified. b. List all of your education since the entry of the Final Judgment sought to be modified including, but not limited to, vocational or specialized training, including the following: (1) name and address of each educational institution. (2) dates of attendance. (3) degrees or certificates obtained or anticipated dates of same. 3. EMPLOYMENT: a. For each place of your employment or self-employment since the entry of the Final Judgment sought to be modified, state the following: (1) name, address, and telephone number of your employer. (2) dates of employment. (3) job title and brief description of job duties. (4) starting and ending salaries. (5) name of your direct supervisor. (6) all benefits received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. *1198 b. Other than as an employee, if you have been engaged in or associated with any business, commercial, or professional activity since the entry of the Final Judgment sought to be modified that was not detailed above, state for each such activity the following: (1) name, address, and telephone number of each activity. (2) dates you were connected with such activity. (3) position title and brief description of activities. (4) starting and ending compensation. (5) name of all persons involved in the business, commercial, or professional activity with you. (6) all benefits and compensation received, including, for example, health, life, and disability insurance; expense account; use of automobile or automobile expense reimbursement; reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension or profit sharing plans. c. If you have been unemployed at any time since the entry of the Final Judgment sought to be modified, state the dates of unemployment. If you have not been employed at any time since the entry of the Final Judgment sought to be modified, give the information requested above in question 3.a for your last period of employment. 4. ASSETS: a. Real Estate. State the street address, if any, and if not, the legal description of all real property that you own or owned during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. For each property, state the following: (1) the names and addresses of any other persons or entities holding any interest and their percentage of interest. (2) the present fair market value. *1199 b. Tangible Personal Property. List all items of tangible personal property that are owned by you or in which you have had any interest during the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including, but not limited to, motor vehicles, tools, furniture, boats, Jewelry, art objects or other collections, and collectibles whose fair market value exceeds $100. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest. (3) the present fair market value. c. Intangible Personal Property. Other than the financial accounts (checking, savings, money market, credit union accounts, retirement accounts, or other such cash management accounts) listed in the answers to interrogatories 4.d and 4.e below, list all items of intangible personal property that are owned by you or in which you have had any ownership interest (including closed accounts) within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, including but not limited to, partnership and business interests (including good will), deferred compensation accounts unconnected with retirement, including but not limited to stock options, sick leave, and vacation pay, stocks, stock funds, mutual funds, bonds, bond funds, real estate investment trust, receivables, certificates of deposit, notes, mortgages, and debts owed to you by another entity or person. For each item, state the following: (1) the percentage and type interest you hold. (2) the names and addresses of any other persons or entities holding any interest and the names and addresses of the persons and entities who are indebted to you. (3) the present fair market value or the amounts you claim are owned by or owed to you, at the time of answering these interrogatories. You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. However, if the date of acquisition, the purchase price, and the market valuations are not clearly reflected in the periodic statements which are furnished, then these questions must be answered separately. You do not have to resubmit any periodic statements previously furnished under rule 12.285 (Mandatory Disclosure). *1200 d. Retirement Accounts: List all information regarding each retirement account/plan, including but not limited to defined benefit plans, 401k, 403B, IRA accounts, pension plans, Florida Retirement System plans (FRS), Federal Government plans, money purchase plans, HR10 (Keogh) plans, profit sharing plans, annuities, employee savings plans, etc. that you have established and/or that have been established for you by you, your employer, or any previous employer. For each account, state the following: (1) the name and last 4 digits of the account number of each account/plan and where it is located. (2) the type of account/plan. (3) the name and address of the fiduciary plan administrator/service representative. (4) the present fair market value of your interest in each account/plan. (5) whether you are vested or not vested; and if vested, in what amount, as of a certain date and the schedule of future vesting. (6) the date at which you became/become eligible to receive some funds in this account/plan. (7) monthly benefits of the account/plan if no fair market value is ascertained. (8) beneficiary(ies) and/or alternate payee(s). e. Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) last 4 digits of account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) highest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. (6) lowest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You may comply with this interrogatory (4.e) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished pursuant to rule 12.285 (Mandatory Disclosure). *1201 f. Closed Financial Accounts. For all financial accounts (checking, savings, money market, credit union accounts, or other such cash management accounts) closed within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each institution. (2) name in which the account is or was maintained. (3) last 4 digits of account numbers. (4) name of each person authorized to make withdrawals from the accounts. (5) date account was closed. g. Trust. For any interest in an estate, trust, insurance policy, or annuity, state the following: (1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one the following: (a) identification of the estate, trust, insurance policy, or annuity. (b) the nature, amount, and frequency of any distributions of benefits. (c) the total value of the beneficiaries' interest in the benefit. (d) whether the benefit is vested or contingent. (2) If you have established any trust or are the trustee of a trust, state the following: (a) the date the trust was established. (b) the names and addresses of the trustees. (c) the names and addresses of the beneficiaries. (d) the names and addresses of the persons or entities who possess the trust documents. (e) each asset that is held in each trust, with its fair market value. h. Name of Accountant, Bookkeeper, or Records Keeper. State the names, addresses, and telephone numbers of your accountant, bookkeeper, and any other persons who possess your records, and state which records each possesses. *1202 5. LIABILITIES: a. Loans, Liabilities, Debts, and Other Obligations. For all loans, liabilities, debts, and other obligations (other than credit cards and charge accounts) listed in your Financial Affidavit, indicate for each the following: (1) name and address of the creditor. (2) name in which the obligation is or was incurred. (3) last 4 digits of loan or account number, if any. (4) nature of the security, if any. (5) payment schedule. (6) present balance and current status of your payments. (7) total amount of arrearage, if any. You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). b. Credit Cards and Charge Accounts. For all financial accounts (credit cards, charge accounts, or other such accounts) listed in your Financial Affidavit, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of the creditor. (2) name in which the account is or was maintained. (3) names of each person authorized to sign on the accounts. (4) last 4 digits of account numbers. (5) present balance and current status of your payments. (6) total amount of arrearage, if any. (7) highest and lowest balance within each of the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). *1203 c. Closed Credit Cards and Charge Accounts. As to all financial accounts (credit cards, charge accounts, or other such accounts) closed with no remaining balance, within the last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in which you have had any legal or equitable interest, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, give the following: (1) name and address of each creditor. (2) name in which the account is or was maintained. (3) last 4 digits of account numbers. (4) name of each person authorized to sign on the accounts. (5) date the balance was paid off. (6) amount of final balance paid off. You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 years, or since the entry of the Final Judgment sought to be modified, if shorter. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit account statements previously furnished under rule 12.285 (Mandatory Disclosure). 6. MISCELLANEOUS: a. If you are claiming a diminished earning capacity since the entry of the Final Judgment sought to be modified as grounds to modify alimony or deviate from the child support established in your case, describe in detail how your earning capacity is lowered and state all facts upon which you rely in your claim. If unemployed, state how, why, and when you lost your job. b. If you are claiming a change in a mental of physical condition since the entry of the Final Judgment sought to be modified as grounds to modify alimony or change the child support established in your case, describe in detail how your mental and/or physical capacity has changed and state all facts upon which you rely in your claim. Identify the change in your mental and/or physical capacity, and state the name and address of all health care providers involved in the treatment of this mental or physical condition. c. If you are requesting a change in shared or sole parental responsibility, ultimate decision-making, the time-sharing schedule, the parenting plan, or any combination thereof, for the minor child(ren), describe in detail the change in circumstances since the entry of the Final Judgment sought to be modified that you feel justify the requested change. State when the change of circumstances occurred, how the change of circumstances affects the child(ren), and why it is in the best interests of the child(ren) that the Court make the requested change. Attach your proposed parenting plan. *1204 d. If you do not feel the requested change in shared or sole parental responsibility, ultimate decision-making, the time-sharing schedule, the parenting plan, or any combination thereof, for the minor child(ren) is in their best interests, or if you feel there has not been a change in circumstances since the entry of the Final Judgment sought to be modified, describe in detail any facts since the entry of the Final Judgment sought to be modified that you feel justify the Court denying the requested change. State what requested change, if any in shared or sole parenting responsibility, ultimate decision-making, the time-sharing schedule, or of the parenting plan is justified or agreeable to you and why it is in the best interests of the child(ren). 7. LONG FORM AFFIDAVIT: If you filed the short form affidavit, Florida Family Law Rules of Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), you must do so within the time to serve the answers to these interrogatories. *1205 I certify that a copy of this document was [check one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ________________________. Other party or his/her attorney: Name: _________________________ Address: ______________________ City, State, Zip: _____________ Fax Number: ____________________ I understand that I am swearing or affirming under oath to the truthfulness of the answers to these interrogatories and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ___________________ ______________________________ Signature of Party Printed Name: _________________ Address: ______________________ City, State, Zip: _____________ Telephone Number: _____________ Fax Number: ___________________ STATE OF FLORIDA COUNTY OF ___________________ Sworn to or affirmed and signed before me on ________________by _______________. ____________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced __________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _____________________________________, a nonlawyer, located at {street} ________________, {city} ___________________, {state} _____________, {phone} _____, helped {name} ________________, who is the [check one only] ___ petitioner or ___ respondent, fill out this form.You should use this form to tell the court that you have responded to the other party's request to answer certain standard questions (interrogatories) in writing.
This form should be typed or printed in black ink. You must indicate whether you are sending the answers to interrogatories for original and enforcement proceedings, Florida Family Law Rules of Procedure Form 12.930(b), or modification proceedings, Florida Family Law Rules of Procedure Form 12.930(c). You must also indicate whether you have additional questions that you were asked to answer. After completing this form you should file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records.
A copy of this form and the original completed answers to the interrogatories must be mailed or hand delivered to the other party in your case. However, file only this form with the clerk. DO NOT FILE THE ORIGINAL ANSWERS TO THE INTERROGATORIES OR ANY ATTACHMENTS WITH THE CLERK UNLESS THEY ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425.
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information see Florida Family Law Rules of Procedure Rules 12.280, 12.285, 12.340, and 12.380, and Florida Rules of Civil Procedure Rules 1.280, 1.340, and 1.380.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1207 IN THE CIRCUIT COURT OF THE_______________________JUDICIAL CIRCUIT, IN AND FOR________________________COUNTY, FLORIDA Case No.:_________________ Division:________________ __________________________, Petitioner and __________________________, Respondent. NOTICE OF SERVICE OF ANSWERS TO STANDARD FAMILY LAW INTERROGATORIES I, {full legal name} ________________________________, have on {date}____________ served on {name}_________________________ fully completed and sworn answers to the standard family law interrogatories served on me, and additional interrogatories if requested. The interrogatories were for [check one only] ( ) original or enforcement proceedings ( ) modification proceedings. I UNDERSTAND THAT I SHOULD NOT FILE THE ANSWERS TO INTERROGATORIES WITH THE CLERK OF THE CIRCUIT COURT EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE 1.340(e). *1208 I certify that a copy of this document was [choose only one ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _______________________. Other party or his/her attorney: Name:_____________________________ Address:__________________________ City, State, Zip:_________________ Fax Number:_______________________ Dated:____________________________ ____________________________________________ Signature of Party Printed Name:_______________________________ Address:____________________________________ City, State, Zip:___________________________ Telephone Number:___________________________ Fax Number:_________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ______________________, a nonlawyer, located at {street}___________________________________________, {city}__________________________________________, {state}__________, {phone}______, helped {name}_________________________________________________, who is the [check one only] ( ) petitioner or ( ) respondent, fill out this form.Mandatory disclosure requires each party in a dissolution of marriage case to provide the other party with certain financial information and documents. These documents must be provided by mail or hand delivery to the other party within 45 days of service of the petition for dissolution of marriage or supplemental petition for modification on the respondent. The mandatory disclosure rule applies to all original and supplemental dissolution of marriage cases, except simplified dissolution of marriage cases and cases where the respondent is served by constructive service and does not answer. You should use this form to notify the court and the other party that you have complied with the mandatory disclosure rule.
Each party must provide the other party with the documents listed in section 2 of this form if the relief being sought is permanent regardless of whether it is an initial or supplemental proceeding. Of the documents listed on this form, the financial affidavit and child support guidelines worksheet are the only documents that may be required to be filed with the court under Florida Family Law Rules of Procedure 12.285(c) and (k) but must be sent to the other party; all other documents should be sent to the other party but shall not be filed with the court. If your individual gross annual income is under $50,000, you should complete the Family Law Financial Affidavit (Short Form), Florida Family Law Rules of Procedure Form 12.902(b). If your individual gross annual income is $50,000 or more, you should complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(c).
In addition, there are separate mandatory disclosure requirements that apply to temporary financial hearings, which are listed in section 1 of this form. The party seeking temporary financial relief must serve these documents on the other party with the notice of temporary financial hearing. The responding party must either deliver the required documents to the party seeking temporary relief on or before 5:00 p.m., 2 business days before the hearing on temporary relief, or mail (postmark) them to the other party seeking temporary relief 7 days before the hearing on temporary financial relief. Any documents that have already been served under the requirements for temporary or initial proceedings, do not need to be reserved again in the same proceeding. If a supplemental petition is filed, seeking modification, then the mandatory disclosure requirements begin again.
This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records. A copy of this form must be mailed or hand delivered to any other party in your case.
After you have provided the other party all of the financial information and documents and have filed this form certifying that you have complied with this rule, you are under a continuing duty to promptly give the other party any information or documents that change your financial status or that make the information already provided inaccurate. You should not file with the clerk any of the documents listed in the *1210 certificate of compliance other than the financial affidavit and child support guidelines worksheet. Refer to the instructions regarding the petition in your case to determine how you should proceed after filing this form.
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. For further information, see rule 12.285, Florida Family Law Rules of Procedure.
You may provide copies of required documents; however, the originals must be produced for inspection if the other party requests to see them.
Although the financial affidavits are based on individual gross income, either party may ask the other party to complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(c), by serving the appropriate interrogatory form. (See Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(b) (original proceedings) or (c) (modification proceedings)).
Any portion of the mandatory disclosure rule may be modified by order of the judge or agreement of the parties. Therefore, you and your spouse may agree that you will not require each other to produce the documents required under the mandatory disclosure rule. This exception does not apply to the Financial Affidavit, Family Law Rules of Procedure Form 12.902(b) or (c), which is required in all cases and cannot be waived.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of 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.
*1211 IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR __________________ COUNTY, FLORIDA Case No.: ________________ Division: ________________ _________________________, Petitioner, and _________________________, Respondent. CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE I, {full legal name}________________________________, certify that I have complied with the mandatory disclosure required by Florida Family Law Rule 12.285 as follows: 1. FOR TEMPORARY FINANCIAL RELIEF, ONLY: The date the following documents were served: ____________________________. [Check all that apply] a. ___ Financial Affidavit ( ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) ( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) b. ___( ) All personal (1040) federal tax, gift tax, and intangible personal property tax returns for the preceding year; or ( ) Transcript of tax return as provided by IRS form 4506-T; or ( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the past year has not been prepared. c. ___Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. 2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF: The date the following documents were served: _______________________. [Check all that apply] a. ___ Financial Affidavit ( ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) ( ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) b. ___( ) All personal (1040) federal and state income tax returns, gift tax returns, and intangible personal property tax returns for the preceding 3 years; ( ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the past year has not been prepared. c. ___Pay stubs or other evidence of earned income for the 3 months before the service of the financial affidavit. *1212 d. ___ A statement identifying the source and amount of all income for the 3 months before the service of the financial affidavit, if not reflected on the pay stubs produced. e. ___ All loan applications and financial statements prepared for any purpose or used for any purpose within the 12 months preceding the service of the financial affidavit. f. ___ All deeds to real estate in which I presently own or owned an interest within the past 3 years. All promissory notes in which I presently own or owned an interest within the last 12 months. All present leases in which I own an interest. g. ___ All periodic statements for the last 3 months for all checking accounts and for the last year for all savings accounts, money market funds, certificates of deposit, etc. h. ___ All brokerage account statements for the last 12 months. i. ___ Most recent statement for any pension, profit sharing, deferred compensation, or retirement plan (for example, IRA, 401(k), 403(b), SEP, KEOGH, etc.) and summary plan description for any such plan in which I am a participant or alternate payee. j. ___ The declaration page, the last periodic statement, and the certificate for any group insurance for all life insurance policies insuring my life or the life of me or my spouse. k. ___ All health and dental insurance cards covering either me or my spouse and/or our dependent child(ren). l. ___ Corporate, partnership, and trust tax returns for the last 3 tax years, in which I have an ownership or interest greater than or equal to 30%. m. ___ All credit card and charge account statements and other records showing my (our) indebtedness as of the date of the filing of this action and for the prior 3 months. All promissory notes on which I presently owe or owned within the past year. All lease agreements I presently owe. n. ___ All premarital and marital agreements between the parties to this case. o. ___ If a modification proceeding, all written agreements entered into between the parties at any time since the order to be modified was entered. p. ___ All documents and tangible evidence relating to claims for an unequal distribution of marital property, enhancement or appreciation in nonmarital property, or nonmarital status of an asset or debt. q. ___ Any court order directing that I pay or receive spousal support (alimony) or child support. I certify that a copy of this document was [Check one only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ___________________________________. *1213 I understand that I am swearing or affirming under oath to the accuracy of my compliance with the mandatory disclosure requirements of Fla. Fam. L. R. P. 12.285 and that, unless otherwise indicated with specificity, this disclosure is complete. I further understand that the punishment for knowingly making a false statement or incomplete disclosure includes fines and/or imprisonment. Other party or his/her attorney: Name: _________________________________ Address: ______________________________ City, State, Zip: _____________________ Fax Number: ___________________________ Dated: ___________________________ ___________________________________ Signature of Party Printed Name: _____________________ Address: __________________________ City, State, Zip: _________________ Telephone Number: _________________ Fax Number: _______________________ STATE OF FLORIDA COUNTY OF ___________________________ Sworn to or affirmed and signed before me on _____________ by ____________. __________________________________ NOTARY PUBLIC or DEPUTY CLERK ___________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ___________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________________________, a nonlawyer, located at {street} __________________________, {city} ____________, {state} ______________________, {phone}______________, helped {name}___, who is the [Check one only] ___ petitioner or ___ respondent, fill out this form.Child support in Florida is determined by the child support guidelines found in section 61.30, Florida Statutes. The court, at its discretion, may raise or lower the child support guidelines amount by up to 5%. In addition, the court may raise or lower the guidelines support amount by more than 5%, if written reasons are given for the adjustment. The court may make these additional adjustments based on certain considerations, which are reflected in this form. You should review this form to determine if any of the reasons for adjusting the child support guidelines amount apply to your situation and you should complete this form only if you want the court to order more child support or less child support than the amount required by the child support guidelines.
This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.
A copy of this form must be mailed or hand delivered to the other party in your case.
Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. For further information, see section 61.30, Florida Statutes.
More information on the child support guidelines as well as a chart for converting income and expenses to monthly amounts if paid or incurred on other than a monthly basis is contained in the instructions to Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e).
With this form you must also file the following, if not already filed:
Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you should file this worksheet as soon as you receive a copy of his or her financial affidavit.)
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1215 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: _________________________________________ Division: ________________________________________ ________________________________, Petitioner, and ________________________________, Respondent. MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following: SECTION I. [Choose only one] A. ___MORE child support than the amount required by the child support guidelines. The Court should order MORE child support than the amount required by the child support guidelines because of: [Choose all that apply to your situation] 1. ___ Extraordinary medical, psychological, educational, or dental expenses; 2. ___ Seasonal variations in one or both parent's income or expenses; 3. ___ Age(s) of the child(ren), taking into consideration the greater needs of older child(ren); 4. ___ Special needs, such as costs that may be associated with the disability of a child or child(ren), that have traditionally been met within the family budget even though the fulfilling of those needs will cause support to exceed the presumptive amount established by the guidelines; 5. ___ Total available assets of obligee, obligor, and the child(ren); 6. ___ Impact of IRS dependency exemption and waiver of that exemption; 7. ___ The Parenting Plan, such as where the child or children spend a significant amount of time, but less than 40 percent of the overnights, with one parent, thereby reducing the financial expenditures incurred by the other parent, or the refusal of a parent to become involved in the activities of the child(ren) has increased the financial expenditure incurred by the obligee; 8. ___ Any other adjustment that is needed to achieve an equitable result, which may include reasonable and necessary expenses or debts jointly incurred during the marriage. Explain any items marked above: _______________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ *1216 B. ___ LESS child support than the amount required by the child support guidelines. The Court should order LESS child support than the amount required by the child support guidelines because of: [Choose all that apply to your situation] 1. ___ Extraordinary medical, psychological, educational, or dental expenses; 2. ___ Independent income of child(ren), excluding the child(ren)'s SSI (supplemental security income) 3. ___ Payment of both child support and spousal support to a parent that regularly has been paid and for which there is a demonstrated need; 4. ___ Seasonal variations in one or both parent's income or expenses; 5. ___ Age of the child(ren), taking into consideration the greater needs of older child(ren); 6. ___ Total available assets of obligee, obligor, and child(ren); 7. ___ Impact of IRS dependency exemption and waiver of that exemption; 8. ___ Application of the child support guidelines which requires the obligor to pay more than 55% of gross income for a single support order; 9. ___ Residency of subsequently born or adopted child(ren) with the obligor, include consideration of the subsequent spouse's income; 10. ___ The Parenting Plan, where the child(ren) spend a significant amount of time, but less than 40 percent of the overnights, with one parent, thereby reducing the financial expenditures incurred by the other parent; or the refusal of a parent to become involved in the activities of the child(ren); 11. ___ Any other adjustment that is needed to achieve an equitable result, which may include reasonable and necessary expenses or debts jointly incurred during the marriage. Explain any items marked above __________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES List the total of any independent income or assets of the child(ren) common to both parties (income from Social Security, gifts, stocks/bonds, employment, trust fund(s), investment(s), etc.). If any account numbers are listed, please list only the last four (4) digits of the number. Attach an explanation. TOTAL VALUE OF ASSETS OF CHILD(REN) $ ____ TOTAL MONTHLY INCOME OF CHILD(REN) $ ____ I have filed, will file, or am filing with this form the following additional documents: 1. Florida Family Law Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 2. Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). *1217 I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} _________________________________________ Other party or his/her attorney: Name: ________________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Fax Number: __________________________________ _________________________________________________________________ Signature of Party or his/her attorney Printed Name: ___________________________________________________ Address: ________________________________________________________ City, State, Zip: _______________________________________________ Telephone Number: _______________________________________________ Fax Number: _____________________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ____________________ _________________________________________________________________ Signature Printed name: ___________________________________________________ Address: ________________________________________________________ City, State, Zip: _______________________________________________ Telephone Number: _______________________________________________ Fax Number: _____________________________________________________ STATE OF FLORIDA COUNTY OF ____________________________ Sworn to or affirmed and signed before me on ______________ by ______________________________________________. ________________________________________________________________ NOTARY PUBLIC or CLERK ________________________________________________________________ {Print, type, or stamp commissioned name of notary or Clerk} ____ Personally known ____ Produced identification {type of identification produced} _____________________________________ *1218 IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ____________________________________________________________, a nonlawyer, whose address is {street} ______________________________________________________________________, {city} _____________________________________________, {state} ___________, {phone} ________, helped {name} _______________________________________, who is the petitioner, fill out this form.This form may be used by:
(1) The respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); temporary time-sharing schedule with minor child(ren); temporary child support; and other relief.
(2) The petitioner in a pending action for support unconnected with dissolution. For you to use this form, a petition for support unconnected with dissolution of marriage must have already been filed. You should use this form to ask the court to award temporary spousal support (alimony) and/or temporary child support.
This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition for dissolution of marriage was filed and keep a copy for your records.
A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. Words in bold underline in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure.
If you use paragraph 1.c of this form to ask the court to enter a temporary injunction, the court may require you to post a bond.
With this form you must also file the following, if not already filed:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), if this case involves a minor or dependent child(ren).
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if you are asking that temporary child support be ordered. (If you do not know the other party's income, *1220 you may file this worksheet as soon as a copy of his or her financial affidavit has been served on you.)
The parties seeking relief shall serve a financial affidavit (Florida Family Law Rules of Procedure Form 12.902 (b) or (c)) and certificate of compliance (Florida Family Law Rules of Procedure Form 12.932) with the notice of hearing on the motion for temporary support and time-sharing.
Parenting Plan. If you have reached an agreement on either a temporary Parenting Plan or time-sharing schedule, the proposed temporary Parenting Plan or time-sharing schedule, signed by both parties, should be filed. Florida Supreme Court Family Law Form 12.995(a), 12.995(b), or 12.995(c). If you have not reached an agreement, a proposed Parenting Plan or temporary time-sharing schedule may be filed for consideration by the Court.
Temporary Order ... These family law forms contain a Temporary Order for Support and Time-Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(b), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1221 THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: ______________________________________________ Division: _____________________________________________ _________________________________, Petitioner, and _________________________________, Respondent. MOTION FOR TEMPORARY SUPPORT AND TIME-SHARING WITH DEPENDENT OR MINOR CHILD(REN) The ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support: [Complete all that apply] 1. Assets and Liabilities. a. ___ Award temporary exclusive use and possession of the marital home. {address} _______________________ _______________________________________________________________________________________________________ The Court should do this because: _____________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ b. ___ Award temporary use and possession of marital assets. {Specify, without giving account numbers} _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ The Court should do this because: _____________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ c. ___ Enter a temporary injunction prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {Explain} _____________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ *1222 _______________________________________________________________________________________________________ The Court should do this because: _____________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ d. ___ Require temporary payment of specific marital debts. {Explain without using account numbers} ___________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ The Court should do this because: _____________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 2. Child(ren). a. ___ Enter a temporary Parenting Plan with a time-sharing schedule for the parties' minor child(ren). ________________________________________________________________________________________ b. ___ Enter a temporary injunction prohibiting the parties from permanently removing the child(ren) from the jurisdiction of the Court. The Court should do this because: ___________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 3. Support. a. ___ Award temporary child support of $ _________ per month. b. ___ Award temporary spousal support/alimony of $ __________ per month. The Court should do this because: __________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 4. Attorney's fees and costs. a. ___ Award temporary attorney's fees of $ ___________ b. ___ Award temporary costs of $_______________ The Court should do this because: __________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 5. Other Relief. {specify} __________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ *1223 __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ 6. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this motion or has already been filed with the Court. 7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if required, is filed with this motion or has already been filed with the Court. I request that the Court hold a hearing on this matter and grant the relief specifically requested and any other relief this Court may deem just and proper. I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} __________________________________________________ Other party or his/her attorney: Name: ________________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Fax Number: __________________________________ ______________________________________________________________________ Signature of Party or his/her attorney Printed Name: ________________________________________________________ Address: _____________________________________________________________ City, State, Zip: ____________________________________________________ Telephone Number: ____________________________________________________ Fax Number: __________________________________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ___________________________________________________________, a nonlawyer, whose address is {street}______________________________________________________________________, {city} _________________________________________, {state} ________________, {phone} __________________________, helped {name} _______________________________, who is the petitioner, fill out this form. *1224 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: _________________________________________ Division: ________________________________________ _________________________________, Petitioner, and _________________________________, Respondent. TEMPORARY ORDER OF SUPPORT AND TIME-SHARING WITH DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a hearing on a Motion for Temporary Support and Time-Sharing with Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony, makes these findings of fact and ORDERS as follows: The Court has jurisdiction over the subject matter and the parties. SECTION I. MARITAL ASSETS AND LIABILITIES A. Injunction. 1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital assets without the written permission of the other party or a court order. If checked here ( ), the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay all ordinary and usual expenses. 2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 3. Violation of this injunction may constitute criminal contempt of court. 4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $__________ with the clerk of this Court. B. Temporary Use of Assets. 1. The assets listed below are temporarily determined to be marital assets. Each party shall temporarily have the use of, as his/her own, the assets awarded in this section, and the other party shall temporarily have no further use of said assets. Any personal property not listed *1225 below shall be for the use of party currently in possession of that item(s), and he or she may not dispose of that item(s) without the written permission of the other party or a court order.----------------------------------------------------------------------------------------- | | Wife Shall | Husband | | | Have | Shall Have | | | Temporary | Temporary | | ASSETS: DESCRIPTION OF ITEM(S) | Use | Use | |---------------------------------------------------|----------------|------------------| | Automobiles | | | |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| | Furniture & furnishings in home | | | |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| | Furniture & furnishings elsewhere | | | |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| | Jewelry | | | |---------------------------------------------------|----------------|------------------| | Business interests | | | |---------------------------------------------------|----------------|------------------| |---------------------------------------------------|----------------|------------------| | Other Assets | | | -----------------------------------------------------------------------------------------C. Temporary Responsibility for Liabilities/Debts. 1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his or her own the marital liabilities indicated below and shall keep said payments current. The other party shall temporarily have no further responsibility for the payment of these debts.
*1226
------------------------------------------------------------------------------------
| | Current | | |
| LIABILITIES: DESCRIPTION OF DEBT(S) | Amount |Wife |Husband |
| | Owed |Shall Pay | Shall Pay |
|----------------------------------------------|----------|-----------|------------|
| Mortgages on real estate: (home) | $ |$ |$ |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
| | - | | |
|----------------------------------------------|----------|-----------|------------|
| Charge/credit card accounts | | | |
|----------------------------------------------|----------|-----------|------------|
| | ======= | | |
|----------------------------------------------|----------|-----------|------------|
| Auto loan | | | |
|----------------------------------------------|----------|-----------|------------|
| Auto loan | | | |
|----------------------------------------------|----------|-----------|------------|
| Bank/Credit Union loans | | | |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
| Money owed (not evidenced by a note) | | | |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
| Other | | | |
|----------------------------------------------|----------|-----------|------------|
|----------------------------------------------|----------|-----------|------------|
-----------------------------------------------------------------------------------
SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Choose all that apply]
1. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
dwelling located at: {address} ____________________________________________________
___________________________________________________________________________________
until: {date or event} ____________________________________________________________
____________________________________________________________________________________.
2. ___ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the
paragraph above for the purpose of obtaining his or her clothing and items of personal health
and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to
the person granted temporary exclusive use and possession of the dwelling and at the earliest
convenience of both parties.
3. ___ Other: ________________________________________________________________
*1227
___________________________________________________________________________________
___________________________________________________________________________________
SECTION III. TEMPORARY PARENTAL RESPONSIBILITY AND TIME-SHARING WITH DEPENDENT OR
MINOR CHILD(REN)
1. Jurisdiction. The Court has jurisdiction to determine temporary parental responsibility and
time-sharing for the parties' minor child(ren) listed in paragraph 2 below.
2. The parties' dependent or minor child(ren) is (are):
Name Birth date
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3. Temporary Parental Responsibility for the Minor Child(ren).
[Choose only one]
a. ___ The parties shall have temporary shared parental responsibility for the parties' minor
child(ren).
b. ___ ( ) Mother ( ) Father shall have temporary sole parental responsibility for the
parties' minor child(ren). Temporary shared parental responsibility would be detrimental to
the child(ren) at this time because _______________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________.
c. ( ) Mother ( ) Father shall have ultimate decision-making authority regarding the
following:
____________________________________________________________________________________________
____________________________________________________________________________________________
___________________________________________________________________________________________.
d. Other provisions: _________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
4. Temporary Time-sharing Schedule with Minor Child(ren). The parent(s) shall have:
*1228
[Choose only one]
a. ___ reasonable time-sharing schedule with the parties' minor child(ren) as agreed to by the
parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to
set a specific schedule.
b. ___the following specified time-sharing schedule with the parties' minor child(ren), subject
to any limitations set out in paragraph 5 below: {specify days and times} _________________
_____________________________________________________________________
Mother's Temporary Time-Sharing Schedule.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Father's Temporary Time-sharing Schedule.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
c. ___ Time-sharing in accordance with the temporary Parenting Plan attached as Exhibit ______.
d. ___ ( ) Mother ( ) Father shall have no contact with the parties' minor child(ren) until
further order of the Court, due to the existing conditions that are detrimental to the welfare
of the minor child(ren): {explain}:
___________________________________________________________________________________________
___________________________________________________________________________________________
5. Limitations on Time-sharing. Neither parent shall take the child(ren) from the other parent, any
child care provider or other person entrusted by the other parent with the care of the child(ren)
without the agreement of the other party during the other party's time-sharing. The above
time-sharing shall be:
[Choose if applies]
a. ___ supervised by a responsible adult who is mutually agreeable to the parties. If the
parties cannot agree, the supervising adult shall be: {name} ___________________________.
b. ___ at a supervised visitation center located at: {address} ____________________________
________________________________________________________________________________________,
subject to the available times and rules of the supervised visitation center. The cost of such
visits shall be paid by ( ) Mother ( ) Father ( ) Both.
6. Communication Arrangements, Parental Responsibility and Time-sharing with Minor
Child(ren).
*1229
[Choose if applies]
______ The parties' communications to arrange time-sharing and discuss issues relating to the
child(ren) (if temporary shared parenting, or time-sharing is provided in paragraph 3 above) are
restricted as follows: ( ) telephone, ( ) fax, e-mail, or letter, ( ) a responsible person shall
coordinate the time-sharing arrangements of the minor child(ren). If the parties cannot agree,
the responsible person shall be: {name} ___________________________________________________
( ) other conditions for arrangements or discussions: {explain} __________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7. Exchange of Minor Child(ren). The exchange of the minor child(ren) shall be on time as
scheduled and as agreed to by the parties. The following conditions, if checked below, shall also
apply.
[Choose all that apply]
a. ___ The parties shall temporarily exchange the child(ren) at the following location(s): _____
________________________________________________________________________________________
b. ___ ( ) Mother ( ) Father shall not get out of the vehicle, and the other parent shall not
approach the vehicle, during the time the child(ren) are exchanged.
c. ___ A responsible person shall conduct all exchanges of the child(ren). ( ) Mother
( ) Father shall not be present during the exchange. If the parties cannot agree, the
responsible person shall be: {name} ______________________________________________________________
d. ___ Other conditions for exchange of the child(ren) are as follows: ______________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
8. ___ Injunction Prohibiting Removing the Child(ren). The Court hereby temporarily prohibits
and enjoins the ( ) Mother ( ) Father ( ) Both from permanently removing the minor
child(ren) from the State of Florida without a court order or the written consent of the other
party.
9. ___ Other Temporary Provisions Relating to the Minor Child(ren).
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
*1230
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
SECTION IV. TEMPORARY ALIMONY
1. ( ) The Court denies the request(s) for temporary alimony. OR
( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
hereinafter Obligor, has/had the present ability to pay temporary alimony as follows:
[Choose all that apply]
a. ___ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
amount of $ per month, payable ( ) in accordance with Obligor's employer's
payroll cycle, and in any event, at least once a month ( ) other {explain}
__________________________________________________________________________________________________,
beginning {date} _________ This temporary periodic alimony shall continue until modified
by court order, the death of either party, or until, {date/event} ________________________________,
whichever occurs first.
b. ___ Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of
$ ______. This amount shall be paid as follows: __________________________________________________
__________________________________________________________________________________________________
____________________________________________________________________________________________________.
c. ___ Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the
amount of $ ______ per month, payable ( ) in accordance with Obligor's employer's
payroll cycle, and in any event, at least once a month ( ) other {explain} _______________________
__________________________________________________________________________________________________
beginning {date} ___________. This temporary rehabilitative alimony shall continue until
modified by court order, the death of either party or until {date/event}
_________________ whichever occurs first. The temporary rehabilitative plan
presented demonstrated the following: ____________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________.
d. ___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ ______ for
the period of {date} _________ through {date} _______, which shall be paid pursuant
to paragraph 3 below.
2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for
awarding/denying temporary alimony are as follows:
a. ___ length of the marriage of the party receiving temporary alimony: ________ years;
b. ___ age of party receiving temporary alimony: ________ years;
c. ___ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor
*1231
( ) other ______________________________________________________________;
d.___other factors ________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
________ Please indicate here if additional pages are attached.
3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
retroactive alimony of $ ______, as of {date} ______. This amount shall be paid in
the amount of $_________, per month, payable in accordance with Obligor's employer's payroll
cycle, and in any event at least once a month ( ) other {explain} _____________
_________________________________________________________________________________________
beginning: {date} _______________, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay
health insurance premiums for the other party not to exceed $ _______ per month,
Further, ( ) Petitioner ( ) Respondent shall pay any uninsured medical costs for the other
party not exceed $ _______ per year. As to these uninsured medical expenses, the party
who is entitled to reimbursement of the uninsured medical expense shall submit request for
reimbursement to the other party within 30 days, and the other party shall, within 30 days
after receipt, submit the applicable reimbursement for that expense.
b. ___ Life Insurance (to secure payment of support). To secure the temporary alimony
obligations set forth in this order, the Obligor shall temporarily maintain life insurance
coverage on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as
reasonably available. This temporary insurance shall be in the amount of at least
$ _________ and shall remain in effect until this temporary obligation for alimony
terminates.
5. Other provisions relating to temporary alimony:
___________________________________________________________________________
___________________________________________________________________________
SECTION V. TEMPORARY CHILD SUPPORT
1. The Court finds that there is a need for temporary child support and that the ( ) Mother
( ) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e),
filed by the ( ) Mother ( ) Father are correct OR the Court makes the following findings: The
*1232
Mother's net monthly income is $ _________. The Father's net monthly income is $ _______.
Monthly child care costs are $ _________. Monthly health/dental insurance costs are
$ ________.
2. Amount. Obligor shall be obligated to pay temporary child support in the amount of $ ______
per month payable ( ) in accordance with Obligor's payroll cycle, and in any event at least once
a month ( ) {explain} _________________________________________________________________
_________________________________________________________________________________________________
beginning {date} ______________, and continuing until further court order or until
{date/event} ____________________________________________________________________,
{explain} _______________________________________________________________________.
If the temporary child support ordered deviates from the guidelines by more than 5%, the
factual findings which support that deviation are: ________________________________________.
__________________________________________________________________________
__________________________________________________________________________.
3. Retroactive Child Support.
[Choose if applies]
( ) Mother ( ) Father shall pay to the other party the temporary retroactive child support of
$ __________, as of {date} ___________. This amount shall be paid in the amount of
$ __________ per month, payable in accordance with Obligor's employer's payroll cycle, and in
any event at least once a month ( ) other {explain} ______________________________
___________________________________________________________________________________________
beginning {date} _________________, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
Health/Dental insurance. ( ) Mother ( ) Father shall be required to temporarily maintain
( ) health ( ) dental insurance for the parties' minor child(ren), so long as reasonable in cost
and accessible to the child(ren). The party providing insurance shall be required to convey cards
showing coverage to the other party.
OR
( ) Health ( ) dental insurance is not reasonable in cost and accessible to the child(ren) at this
time.
Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor
child(ren) shall temporarily be assessed as follows:
( ) Shared equally by both parents.
( ) Prorated according to the child support guideline percentages.
*1233
( ) Other {explain}: _____________________________________________________
___________________________________________________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the
expense shall submit request for reimbursement to the other party within 30 days, and the
other party, within 30 days of receipt, shall submit the applicable reimbursement for that
expense, according to the schedule of reimbursement set out in this paragraph.
5. Life Insurance (to secure payment of support). To secure the temporary child support
obligations in this order,( ) Petitioner ( ) Respondent ( ) Each party shall temporarily
maintain life insurance coverage, in an amount of at least $ ________, on ( ) his life ( ) her
life ( ) his/her life naming the ( ) minor child(ren) as the beneficiary (ies) OR naming the
( ) Mother Father ( ) other {name}: ______________________________________________
as trustee for the minor child(ren), so long as reasonably available. The obligation to maintain
the life insurance coverage shall continue until the Court orders otherwise or until {date/event}
______________________________________________________________________________
______________________________________________________________________________
6. IRS Income Tax Deduction(s). The assignment of any tax deduction for the child(ren) shall be as
follows: _______________________________________________________________________
________________________________________________________________________________
7. Other provisions relating to temporary child support: ________________
_________________________________________________________________________________
SECTION VI. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered child support/alimony and arrears, if any, as follows:
1. State Disbursement Unit.
[Choose if applies]
a. ___ Obligor shall pay temporary court-ordered support directly to the State Disbursement
Unit, along with any applicable service charge.
b. ___ Both parties have requested and the court finds that it is in the best interests of the
child(ren) that temporary support payments need not be directed through the State
Disbursement Unit. However, either party may subsequently apply, pursuant to section
61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit.
2. Income Deduction.
[Choose if applies]
_____ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
*1234
paying this temporary support obligation until all of said support is deducted from Obligor's
income. Until temporary support payments are deducted from Obligor's paycheck, Obligor is
responsible for making timely payments directly to the State Disbursement Unit or the Obligee,
as previously set forth in this order.
_____ Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $ ____________, or, if not specified, an amount equal to one month's obligation
occurs. Income deduction is not being implemented immediately based on the following
findings: Income deduction is not in the best interests of the child(ren) because: {explain}
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
AND
there is proof of timely payment of a previously ordered obligation without an income
deduction order in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the central governmental depository of
any change in payor and health insurance OR ( ) there is a signed written agreement
providing an alternative arrangement between the Obligor and the Obligee.
3. Bonus/one-time payments. ( ) All ( ) _______% ( ) No income paid in the form of a bonus or
other similar one-time payment, up to the amount of any arrearage or the remaining balance
thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the payment
method prescribed above.
4. Other provisions relating to method of payment. ___________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SECTION VII. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY
1. ___ ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit
money is (are) denied because __________________________________________________
________________________________________________________________________________.
2. ___ The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and
suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
$ ______ in temporary attorney fees, and $ ________ in costs. The Court further finds that
the temporary attorney fees awarded are based on the reasonable rate of $________ per hour
and ________ reasonable hours. Other provisions relating to temporary attorney fees, costs,
*1235
and suit money are as follows: ___________________________________________
__________________________________________________________________________
__________________________________________________________________________
SECTION VIII. OTHER PROVISIONS
Other Provisions: __________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
DONE AND ORDERED at __________________, Florida on {date} ____________.
________________________________
CIRCUIT JUDGE
A copy of the {name of document(s)} ___________________________ was [Choose one
only] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on
{date} ____________.
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other: ____________________________
When should this form be used?
This form may be used by:
(1) the respondent or the petitioner in a pending dissolution of marriage action. For you to use this form, a petition for dissolution of marriage must have already been filed. You should use this form to ask the court to award any of the following: temporary use of assets; temporary exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary spousal support (alimony); and other relief.
OR
(2) the petitioner in a pending action for support unconnected with a dissolution. For you to use this form, a petition for support unconnected with a dissolution of marriage must have already been filed. You should use this form to ask the court to award temporary spousal support (alimony).
This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition for dissolution of marriage was filed and keep a copy for your records.
A copy of this form, along with all of the other forms required with this motion, must be mailed or hand delivered to the other party in your case. When you have filed all of the required forms, you are ready to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial assistant for information on the local procedure for scheduling a hearing. When you know the date and time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. Words in bold underline in these instructions are defined there. For further information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and rule 1.610, Florida Rules of Civil Procedure.
If you use paragraph 1.c of this form to ask the court to enter a temporary injunction, the court may require you to post a bond.
With this form you must also file the following, if not already filed:
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days if not filed at the time of the petition.)
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932.
Temporary Order ... These family law forms contain a Temporary Support Order with No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(d), which *1237 the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing.
Nonlawyer. Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1238 IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: ________________________ Division: ________________________ _________________________________, Petitioner, and _________________________________, Respondent. MOTION FOR TEMPORARY SUPPORT WITH NO DEPENDENT OR MINOR CHILD(REN) ( ) Petitioner ( ) Respondent requests that the Court enter an order granting the following temporary support: [Complete all that apply] 1. Assets and Liabilities. a. ___ Award temporary exclusive use and possession of the marital home. {address} ________ ______________________________________________________________________________ The Court should do this because: ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ b. ___ Award temporary use and possession of marital assets. {Specify, without using account numbers} ___________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ The Court should do this because: _______________________________________________ _________________________________________________________________________________ _________________________________________________________________________________. c. ___ Enter a temporary injunction prohibiting the parties from disposing of any marital assets, other than ordinary and usual expenses. {Explain} __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent or Minor Child(ren)(10/11) *1239 _____________________________________________________________________________ The Court should do this because: ___________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ d. ___ Require temporary payment of specific marital debts. {Explain, without using account numbers} ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ The Court should do this because: __________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. Support. Award temporary spousal support/alimony of $ ___________ per month. The Court should do this because: ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Attorney's fees and costs. a. ___ Award temporary attorney's fees of $ __________. b. ___ Award temporary costs of $ __________. The Court should do this because: _____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 4. Other Relief. {specify} ____________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 5. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932, is filed with this motion or has already been filed with the Court. 6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), if required, is filed with this motion or has already been filed with the Court. *1240 I request that the Court hold a hearing on this matter and grant the relief specifically requested and any other relief this Court may deem just and proper. I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on {date} ______________________________ Other party or his/her attorney: Name: ______________________________________ Address: ___________________________________ City, State, Zip: __________________________ Fax Number: ________________________________ _____________________________________________ Signature of Party or his/her attorney Printed Name: ________________________________ Address: _____________________________________ City, State, Zip: ____________________________ Telephone Number: ____________________________ Fax Number: __________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} ________________________________________, a nonlawyer, whose address is {street} __________________________________________________, {city} ________________________________________, {state} _________________, {phone} ________, helped {name} _______________________________, who is the petitioner, fill out this form. *1241 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: ________________________ Division: _______________________ _________________________________, Petitioner, and _________________________________, Respondent. TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN) This cause came before this Court for a hearing on a Motion for Temporary Support with No Dependent or Minor Child(ren). The Court, having reviewed the file and heard the testimony, makes these findings of fact and ORDERS as follows: The Court has jurisdiction over the subject matter and the parties. SECTION I. MARITAL ASSETS AND LIABILITIES A. Injunction. 1. ( ) Petitioner ( ) Respondent is (are) prohibited and enjoined from disposing of any marital assets without the written permission of the other party or a court order. If checked here ( ), the person(s) prohibited and enjoined from disposing of any marital assets may continue to pay all ordinary and usual expenses. 2. The Court may enforce compliance with the terms of this injunction through civil and/or indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a fine. 3. Violation of this injunction may constitute criminal contempt of court. 4. Bond. This order is conditioned upon ( ) Petitioner ( ) Respondent posting bond in the sum of $ _________ with the clerk of this Court. B. Temporary Use of Assets. 1. The assets listed below are temporarily determined to be marital assets. Each party shall temporarily have the use of, as his/her own, the assets awarded in this section, and the other party shall temporarily have no further use of said assets. Any personal property not listed *1242 below shall be for the use of party currently in possession of that item(s), and he or she may not dispose of that item(s) without the written permission of the other party or a court order.------------------------------------------------------------------------------------- | | Wife Shall | Husband | | | Have | Shall Have | | ASSETS: DESCRIPTION OF ITEM(S) | Temporary | Temporary | | | Use | Use | |-------------------------------------------------|----------------|------------| | Automobiles | | | |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| | Furniture & furnishings in home | | | |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| | Furniture & furnishings elsewhere | | | |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| | Jewelry | | | |-------------------------------------------------|----------------|------------| | Business interests | | | |-------------------------------------------------|----------------|------------| |-------------------------------------------------|----------------|------------| | Other Assets | | | --------------------------------------------------------------------------------C. Temporary Responsibility for Liabilities/Debts. 1. The liabilities listed below are temporarily determined to be marital. Each party shall pay as his or her own the marital liabilities indicated below and shall keep said payments current. The other party shall temporarily have no further responsibility for the payment of these debts.
*1243
-----------------------------------------------------------------------------------------
| | Current | | |
| LIABILITIES: DESCRIPTION OF DEBT(S) | Amount | Wife | Husband |
| | Owed | Shall Pay | Shall Pay |
|-------------------------------------------------|------------|-----------|------------|
| Mortgages on real estate: (home) |$ |$ |$ |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Charge/credit card accounts | | | |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Auto loan | | | |
|-------------------------------------------------|------------|-----------|------------|
| Auto loan | | | |
|-------------------------------------------------|------------|-----------|------------|
| Bank/Credit Union loans | | | |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Money owed (not evidenced by a note) | | | |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
| Other | | | |
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
|-------------------------------------------------|------------|-----------|------------|
SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME
[Choose all that apply]
1. ___ ( ) Petitioner ( ) Respondent shall have temporary exclusive use and possession of the
dwelling located at: {address} ___________________________________________
___________________________________________________________________________________
until {date or event} ____________________________________________________
___________________________________________________________________________________.
*1244
2. ___ ( ) Petitioner ( ) Respondent may make a visit to the premises described in the paragraph
above for the purpose of obtaining his or her clothing and items of personal health and hygiene
and to obtain any items awarded in this order. This visit shall occur after notice to the person
granted temporary exclusive use and possession of the dwelling and at the earliest convenience
of both parties.
3. ___ Other: ________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
SECTION III. TEMPORARY ALIMONY
1. ( ) The Court denies the request(s) for temporary alimony. OR
( ) The Court finds that there is a need for, and that ( ) Petitioner ( ) Respondent,
hereinafter Obligor, has/had the present ability to pay, temporary alimony as follows:
[Choose all that apply]
a. ___ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the
amount of $ __________ per month, payable ( ) in accordance with Obligor's employer's
payroll cycle, and in any event, at least once a month ( ) other {explain} ___
________________________________________________________________________________,
beginning {date} ________ This temporary periodic alimony shall continue until modified
by court order, the death of either party, or until, {date/event} _________________,
whichever occurs first.
b. ___ Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of
$ __________. This amount shall be paid as follows: __________________________________
______________________________________________________________________________________
______________________________________________________________________________________
c. ___ Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the
amount of $ __________ per month, payable ( ) in accordance with Obligor's employer's
payroll cycle, and in any event, at least once a month ( ) other {explain} _______________
beginning {date} ___________. This temporary rehabilitative alimony shall continue until
modified by court order, the death of either party or until {date/event} ______________,
whichever occurs first. The temporary rehabilitative plan presented demonstrated the
following:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________.
d. ___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ _________ for
the period of {date} __________ through {date} _________, which shall be paid pursuant
to paragraph 3 below.
*1245
2. Reasons for Awarding/Denying Temporary Alimony Award. The reasons for awarding/denying
temporary alimony are as follows:
a. ___ length of the marriage of the party receiving temporary alimony: ______ years;
b. ___ age of party receiving temporary alimony: _____________;
c. ___ health of party receiving temporary alimony: ( ) excellent ( ) good ( ) poor ( )
other ______________________________________________________________________;
d. ___ other factors __________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___ Please indicate here if additional pages are attached.
3. Retroactive Alimony. ( ) Petitioner ( ) Respondent shall pay to the other party the temporary
retroactive alimony of $__________, as of {date} __________ This amount shall be paid in the
amount of $__________ per month, payable in accordance with Obligor's employer's payroll
cycle, and in any event at least once a month ( ) other {explain} ____________________
_______________________________________________________________________________________________,
beginning {date} __________, until paid in full including statutory interest.
4. Insurance.
[Choose all that apply]
a. ___ Health Insurance. ( ) Petitioner ( ) Respondent shall temporarily be required to pay
health insurance premiums for the other party not to exceed $__________ per month. Further,
( ) Petitioner ( ) Respondent shall pay any uninsured medical costs for the other party not
exceed $__________ per year. As to these uninsured medical expenses, the party who is
entitled to reimbursement of the uninsured medical expense shall submit request for
reimbursement to the other party within 30 days, and the other party shall, within 30 days after
receipt, submit the applicable reimbursement for that expense.
b. ___ Life Insurance (to secure payment of support). To secure the temporary alimony
obligations set forth in this order, the Obligor shall temporarily maintain life insurance coverage
on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as reasonably
available. This temporary insurance shall be in the amount of at least $__________ and shall
remain in effect until this temporary obligation for alimony terminates.
5. Other provisions relating to temporary alimony: _________________________
____________________________________________________________________________________
____________________________________________________________________________________
SECTION IV. METHOD OF PAYMENT
Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows:
1. State Disbursement Unit.
[Choose if applies]
a. ___ Obligor shall pay temporary court-ordered support directly to the State Disbursement
*1246
Unit, along with any applicable service charge.
b. ___ Both parties have requested and the court finds that it is in the best interests that
temporary support payments need not be directed through the State Disbursement Unit.
However, either party may subsequently apply to the depository pursuant to section
61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit.
2. Income Deduction.
[Choose if applies]
a. ___ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor is individually responsible for
paying this temporary support obligation until all of said support is deducted from Obligor's
income. Until support payments are deducted from Obligor's paycheck, Obligor is
responsible for making timely payments directly to the State Disbursement Unit or the
Obligee, as previously set forth in this order.
b. ___ Deferred. Income deduction is ordered this day, but it shall not be effective until a
delinquency of $ __________, or, if not specified, an amount equal to one month's
obligation occurs. Income deduction is not being implemented immediately based on the
following findings: there are no minor child(ren) common to the parties,
AND
there is proof of timely payment of a previously ordered obligation without an income
deduction order in cases of modification,
AND
( ) there is an agreement by the Obligor to advise the State Disbursement Unit of any
change in payor and health insurance OR ( ) there is a signed written agreement providing
an alternative arrangement between the Obligor and the Obligee.
3. Bonus/one-time payments. ( ) All ( ) __________% ( ) No income paid in the form of a
bonus or other similar one-time payment, up to the amount of any arrearage or the remaining
balance thereof owed pursuant to this order, shall be forwarded to Obligee pursuant to the
payment method prescribed above.
4. Other provisions relating to method of temporary payment: _________________
_____________________________________________________________________________________
_____________________________________________________________________________________
SECTION V. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY
1. ___ ( ) Petitioner's ( ) Respondent's request(s) for temporary attorney fees, costs, and suit
money is (are) denied because _______________________________________________________
____________________________________________________________________________________.
*1247
2. ___ The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and
suit money. ( ) Petitioner ( ) Respondent is hereby ordered to pay to the other party
$ _________ in temporary attorney fees, and $__________ in costs. The Court further finds
that the temporary attorney fees awarded are based on the reasonable rate of $__________
per hour and ___________________________________________________________________________
reasonable hours. Other provisions relating to temporary attorney fees, costs, and suit money
are as follows: _______________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
SECTION VI. OTHER PROVISIONS
Other Provisions: _________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
DONE AND ORDERED in _______________________, Florida on {date} __________________.,
__________________________________________________
CIRCUIT JUDGE
COPIES TO:
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
State Disbursement Unit
Other: ____________________________
This form should be used by a birth mother or father to ask the court to establish paternity, a time-sharing schedule, and/or child support of a minor child or children. This means that you are trying to legally establish who is the father of the child(ren).
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records.
For your case to proceed, you must properly notify the respondent of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives, you may use constructive service. However, if constructive service is used, the court may only grant limited relief. You should seek legal advice on constructive service in a paternity case. For more information see chapter 49, Florida Statutes, or you may contact Child Support Enforcement at the Florida Department of Revenue if you need assistance with your case.
If personal service is used, the respondent has 20 days to answer after being served with your petition. Your case will then generally proceed in one of the following three ways:
DEFAULT ... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
UNCONTESTED ... If the respondent files an answer that agrees with everything in your petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED ... If the respondent files an answer or an answer and counterpetition, which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure, completed the scientific paternity testing, if necessary, and filed all of the required papers. Then you should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If the respondent files an answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.983(d).
Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms. The words that are in "bold underline" in these instructions are defined there. For further information, see chapter 742, Florida Statutes.
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred.
More than one child of the same alleged father may be listed on a single petition. However, if you are filing a paternity action involving more than one possible father, a separate petition must be filed for each alleged father.
If the respondent files an answer denying that the person named in the petition is the child(ren)'s father, one of you should file a Motion for Scientific Paternity Testing, Florida Supreme Court Approved Family Law Form 12.983(e). This is used to ask the court to order a scientific test to determine who is the child(ren)'s father.
If the father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be indicated on page 2, section 9a on this form.
If the paternity of a child who was conceived or born during a marriage is at issue, the court may appoint a guardian ad litem to assist the court in this matter and to protect the rights of child.
With this petition, you must file the following and provide a copy to the other party:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days, if not filed with the petition, unless you and the other party have agreed not to exchange these documents.)
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.)
Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a), 12.995(b), or 12.995(c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Parenting Plan and Time-Sharing. If the parties are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor or dependent child(ren).
The judge may request a parenting plan recommendation or appoint a guardian *1250 ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) are being served. For more information, you may consult sections 61.401-61.405, Florida Statutes.
Listed below are some terms with which you should become familiar before completing your petition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
Shared Parental Responsibility
Sole Parental Responsibility
Supervised Time-Sharing
No contact
Parenting Plan
Parenting Plan Recommendation
Time-Sharing Schedule
Many circuits require that parents of a minor or dependent child(ren) who are involved in dissolution or paternity actions attend mediation before being allowed to schedule a final hearing. A parenting course must be completed prior to entry of the final judgment. You should check with your local clerk of court's office, family law intake staff, or judicial assistant for more information on the parenting course and mediation requirements in your area.
Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1251 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: ________________________ Division: _______________________ _________________________________, Petitioner, and _________________________________, Respondent. PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF Petitioner, {full legal name} ____________________________, being sworn, certifies that the following information is true: This is an action for paternity and to determine parental responsibility, time-sharing, and child support under chapter 742, Florida Statutes. SECTION I. 1. Petitioner is the [ ] mother [ ] father of the following minor child(ren): Name Birth date (1). ____________________________________________________________________ (2). ____________________________________________________________________ (3). ____________________________________________________________________ (4). ____________________________________________________________________ (5). ____________________________________________________________________ (6). ____________________________________________________________________ 2. Petitioner's current address is: {street address, city, state} _________________ __________________________________________________________________________. 3. Respondent's current address is: {street address, city, state} ____________________________________________________________________________ 4. Both parties are over the age of 18. 5. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service. Respondent [Choose only one] ( ) is ( ) is not a member of the military service. Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related Relief (10/11) *1252 6. Neither Petitioner nor Respondent is mentally incapacitated. 7. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this petition. 9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or(c), is, or will be, filed. 10. Paternity Facts. [Choose only one] a. ___ Paternity has previously been established as a matter of law. b. ___ The parties engaged in sexual intercourse with each other in the month(s) of {list month(s) and year(s}} ____________in {city and state} ________________________________________ c. As a result of the sexual intercourse, [ ] Petitioner [ ] Respondent conceived and gave birth to the minor child(ren) named in paragraph 1. [ ] Petitioner [ ] Respondent is the natural father of the minor child(ren). The mother [ ] was [ ] was not married at the time of the conception and/or birth of the minor child(ren) named in paragraph 1. If the mother was married, the name and address of her husband at the time of conception and/or birth is: _____________________________________________________________________________ _____________________________________________________________________________ SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING 1. The minor child(ren) currently reside(s) with [ ] Mother [ ]Father [ ] Other: {explain} _______ _________________________________________________________________________________ 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [Choose only one] a. ___ shared by both Father and Mother. b. ___ awarded solely to [ ] Father [ ] Mother. Shared parental responsibility would be detrimental to the child(ren) because: ____________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be ordered to comply with a Parenting Plan that [ ] includes [ ] does not include parental time-sharing with the child(ren). The Petitioner states that it is in the best interests of the child(ren) that: [Choose only one] a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties [ ] have [ ] have not agreed to the Parenting Plan. b. ___ The court should establish a Parenting Plan with the following provisions: [ ] No time-sharing for the [] Father [ ] Mother [ ] Limited time-sharing with the [ ] Father [ ] Mother [ ] Supervised time-sharing for the [ ] Father [ ] Mother. *1253 [ ] Supervised or third-party exchange of the child(ren). [ ] Time-sharing schedule as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Explain why this schedule is in the best interests of the child(ren): ________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. The minor child(ren) should [Choose only one] a. ___ retain his/her (their) present name(s). b. ___ receive a change of name as follows: present name(s) be changed to (1). ________________________________ (1). ___________________________ (2). ________________________________ (2). ___________________________ (3). ________________________________ (3). ___________________________ (4). ________________________________ (4). ___________________________ (5). ________________________________ (5). ___________________________ (6). ________________________________ (6). ___________________________ c. The name change would be in the best interest of the child(ren) because: _______ ______________________________________________________________________________ SECTION III. CHILD SUPPORT [Choose as applicable] 1. ___ Petitioner requests that the Court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such support should be ordered retroactive to: [Choose only one] a. ___ the date when the parents did not reside together in the same household with the child, not to exceed a period of 24 months before the date of filing of this petition. b. ___ the date of the filing of this petition. c. ___ other: {date} ___________. {Explain} _______________________ __________________________________________________________________________________ 2. ___ Petitioner requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Petitioner understands that a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be completed before the Court will consider this request. 3. ___ Petitioner requests that medical/dental insurance for the minor child(ren) be provided by: [Choose only one] a. ___ Father. b. ___ Mother. *1254 4. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid by: [Choose only one] a. ___ Father. b. ___ Mother. c. ___ Father and Mother each pay one-half. d. ___ Father and Mother each pay according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). e. ___ Other {explain}: __________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 5. ___ Petitioner requests that life insurance to secure child support be provided by: [Choose only one] a. ___ Father. b. ___ Mother. c. ___ Both 6. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) incurred medical expenses in the amount of $ __________ on behalf of the minor child(ren), including hospital and other expenses incidental to the birth of the minor child(ren). There should be an appropriate allocation or apportionment of these expenses. 7. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) received past public assistance for this (these) minor child(ren). PETITIONER'S REQUEST 1. Petitioner requests a hearing on this petition and understands that he or she must attend the hearing. 2. Petitioner requests that the Court enter an order that: [Choose all that apply] a. ____ establishes paternity of the minor child(ren), ordering proper scientific testing, if necessary; b. ____ adopts or establishes a Parenting Plan containing provisions for parental responsibility and time-sharing for the minor or dependent child(ren); d. ____ awards child support, including medical/dental insurance for the minor child(ren); e. ____ determines the appropriate allocation or apportionment of all expenses incidental to the birth of the child(ren), including hospital and medical expenses; f. ____ determines the appropriate allocation or apportionment of all other past, present, and future medical and dental expenses incurred or to be incurred on behalf of the minor child(ren); g. ____ changes the child(ren)'s name(s); h. ____ other relief as follows: __________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________________________________________________________________ and grants such other relief as may be appropriate and in the best interests of the minor child(ren). *1255 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________ _________________________________________________ Signature of PETITIONER Printed Name: ___________________________________ Address: ________________________________________ City, State, Zip: _______________________________ Telephone Number: _______________________________ Fax Number: _____________________________________ STATE OF FLORIDA COUNTY OF ____________________ Sworn to or affirmed and signed before me on ____________ by ____________________________. ____________________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________ [Print, type, or stamp commissioned name of notary or deputy clerk.] ____ Personally known ____ Produced identification ____ Type of identification produced __________________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer} _______________________________________, a nonlawyer, whose address is {street} __________________, {city} _____________, {state} _____________, {phone} ______, helped {name} ______________, who is the petitioner, fill out this form.This form should be used when you are responding to a petition to determine paternity and asking the court for something different than what was in the petition, such as parental responsibility, time-sharing, and child support. The answer is used to admit or deny the allegations contained in the petition, and the counterpetition is used to ask for whatever you want the court to do for you. The other party has 20 days to answer your counterpetition after being served with your counterpetition.
This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.
You have 20 days to file an answer or answer and counterpetition to the other party's petition. A copy of this form, along with all of the other forms required with this answer and counterpetition, must be mailed or hand delivered to the other party in your case.
If you deny that the person named in the petition is the child(ren)'s father, a Motion for Scientific Paternity Testing Florida Supreme Court Approved Family Law Form 12.983(e), should be filed. This is used to ask the court to order a scientific test to determine who is the child(ren)'s father.
After you file an answer and counterpetition, the case will then generally proceed as follows:
UNCONTESTED. This case is uncontested if you and the other party agree on all issues raised in the petition and the counterpetition. If this is the case, and you and the other party have complied with mandatory disclosure and filed all of the required papers, either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the other party of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED. This case is contested if you and the other party disagree on any issues raised in the petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and filed all of the required papers. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing).
Before proceeding, you should read General Information for Self-Represented Litigants for some basic information. The words that are in bold underline in these instructions are defined there. For further information, see chapter 742, Florida Statutes.
If the child(ren)'s father signed papers at the hospital acknowledging that he was the father, paternity was established as a matter of law. This should be checked on page 2, section 9a of the counterpetition part of this form. With this answer, you must file the following:
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).
Notice of Social Security Number Florida Supreme Court Approved Family Law Form 12.902(j).
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). (This must be filed within 45 days of service of the petition on you if not filed with this answer.)
Certificate of Compliance with Mandatory Disclosure Florida Family Law Rules of Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed with this answer, unless you and the other party have agreed not to exchange these documents.)
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If you do not know the other party's income, you may file this worksheet after his or her financial affidavit has been filed.)
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or (c). If the parents have reached an agreement, a signed and notarized Parenting Plan should be attached. If the parents have not reached an agreement, a proposed Parenting Plan may be filed.
Many jurisdictions may require the completion of mediation before a final hearing may be set. A parenting course must be completed prior to entry of the final judgment. You should contact the office of your local clerk of court, family law intake staff, or the judicial assistant about requirements for parenting courses or mediation where you live.
Parenting Plan and Time-Sharing. If the parties are unable to agree on parenting arrangements and a time-sharing schedule, a judge will decide as part of establishing a Parenting Plan. The judge will decide the parenting arrangements and time-sharing schedule based on the child(ren)'s best interests. Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues relating to minor child(ren).
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. This means that a neutral person will review your situation and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is being served. For more information, you may consult section 61.401 and 61.405, Florida Statutes.
Listed below are some terms with which you should become familiar before completing your answer and counterpetition. If you do not fully understand any of the terms below or their implications, you should speak with an attorney before going any further.
Shared Parental Responsibility
Sole Parental Responsibility
Supervised Time-Sharing
No contact
Parenting Plan
Parenting Plan Recommendations
Time-Sharing Schedule
*1258 Child Support. The court may order one parent to pay child support to assist the other parent in meeting the child(ren)'s material needs. Both parents are required to provide financial support, but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent.
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines are based on the combined income of both parents and take into account the financial contributions of both parents. You should file a financial affidavit, and the other parent will be required to do the same. From your financial affidavits, you should be able to calculate the amount of child support that should be paid. Because the child support guidelines take several factors into consideration, change over time, and vary from state to state, your child support obligation may be more or less than that of other people in seemingly similar situations.
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved or established by the court. If the parties have reached an agreement, you should file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), 12.995(b), or 12.995(c), which addresses the time-sharing schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be filed. A Parenting Plan will be established by the court.
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. If so, you should type or print the heading, including the circuit, county, case number, division, and the parties' names, and leave the rest blank for the judge to complete at your hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.
*1259 IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, IN AND FOR ______________________________ COUNTY, FLORIDA Case No: _____________________ Division: ____________________ _________________________________, Petitioner, and _________________________________, Respondent. ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF I, {full legal name} ______________________________________, Respondent, being sworn, certify that the following information is true: ANSWER TO PETITION 1. I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, admit those allegations: {indicate section and paragraph number} ___________________________________________________________________________________ ___________________________________________________________________________________. 2. I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in the Petition and, therefore, deny those issues: {indicate section and paragraph number} ___________________________________________________________________________________ ___________________________________________________________________________________. 3. I currently am unable to admit or deny the following paragraphs due to lack of information: {indicate section and paragraph number} __________________________________________________ _____________________________________________________________________________________. COUNTERPETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF SECTION I. PATERNITY 1. Respondent is the [ ] mother [ ] father of the following minor child(ren): Name Birth Date (1). __________________________________________________________________________ (2). __________________________________________________________________________ (3). __________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine Paternity and for Related Relief (10/11) *1260 (4). __________________________________________________________________________ (5). __________________________________________________________________________ (6). __________________________________________________________________________ 2. Petitioner's current address is: {street address, city, state} ______________________________________________________________________________ ______________________________________________________________________________. 3. Respondent's current address is: {street address, city, state} ______________________________________________________________________________ ______________________________________________________________________________. 4. Both parties are over the age of 18. 5. Petitioner [Choose only one] ( ) is ( ) is not a member of the military service. Respondent [Choose only one] ( ) is ( ) is not a member of the military service. 6. Neither Petitioner nor Respondent is mentally incapacitated. 7. A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition. 8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), is filed with this counterpetition. 9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), [ ] is,or [ ] will be, filed. 10. Paternity Facts. [Choose only one] a. ___ Paternity has previously been established as a matter of law. b. ___ The parties engaged in sexual intercourse with each other in the month(s) of {list month(s) and year(s)} ____________, in: {city and state} _______________________________________________________________________. As a result of the sexual intercourse, [ ] Petitioner [ ] Respondent conceived and gave birth to the minor child(ren) named in paragraph 1. [ ] Petitioner [ ] Respondent is the natural father of the minor child(ren). The mother [ ] was [ ] was not married at the time of the conception and/or birth of the minor child(ren) named in paragraph I. If the mother was married, the name and address of her husband at the time of conception and/or birth is: ________________________________________________________________________ ____________________________________________________________________________. SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING 1. The minor child(ren) currently reside(s) with [ ] Mother [ ] Father [ ] Other: {explain} _____ Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine Paternity and for Related Relief (10/11) *1261 _______________________________________________________________________________. 2. Parental Responsibility. It is in the child(ren)'s best interests that parental responsibility be: [Choose only one] a. ___ shared by both Father and Mother. b. ___ awarded solely to [ ] Father [ ] Mother. Shared parental responsibility would be detrimental to the child(ren) because:_________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________. 3. Parenting Plan and Time-Sharing. It is in the best interests of the child(ren) that the family be ordered to comply with a Parenting Plan that [ ] includes [ ] does not include parental time-sharing with the child(ren). The Respondent states that it is in the best interests of the child(ren) that: [Choose only one] a. ___ The attached proposed Parenting Plan should be adopted by the court. The parties [ ] have [ ] have not agreed to the Parenting Plan. b. ___ The court should establish a Parenting Plan with the following provisions: [ ] No time-sharing for the [ ] Father [ ] Mother. [ ] Limited time-sharing with the [ ] Father [ ] Mother. [ ] Supervised time-sharing for the [ ] Father [ ] Mother [ ] Supervised or third-party exchange for the child(ren). [ ] Time-sharing schedule as follows: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________. 4. Explain why this request is in the best interest of the child(ren):________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 5. The minor child(ren) should:[Choose only one] a. retain his/her (their) present name(s). b. receive a change of name as follows: *1262 present name(s) be changed to (1)._________________________ (1)._________________________ (2)._________________________ (2)._________________________ (3)._________________________ (3)._________________________ (4)._________________________ (4)._________________________ (5)._________________________ (5)._________________________ (6)._________________________ (6)._________________________ SECTION III. CHILD SUPPORT [Choose all that apply] 1. Respondent requests that the court award child support as determined by Florida's child support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such support should be ordered retroactive to: [Choose only one] a. ___ the date when the parents did not reside together in the same household with the child, not to exceed a period of 24 months before the date of filing of this counterpetition. b. ___ the date of the filing of this petition. c. ___ other: {date}______________. {Explain} _____________________________ ___________________________________________________________________________ 2. ___ Respondent requests that the Court award a child support amount that is more than or less than Florida's child support guidelines. Respondent understands that a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be completed before the Court will consider this request. 3. ___ Respondent requests that medical/dental insurance for the minor child(ren) be provided by: [Choose only one] a. ___ Father. b. ___ Mother. 4. ___ Respondent requests that uninsured medical/dental expenses for the child(ren) be paid by: [Choose only one] a. ___ Father. b. ___ Mother. c. ___ Father and Mother each pay one-half. d. ___ Father and Mother each pay according to the percentages in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). e. ___ Other {explain}: ___________________________________________________ ____________________________________________________________________ ____________________________________________________________________. *1263 5. ___ Respondent requests that life insurance to secure child support be provided by: [Choose only one] a. ___ Father. b. ___ Mother. c. ___ Both. 6. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) incurred medical expenses in the amount of $______ on behalf of the minor child(ren), including hospital and other expenses incidental to the birth of the minor child(ren). There should be an appropriate allocation or apportionment of these expenses. 7. ___ [ ] Petitioner [ ] Respondent [ ] Both has (have) received past public assistance for this (these) minor child(ren). RESPONDENT'S REQUEST 1. Respondent requests a hearing on this petition and understands that he or she must attend the hearing. 2. Respondent requests that the Court enter an order that: [Choose all that apply] a. ___ establishes paternity of the minor child(ren), ordering proper scientific testing, if necessary; b. ___ establishes a Parenting Plan containing provisions for parental responsibility and time-sharing for the minor or dependent child(ren); c. ___ awards child support, including medical/dental insurance, for the minor child(ren); d. ___ determines the appropriate allocation or apportionment of all expenses incidental to the birth of the child(ren), including hospital and medical expenses; e. ___ determines the appropriate allocation or apportionment of all other past, present, and future medical and dental expenses incurred or to be incurred on behalf of the minor child(ren); f. ___ changes the child(ren)'s name(s); and g. ___ other relief as follows:_____________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ ___________________________________________________________________________; and grants such other relief as may be appropriate and in the best interests of the minor child(ren). *1264 I certify that a copy of this document was [Choose only one] ( ) mailed ( ) faxed and mailed ( ) hand-delivered to the person(s) listed below on {date}___________________. Petitioner or his/her attorney: Name:____________________ Address:_________________ City, State, Zip:________ Fax Number:______________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this answer and counterpetition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated:____________________ ___________________________________________ Signature of Respondent/Counterpetitioner Printed Name: _____________________________ Address:___________________________________ City, State, Zip:__________________________ Telephone Number:__________________________ Fax Number:________________________________ STATE OF FLORIDA COUNTY OF_____________________ Sworn to or affirmed and signed before me on____________ by _____________________. ____________________________________________ NOTARY PUBLIC or DEPUTY CLERK ____________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___Personally known ___Produced identification Type of identification produced____________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer}___________________________________, a nonlawyer, whose address is {street}_______________, {city}_____________, {state}______________, {phone}______________, helped {name}_________, who is the respondent, fill out this form.A Parenting Plan is required in all cases involving time-sharing with minor child(ren), even when time-sharing is not in dispute. The Parenting Plan must be developed and agreed to by the parents and approved by the court. If the parties cannot agree to a Parenting Plan or if the parents agreed to a plan that is not approved by the court, a Parenting Plan will be established by the court with or without the use of parenting plan recommendations. This form or a similar form should be used in the development of a Parenting Plan. If the case involves supervised time-sharing, the Safety Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b) or a similar form should be used. If the case involves relocation, pursuant to Section 61.13001, Florida Statutes, then a Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used.
This form should be typed or printed in black ink. Please either delete or strike-through terms or paragraphs that are inappropriate or in applicable to your agreement. If an agreement has been reached, both parties must sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). If the parents have not reached an agreement, a proposed Parenting Plan may be filed by either parent at the time of or any time prior to the final hearing. If an agreed Parenting Plan is not filed by the parties, the court shall establish a Plan.
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 the instructions for the petition and/or answer that were filed in this case.
At a minimum, the Parenting Plan must describe in adequate detail:
How the parties will share and be responsible for the daily tasks associated with the upbringing of the child(ren),
The time-sharing schedule arrangements that specify the time that the minor child(ren) will spend with each parent,
A designation of who will be responsible for any and all forms of health care, school-related matters, including the address to be used for school-boundary determination and registration, other activities, and
The methods and technologies that the parents will use to communicate with the child(ren).
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. Determination of the best interests *1266 of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest of the particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida Statutes, including, but not limited to:
The demonstrated capacity and disposition of each parent to facilitate and encourage a close and continuing parent-child relationship, to honor the time-sharing schedule, and to be reasonable when changes are required;
The anticipated division of parental responsibilities after the litigation, including the extent to which parental responsibilities will be delegated to third parties;
The demonstrated capacity and disposition of each parent to determine, consider, and act upon the needs of the child(ren) as opposed to the needs or desires of the parent;
The length of time the child(ren) has lived in a stable, satisfactory environment and the desirability of maintaining continuity;
The geographic viability of the parenting plan, with special attention paid to the needs of school-age children and the amount of time to be spent traveling to effectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);
The moral fitness of the parents;
The mental and physical health of the parents;
The home, school, and community record of the child(ren);
The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient intelligence, understanding, and experience to express a preference;
The demonstrated knowledge, capacity, and disposition of each parent to be informed of the circumstances of the minor child(ren), including, but not limited to, the child(ren)'s friends, teachers, medical care providers, daily activities, and favorite things;
The demonstrated capacity and disposition of each parent to provide a consistent routine for the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;
The demonstrated capacity of each parent to communicate with and keep the other parent informed of issues and activities regarding the minor child(ren), and the willingness of each parent to adopt a unified front on all major issues when dealing with the child(ren);
Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child neglect, regardless of whether a prior or pending action relating to those issues has been brought. If the court accepts evidence of prior or pending actions regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect, the court must specifically acknowledge in writing that such evidence was considered when evaluating the best interests of the child(ren);
Evidence that either parent has knowingly provided false information to the court regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect;
The particular parenting tasks customarily performed by each parent and the division or parental responsibilities before the institution of litigation and during the pending litigation, including the extent to which parenting responsibilities were undertaken by third parties;
*1267 The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)'s school and extracurricular activities;
The demonstrated capacity and disposition of each parent to maintain an environment for the child(ren) which is free from substance abuse;
The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation as demonstrated by not discussing the litigation with the child(ren), not sharing documents or electronic media related to the litigation with the child(ren), and refraining from disparaging comments about the other parent to the child(ren); and
The developmental stages and needs of the child(ren) and the demonstrated capacity and disposition of each parent to meet the child(ren)'s developmental needs.
This standard form does not include every possible issue that may be relevant to the facts of your case. The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional provisions should be added to address all of the relevant factors. The parties should give special consideration to the age and needs of each child.
In developing the Parenting Plan, you may wish to consult or review other materials which are available at your local library, law library or through national and state family organizations.
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.
*1268 IN THE CIRCUIT COURT OF THE_____________JUDICIAL CIRCUIT IN AND FOR_______________COUNTY, FLORIDA Case No:____________________ Division:___________________ ____________________ Petitioner, and ____________________ Respondent. PARENTING PLAN This Parenting Plan is: (Choose only one) [ ] A Parenting Plan submitted to the court with the agreement of the parties. [ ] A proposed Parenting Plan submitted by or on behalf of: {Parent's Name}____________________. [ ] A Parenting Plan established by the court. This Parenting Plan is: (Choose only one) [ ] A final Parenting Plan established by the court. [ ] A temporary Parenting Plan established by the court. [ ] A modification of a prior final Parenting Plan or prior final order. I. PARENTS Mother Name:______________________________________________________________ Address:___________________________________________________________ Telephone Number:__________________________________________________ E-Mail:____________________________________________________________ ( ) Address Unknown: (Please indicate here if mother's address is unknown) ( ) Address Confidential: (Please indicate here if mother's address and phone numbers are confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence, or ( ) Other court order_____________________________________________). Father Name:_______________________________________________________________ Address:____________________________________________________________ Telephone Number:___________________________________________________ E-Mail:_____________________________________________________________ ( ) Address Unknown: (Please indicate here if father's address is unknown) Florida Supreme Court Approved Family Law Form 12,995(a), Parenting Plan (10/11) *1269 ( ) Address Confidential: (Please indicate here if father's address and phone numbers are confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence or ( ) Other court order)__________________________________________________). II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties: (add additional lines as needed) Name Date of Birth _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ III. JURISDICTION The United States is the country of habitual residence of the child(ren). The State of Florida is the child(ren)'s home state for the purposes of the Uniform Child Custody Jurisdiction and Enforcement Act. This Parenting Plan is a child custody determination for the purposes of the Uniform Child Custody Jurisdiction and Enforcement Act, the international Child Abduction Remedies Act, 42 U.S.C. Sections 11601 et seq., the Parental Kidnapping Prevention Act, and the Convention on the Civil Aspects of International Child Abduction enacted at the Hague on October 25, 1980, and for all other state and federal laws. Other:___________________________________________________. IV. PARENTAL RESPONSIBILITY AND DECISION MAKING 1. Parental Responsibility (Choose only one) [ ] Shared Parental Responsibility. It is in the best interests of the child(ren) that the parents confer and jointly make all major decisions affecting the welfare of the child(ren). Major decisions include, but are not limited to, decisions about the child(ren)'s education, healthcare, and other responsibilities unique to this family. OR [ ] Shared Parental Responsibility with Decision Making Authority It is in the best interests of the child(ren) that the parents confer and attempt to agree on the major decisions involving the child(ren). If the parents are unable to agree, the authority for making major decisions regarding the child(ren) shall be as follows: *1270 Education/Academic decisions [ ] Mother [ ] Father Non-emergency health care [ ] Mother [ ] Father __________________ [ ] Mother [ ] Father __________________ [ ] Mother [ ] Father __________________ [ ] Mother [ ] Father OR [ ] Sole Parental Responsibility: It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole authority to make major decisions for the child(ren.) It is detrimental to the child(ren) to have shared parental responsibility. 2. Day-to-Day Decisions Unless otherwise specified in this plan, each parent shall make decisions regarding day-to-day care and control of each child, including the performance of daily tasks, while the child is with that parent. Regardless of the allocation of decision making in this Parenting Plan, either parent may make emergency decisions affecting the health or safety of the child(ren) when the child is residing with that parent. A parent who makes an emergency decision shall share the decision with the other parent as soon as reasonably possible. 3. Extra-curricular Activities (Choose all that apply) [ ] Either parent may register the child(ren) and allow them to participate in the activity of the child(ren)'s choice. [ ] The parents must mutually agree to all extra-curricular activities. [ ] The parent with the minor child(ren) shall transport the minor child(ren) to and/or from all mutually agreed upon extra-curricular activities, providing all necessary uniforms and equipment within the parent's possession. [ ] The costs of the extra-curricular activities shall be paid by: Mother_______% Father_______% [ ] The uniforms and equipment required for the extra-curricular activities shall be paid by: Mother_______% Father_______% [ ] Other:________________________________________________ . V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court: *1271 Unless otherwise prohibited by law, each parent shall have access to medical and school records and information pertaining to the child(ren) and shall be permitted to independently consult with any and all professionals involved with the child(ren). The parents shall cooperate with each other in sharing information related to the health, education, and welfare of the child(ren) and they shall sign any necessary documentation ensuring that both parents have access to said records. Each parent shall be responsible for obtaining records and reports directly from the school and health care providers. Both parents have equal rights to inspect and receive governmental agency and law enforcement records concerning the child(ren). Both parents shall have equal and independent authority to confer with the child(ren)'s school, day care, health care providers, and other programs with regard to the child(ren)'s educational, emotional, and social progress. Both parents shall be listed as "emergency contacts" for the child(ren). Each parent has a continuing responsibility to provide a residential, mailing, and contact address and contact telephone number to the other parent. Each parent shall notify the other parent in writing within 24 hours of any changes. Each parent shall notify the court in writing within seven (7) days of any changes. Other:________________________________________________________ __________________________________________________________. VI. SCHEDULING 1. School Calendar If necessary, on or before__________of each year, both parents should obtain a copy of the school calendar for the next school year. The parents shall discuss the calendars and the time-sharing schedule so that any differences or questions can be resolved. The parents shall follow the school calendar of: (Choose all that apply) [ ] the oldest child [ ] the youngest child [ ] the school calendar for_____________ County [ ] the school calendar for_____________ School 2. Academic Break Definition When defining academic break periods, the period shall begin at the end of the last scheduled day of classes before the holiday or break and shall start on the first day of regularly scheduled classes after the holiday or break. *1272 3. Schedule Changes (Choose all that apply) [ ] A parent making a request for a schedule change will make the request as soon as possible, but in any event, except in cases of emergency, no less than _________ before the change is to occur. [ ] A parent requesting a change of schedule shall be responsible for any additional child care, or transportation costs caused by the change. [ ] Other________________________________________________. VII. TIME-SHARING SCHEDULE 1. Weekday and Weekend Schedule The following schedule shall apply beginning on__________________with the [ ] Mother [ ] Father and continue as follows: A. The child(ren) shall spend time with the Mother on the following dates and times: WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)____________________ From___________________________ to____________________________ WEEKDAYS: Specify days________________________________________ From___________________________ to____________________________ OTHER: (Specify)______________________________________________ ______________________________________________________________ ______________________________________________________________. B. The child(ren) shall spend time with the Father on the following dates and times: WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)______________ From_______________________ to ___________________________ WEEKDAYS: Specify days________________________________________ From___________________________ to ___________________________ OTHER: (Specify)______________________________________________ ______________________________________________________________ ______________________________________________________________. C. Please indicate if there is a different time-sharing schedule for any child. Complete a separate Attachment for each child for whom there is a different time-sharing schedule. *1273 [ ] There is a different time-sharing schedule for the following child(ren) in Attachment____. ___________________, and___________________. (Name of Child) (Name of Child) 2. Holiday Schedule (Choose only one) [ ] No holiday time-sharing shall apply. The regular time-sharing schedule set forth above shall apply. [ ] Holiday time-sharing shall be as the parties agree. [ ] Holiday time-sharing shall be in accordance with the following schedule. The holiday schedule will take priority over the regular weekday, weekend, and summer schedules. Fill in the blanks with Mother or Father to indicate where the child(ren) will be for the holidays. Provide the beginning and ending times. If a holiday is not specified as even, odd, or every year with one parent, then the child(ren) will remain with the parent in accordance with the regular schedule Holidays Even Years Odd Years Every Year Begin/End Time Mother's Day __________ _________ __________ __________________ Father's day __________ _________ __________ __________________ President's Day __________ _________ __________ __________________ Martin Luther King Day __________ _________ __________ __________________ Easter __________ _________ __________ __________________ Passover __________ _________ __________ __________________ Memorial Day Weekend __________ _________ __________ __________________ 4th of July __________ _________ __________ __________________ Labor Day Weekend __________ _________ __________ __________________ Columbus Day Weekend __________ _________ __________ __________________ Halloween __________ _________ __________ __________________ Thanksgiving __________ _________ __________ __________________ Veteran's Day __________ _________ __________ __________________ Hanukkah __________ _________ __________ __________________ Yom Kippur __________ _________ __________ __________________ Rosh Hashanah __________ _________ __________ __________________ Child(ren)'s Birthdays __________ _________ __________ __________________ __________ __________ _________ __________ __________________ __________ __________ _________ __________ __________________ This holiday schedule may affect the regular Time-Sharing Schedule. Parents may wish to specify one or more of the following options: *1274 [ ] When the parents are using an alternating weekend plan and the holiday schedule would result in one parent having the child(ren) for three weekends in a row, the parents will exchange the following weekend, so that each has two weekends in a row before the regular alternating weekend pattern resumes. [ ] If a parent has the child(ren) on a weekend immediately before or after an unspecified holiday or non-school day, they shall have the child(ren) for the holiday or non-school day. 3. Winter Break A. Entire Winter Break (Choose only one) [ ] The [ ] Mother [ ] Father shall have the child(ren) from the day and time school is dismissed until December____ at___ a.m./p.m in [ ]odd-numbered years [ ] even-numbered years [ ] every year. The other parent will have the children for the second portion of the Winter Break. The parties shall alternate the arrangement each year. [ ] The [ ] Mother [ ] Father shall have the child(ren) for the entire Winter Break during [ ] odd-numbered years [ ] even-numbered years [ ] every year. [ ] Other:_______________________________________________ _______________________________________________ _______________________________________________. B. Specific Winter Holidays If not addressed above, the specific Winter Holidays such as Christmas, New Year's Eve, Hanukkah, Kwanzaa, etc. and shall be shared as follows: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________. 4. Spring Break (Choose only one) [ ] The parents shall follow the regular schedule. [ ] The parents shall alternate the entire Spring Break with the Mother having the child(ren) during the [ ]odd-numbered years [ ]even numbered years. [ ] The [ ] Father [ ] Mother shall have the child(ren) for the entire Spring Break every year. *1275 [ ] The Spring Break will be evenly divided. The first half of the Spring Break will go to the parent whose regularly scheduled weekend falls on the first half and the second half going to the parent whose weekend falls during the second half. [ ] Other:__________________________________________________. 5. Summer Break (Choose only one) [ ] The parents shall follow the regular schedule through the summer. [ ] The [ ] Mother [ ] Father shall have the entire Summer Break from_________after school is out until____________before school starts. [ ] The parents shall equally divide the Summer Break. During [ ] odd-numbered years [ ] even numbered years, the [ ] Mother [ ] Father shall have the children from _______after school is out until________. The other parent shall have the child(ren) for the second one-half of the Summer Break. The parents shall alternate the first and second one-halves each year unless otherwise agreed. During the extended periods of time-sharing, the other parent shall have the child(ren)________________. [ ] Other:___________________________________________________________ _________________________________________________________________. 6. Number of Overnights: Based upon the time-sharing schedule, the Mother has a total of_____overnights per year and the Father has a total of_____overnights per year. Note: The two numbers must equal 365. 7. [ ] If not set forth above, the parties shall have time-sharing in accordance with the schedule which is attached and incorporated herein. VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN) 1. Transportation (Choose only one) [ ] The [ ] Mother [ ] Father shall provide all transportation. [ ] The parent beginning their time-sharing shall provide transportation for the child(ren). [ ] The parent ending their time-sharing shall provide transportation for the child(ren). [ ] Other: __________________________________________________________. *1276 2. Exchange Both parents shall have the child(ren) ready on time with sufficient clothing packed and ready at the agreed upon time of exchange. If a parent is more than _____minutes late without contacting the other parent to make other arrangements, the parent with the child(ren) may proceed with other plans and activities. (Choose only one): [ ] Exchanges shall be at Mother's and Father's homes unless both parents agree to a different meeting place. [ ] Exchanges shall occur at ___________________________________________ _____________________________________________________________unless both parties agree in advance to a different meeting place. [ ] Other: ________________________________________________________ 3. Transportation Costs (Choose only one) [ ] Transportation costs are included in the Child Support Worksheets and/or the Order for Child Support and should not be included here. [ ] The Mother shall pay ___% and the Father shall pay ____% of the transportation costs. [ ] Other:________________________________________________. 4. Foreign and Out-Of-State Travel (Choose all that apply) [ ] Either parent may travel within the United States with the child(ren) during his/her time-sharing. The parent traveling with the child(ren) shall give the other parent at least ____days written notice before traveling out of state unless there is an emergency, and shall provide the other parent with a detailed itinerary, including locations and telephone numbers where the child(ren) and parent can be reached at least____days before traveling. [ ] Either parent may travel out of the country with the child(ren) during his/her time-sharing. At least ____days prior to traveling, the parent shall provide a detailed itinerary, including locations, and telephone numbers where the child(ren) and parent may be reached during the trip. Each parent agrees to provide whatever documentation is necessary for the other parent to take the child(ren) out of the country. [ ] If a parent wishes to travel out of the country with the child(ren), he/she shall provide the following security for the return of the child _____________________ ________________________________________________________________________. *1277 [ ] Other______________________________________________. IX. EDUCATION 1. School designation. For purposes of school boundary determination and registration, the [ ] Mother's [ ] Father's address shall be designated. 2. (If Applicable) The following provisions are made regarding private or home schooling: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________. 3. Other. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. X. DESIGNATION FOR OTHER LEGAL PURPOSES The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with the [ ] Mother [ ] Father. This majority designation is SOLELY for purposes of all other state and federal laws which require such a designation. This designation does not affect either parent's rights and responsibilities under this Parenting Plan. XI. COMMUNICATION 1. Between Parents All communications regarding the child(ren) shall be between the parents. The parents shall not use the child(ren) as messengers to convey information, ask questions, or set up schedule changes. The parents shall communicate with each other: (Choose all that apply) [ ] in person [ ] by telephone [ ] by letter [ ] by e-mail [ ] Other:____________________________________________________________. 2. Between Parent and Child(ren) Both parents shall keep contact information current. Telephone or other electronic communication between the child(ren) and the other parent shall not be monitored by or interrupted by the other parent. "Electronic communication" includes telephones, electronic mail or e-mail, webcams, video-conferencing equipment and software or other *1278 wired or wireless technologies or other means of communication to supplement face to face contact. The child(ren) may have [ ] telephone [ ] e-mail [ ] other electronic communication in the form of_________________with the other parent: (Choose only one) [ ] Anytime [ ] Every day during the hours of____________________to_____________. [ ] On the following days __________________________________________ during the hours of______________________________to_____________. [ ] Other:__________________________________________________________. 3. Costs of Electronic Communication shall be addressed as follows: __________________________________________________________ __________________________________________________________ __________________________________________________________. XII. CHILD CARE (Choose only one) [ ] Each parent may select appropriate child care providers [ ] All child care providers must be agreed upon by both parents. [ ] Each parent must offer the other parent the opportunity to care for the child(ren) before using a child care provider for any period exceeding______hours. [ ] Other___________________________________________________________. XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN Temporary changes to this Parenting Plan may be made informally without a written document; however, if the parties dispute the change, the Parenting Plan shall remain in effect until further order of the court. Any substantial changes to the Parenting Plan must be sought through the filing of a supplemental petition for modification. XIV. RELOCATION Any relocation of the child(ren) is subject to and must be sought in compliance with section 61.13001, Florida Statutes. XV. DISPUTES OR CONFLICT RESOLUTION Parents shall attempt to cooperatively resolve any disputes which may arise over the terms of the Parenting Plan. The parents may wish to use mediation or other dispute resolution methods *1279 and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court action. XVI. OTHER PROVISIONS _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________. SIGNATURE OF PARENTS I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it. Dated:____________________ _____________________ Signature of Mother Printed Name:__________________ Address:_______________________ City, State, Zip:______________ Telephone Number:______________ Fax Number:____________________ STATE OF FLORIDA COUNTY OF____________ Sworn to or affirmed and signed before me on______________by __________________. ________________________________ NOTARY PUBLIC or DEPUTY CLERK ________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced ______________________ *1280 I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it. Dated:____________________ _____________________________ Signature of Father Printed Name:____________________ Address: ________________________ City, State, Zip:________________ Telephone Number:________________ Fax Number:______________________ STATE OF FLORIDA COUNTY OF________________ Sworn to or affirmed and signed before me on __________ by ________________. _______________________________ NOTARY PUBLIC or DEPUTY CLERK _______________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___Personally known ___Produced identification Type of identification produced________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, {full legal name and trade name of nonlawyer}______________________________, a nonlawyer, whose address is {street}________________________________________, {city}__________________,{state}__________________,{phone}_____________, helped {name} _____, who is the [one only] ____ petitioner or___respondent, fill out this formA Parenting Plan is required in all cases involving minor child(ren). This form or a similar form should be used in cases when you feel your child(ren) cannot be safely alone with the other parent or if you believe shared parental responsibility presents a detriment to the child(ren). In this case, a Parenting Plan must be developed that allows time-sharing with any minor child(ren), while providing protection for the child(ren). If safety or supervised time-sharing is not a concern, Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a) or a similar form should be used. If the case involves relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used. The Parenting Plan must be developed and agreed to by the parents and approved by the court. If the parties cannot agree to a Parenting Plan or if the parents agreed to a plan that is not approved by the court, a parenting plan will be established by the court with or without the use of parenting plan recommendations.
This form should be typed or printed in black ink. If an agreement has been reached, both parties must sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records. You should then refer to the instructions for your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or trial (final hearing). If the parents have not reached an agreement, a proposed Parenting Plan may be filed by either parent at the time of or any time prior to the final hearing. If an agreed Parenting Plan is not filed by the parties, the court shall establish a Plan.
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 the instructions for the petition and/or answer that were filed in this case.
If you fear that disclosing your address would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Form 12.980(h), file it with the clerk of the circuit court and write confidential in the space provided in the Parenting Plan.
At a minimum, the Parenting Plan must describe in adequate detail:
How the parties will share and be responsible for the daily tasks associated with the upbringing of the child(ren),
The time-sharing schedule arrangements that specify the time that the minor child(ren) will spend with each parent,
A designation of who will be responsible for any and all forms of health care, school-related matters, including the address to be used for school-boundary determination and registration, other activities, and
*1282 The methods and technologies that the parents will use to communicate with the child(ren).
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. Determination of the best interests of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest of the particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida Statutes, including, but not limited to:
The demonstrated capacity and disposition of each parent to facilitate and encourage a close and continuing parent-child relationship, to honor the time-sharing schedule, and to be reasonable when changes are required;
The anticipated division of parental responsibilities after the litigation, including the extent to which parental responsibilities will be delegated to third parties;
The demonstrated capacity and disposition of each parent to determine, consider, and act upon the needs of the child(ren) as opposed to the needs or desires of the parent;
The length of time the child(ren) has lived in a stable, satisfactory environment and the desirability of maintaining continuity;
The geographic viability of the parenting plan, with special attention paid to the needs of school-age children and the amount of time to be spent traveling to effectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);
The moral fitness of the parents;
The mental and physical health of the parents;
The home, school, and community record of the child(ren);
The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient intelligence, understanding, and experience to express a preference;
The demonstrated knowledge, capacity, and disposition of each parent to be informed of the circumstances of the minor child(ren), including, but not limited to, the child(ren)'s friends, teachers, medical care providers, daily activities, and favorite things;
The demonstrated capacity and disposition of each parent to provide a consistent routine for the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;
The demonstrated capacity of each parent to communicate with and keep the other parent informed of issues and activities regarding the minor child(ren), and the willingness of each parent to adopt a unified front on all major issues when dealing with the child(ren);
Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child neglect, regardless of whether a prior or pending action relating to those issues has been brought. If the court accepts evidence of prior or pending actions regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect, the court must specifically acknowledge, in writing that such evidence was considered when evaluating the bests interests of the child(ren);
Evidence that either parent has knowingly provided false information to the *1283 court regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect;
The particular parenting tasks customarily performed by each parent and the division of parental responsibilities before the institution of litigation and during the pending litigation, including the extent to which parenting responsibilities were undertaken by third parties;
The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)'s school and extracurricular activities;
The demonstrated capacity and disposition of each parent to maintain an environment for the child(ren) which is free from substance abuse;
The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation as demonstrated by not discussing the litigation with the child(ren), not sharing documents or electronic media related to the litigation with the child(ren), and refraining from disparaging comments about the other parent to the child)ren); and
The developmental stages and needs of the child(ren) and the demonstrated capacity and disposition of each parent to meet the child(ren)'s developmental needs.
This standard form does not include every possible issue that may be relevant to the facts of your case. The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional provisions should be added to address all of the relevant factors. The parties should give special consideration to the age and needs of each child.
In developing the Parenting Plan, you may wish to consult or review other materials which are available at your local library, law library or through national and state family organizations.
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.
*1284 IN THE CIRCUIT COURT OF THE_____________JUDICIAL CIRCUIT IN AND FOR_______________COUNTY, FLORIDA Case No:_______________ Division:______________ _____________________ Petitioner, and _____________________ Respondent. SAFETY-FOCUSED PARENTING PLAN This parenting plan is: (Choose only one) [ ] A Parenting Plan submitted to the court with the agreement of the parties. [ ] A proposed Parenting Plan submitted by or on behalf of: {parent's name}_____________________________________. [ ] A Parenting Plan established by the court. This parenting plan is: (Choose only one) [ ] A final Parenting Plan established by the court. [ ] A temporary Parenting Plan established by the court. [ ] A modification of a prior final Parenting Plan or prior final order. I. PARENTS Mother Name:____________________________________________________________ Address:_________________________________________________________ Telephone Number:________________________________________________ E-Mail:__________________________________________________________ ( ) Address Unknown: (Please indicate if mother's address is unknown) ( ) Address Confidential: (Please indicate if mother's address and phone numbers are confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence or ( ) Other court order ___________________________________________.) Father Name:____________________________________________________________ Address:_________________________________________________________ Telephone Number:________________________________________________ Florida Supreme Court Approved Family Law Form 12,995(b), Safety-Focused Parenting Plan (10/11) *1285 E-Mail:__________________________________________________________ ( ) Address Unknown: (Please indicate if father's address is unknown) ( ) Address Confidential: (Please indicate if father's address and telephone numbers are confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence or ( ) Other court order______________________________________________.) II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties: (add additional lines as needed) Name Date of Birth _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ III. JURISDICTION The United States is the country of habitual residence of the child(ren). The State of Florida is the child(ren)'s home state for the purposes of the Uniform Child Custody Jurisdiction and Enforcement Act. This Parenting Plan is a child custody determination for the purposes of the Uniform Child Custody Jurisdiction and Enforcement Act, the International Child Abduction Remedies Act, 42 U.S.C. Section 11601 et seq., the Parental Kidnapping Prevention Act, and the Convention on the Civil Aspects of International Child Abduction enacted at the Hague on October 25, 1980, and for other state and federal laws. Other: __________________________________________________________. IV. PARENTAL RESPONSIBILITY (Choose only one) [ ] Sole Parental Responsibility It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole authority to make major decisions for the child(ren.) It is detrimental to the child(ren) for the parents to have shared parental responsibility. [ ] Shared Parental Responsibility with Decision Making Authority It is in the best interests of the child(ren) that the parents confer and attempt to agree on the major decisions involving the child(ren). If the parents are unable to agree, the authority for making major decisions regarding the child(ren) shall be as follows: *1286 Education/Academic decisions [ ] Mother [ ] Father Non-emergency health care [ ] Mother [ ] Father ___________________________ [ ] Mother [ ] Father ___________________________ [ ] Mother [ ] Father ___________________________ [ ] Mother [ ] Father [ ] Other: {Explain} ______________________________________. V. TIME SHARING SCHEDULE (Choose only one) [ ] No Time-Sharing: The [ ] Mother [ ] Father shall have no contact with the child(ren) until further order of the court. All parenting decisions shall be made by the other parent. [ ] Supervised Time-Sharing: Whenever the child(ren) are with the [ ] Mother [ ] Father, the supervisor shall be present. The [ ] Mother [ ] Father has the right to spend time with the child(ren) even though the other parent will be making most, if not all, of the parenting decisions which are made on the child(ren)'s behalf. The time-sharing schedule shall be mutually agreed to between the parents, but not less than the schedule set forth below: (Choose only one) [ ] ____ hours per week. The place(s), and time(s) shall be set by the [ ] Mother [ ] Father. [ ] From _______ __ m. to __________ __ m, on the following day(s) ____________________________________________. [ ] Restricted Time-Sharing: the [ ] Mother [ ] Father shall have time-sharing with the following restrictions. (The restrictions should be described in detail such as time-sharing only in public places, no overnight visits, etc.) The time-sharing schedule shall be mutually agreed upon between the parents, but not less than the schedule set forth below:__________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. [ ] ___ hours per week. The place(s), and time(s) shall be set by the [ ] Mother [ ] Father. [ ] Other:___________________________________________________________. VI. SUPERVISOR AND SUPERVISION (Choose only one) 1. Supervisor. The person supervising the time-sharing shall: (Choose only one) *1287 [ ] Be selected by the [ ] Mother [ ] Father. [ ] Be selected by the [ ] Mother [ ] Father, subject to the other parent's approval. [ ] Other:__________________________________________________. 2. Restrictions or Level of Supervision:____________________________ ____________________________________________________________________________ ___________________________________________________________________________. 3. Costs of Supervision [ ] The costs of the supervision shall be paid by the [ ] Mother [ ] Father [ ] Other:___________________________________________________. VII. LOCATION: (Choose only one) The [ ] Mother [ ] Father shall spend his/her time-sharing with the child(ren) at the following location(s): [ ] Supervised visitation center (name and address of facility)__________________ _________________________________________________________________________. [ ] ______________________(location) or other location designated by the [ ] Mother [ ] Father [ ] Any location designated by the [ ] Mother [ ] Father with the approval of the supervisor. [ ] Other:_____________________________________________________. VIII. DESIGNATION FOR OTHER LEGAL PURPOSES 1. The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the majority of the time with the [ ] Mother [ ] Father. This majority designation is SOLELY for purposes of all other state and federal statutes which require such a designation. This designation does not affect either parent's rights and responsibilities under this parenting plan. 2. For purposes of school boundary determination and registration, the [ ] Mother's [ ] Father's address shall be designated. *1288 IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN) 1. Transportation The child(ren) shall not be driven in a car unless the driver has a valid driver's license, automobile insurance, seat belts, and child safety seats as required by Florida law. The [ ] Mother [ ] Father or mutually agreed upon person shall be responsible for transporting the child(ren) to the exchange point. The child(ren) shall be picked up and/or returned to the exchange point by (Choose only one); [ ] The [ ] Mother [ ] Father with the supervisor present. [ ] The supervisor alone. [ ] Other:___________________________________________________. 2. Exchange The exchange of the child(ren) shall occur at: (Choose all that apply) [ ] The site of the supervised visit. [ ] A monitored exchange location {specify name and address of facility}___________. ______________________________________________________________________________. [ ] Other: ___________________________________________________. [ ] The [ ] Mother [ ] Father is prohibited from coming to the exchange point. X. COMMUNICATION 1. Between Parents (Choose only one) [ ] All communications regarding the child(ren) shall be between the parents. The parents shall not use the child(ren) as messengers to convey information, ask questions, or set up schedule changes. The parents shall communicate with each other: (Choose all that apply) [ ] in person [ ] by telephone [ ] by letter [ ] by e-mail [ ] Other:_____________________________________________________. *1289 [ ] No Communication. Unless otherwise prohibited by court order, all information and communication regarding the child(ren) shall be exchanged via or through ________________________________________________________________________________ 2. Between Parent and Child(ren) The [ ] Mother [ ] Father (Choose all that apply) [ ] Shall not telephone, write, or e-mail the child(ren) unless the contact is agreed to in advance by the other parent. [ ] May write or e-mail the child(ren) at any time. Each parent shall provide a contact address (and e-mail address if appropriate) to the other parent, unless other prohibited by court order. [ ] May call the child(ren) on the telephone___ times per week. The call shall last no more than____minutes and shall take place between____ __m. and_____ __m. Each parent shall provide a telephone number to the other parent, unless otherwise prohibited by court order or law. [ ] Long distance telephone calls made by the child(ren) to a parent shall be paid by_____ ________________. Each parent shall provide a telephone number to the other parent, unless otherwise prohibited by court order or law. [ ] Other:____________________________________________________. 3. Costs of Electronic Communication "Electronic communication" includes telephones, electronic mail or e-mail, webcams, video-conferencing equipment and software or other wired or wireless technologies or other means of communication to supplement face-to face contact. The costs of electronic communication shall be addressed as follows: __________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________. XI. ACCESS TO ACTIVITIES AND EVENTS The [ ] Mother [ ] Father (Choose only one) [ ] Shall not attend the child(ren)'s activities and events, including but not limited to, school, athletic, and extra-curricular activities and events. [ ] May attend the child(ren)'s school, athletic, and extra-curricular activities and events. *1290 [ ] The [ ] Mother [ ] Father must stay ____feet from the other parent and____feet from the child. [ ] Other___________________________________________________. XII. CHILD(REN)'S SAFETY The [ ] Mother [ ] Father shall follow the safety rules checked below. (Choose all that apply) [ ] There shall be no firearms in the home, car, or in the child(ren)'s presence during time-sharing. [ ] No alcoholic beverages shall be consumed from twenty-four (24) hours before the child(ren) arrive until they are returned to the other parent. [ ] The child(ren) shall not be disciplined by corporal punishment. [ ] The following person(s) present a danger to the child(ren: ___________________________________________________________ ___________________________________________________________. Each parent shall ensure that during his/her time-sharing that this/these person(s): [ ] will not be present [ ] will not have contact with the child(ren) [ ] Other:______________________________________________________. XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN All changes to the Safety-Focused Parenting Plan must be pursuant to a court order. XIV. OTHER PROVISIONS ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________.I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it.
Dated: __________________ ____________________________________________ Signature of Mother Printed Name: ______________________________ Address: ___________________________________ City, State, Zip: __________________________ Telephone Number: __________________________ Fax Number: ________________________________ STATE OF FLORIDA COUNTY OF ________________ Sworn to or affirmed and signed before me on _________ by __________________. ____________________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _________________________________*1292 I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this Plan and intend to be bound by it.
Dated: ___________________ _____________________________________________ Signature of Father Printed Name: _______________________________ Address: ____________________________________ City, State, Zip: ___________________________ Telephone Number: ___________________________ Fax Number: _________________________________ STATE OF FLORIDA COUNTY OF ________________________ Sworn to or affirmed and signed before me on ___________ by __________________. ______________________________ NOTARY PUBLIC or DEPUTY CLERK _____________________________________________________ [Print, type, or stamp commissioned name of notary or clerk.] ___ Personally known ___ Produced identification Type of identification produced _____________________IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]
I, {full legal name and trade name of nonlawyer} _________________________________________, a nonlawyer, whose address is {street} ________________________, {city} ______________, {state} ____________, {phone} _______________, helped {name} ___________________, who is the [one only] petitioner or ___ respondent, fill out this form.
[1] We have jurisdiction. See art. V, § 2(a), Fla. Const.; Fla. R. Jud. Admin. 2.140(d), (f).
[2] See In re Revised Interim Policy on Elec. Release of Court Records, Fla. Admin. Order No. AOSC07-49 (Fla. Sept. 7, 2007) (providing revised interim policy for the electronic release of court records); In re Implementation of Report and Recommendations of the Comm. on Privacy and Court Records, Fla. Admin. Order No. AOSC06-20 (June 30, 2006) ("Admin. Order No. AOSC06-20") (recognizing that certain conditions, including rule amendments, must be met before goal of providing the public electronic access to court records can be achieved); see also In re Statewide Standards for Elec. Access to the Courts, Fla. Admin. Order No. AOSC09-30 (July 1, 2009) (adopting the Florida Supreme Court Statewide Standards for Electronic Access to the Courts in response to chapter 2009-61, section 16, Laws of Florida, which requested that the Court establish statewide e-filing standards to be used by the clerks of court to implement electronic filing); In re Amends. to Fla. Rules of Civil Pro., Fla. Rules of Jud. Admin., Fla. Rules of Crim. Pro., Fla. Probate Rules, Fla. Small Claims Rules, Fla. Rules of Juv. Pro., Fla. Rules of App. Pro., & Fla. Family Law Rules of Pro. Electronic Filing, No. SC11-399 (Fla. Petition filed Feb. 28, 2011) (Court considering proposed rule amendments to implement electronic filing of documents with courts).
[3] See In re Fla. Courts Tech. Comm'n, Subcomm. on Access to Court Records, Fla. Admin. Order No. AOSC09-3 (Jan. 27, 2009) (directing commission to establish a Subcommittee on Access to Court Records to act as the successor to the Access Committee for the purpose of advancing rule proposals) ("Admin. Order No. AOSC09-3").
[4] See Committee on Privacy and Court Records, Privacy, Access and Court Records: the Report and Recommendations of the Committee on Privacy and Court Records (2005) ("Privacy Committee Report").
[5] Admin. Order No. AOSC06-20.
[6] See Admin. Order AOSC06-20 at 1, 9.
[7] The Court separately considered implementation recommendations concerning electronic access to court records contained in the Access Committee's final report and recommendations submitted in September 2008. See Committee on Access to Court Records, Final Report and Recommendations (2008).
[8] See In re Comm. on Access to Court Records, Fla. Admin. Order No. AOSC06-27 (Aug. 21, 2006) ("Admin. Order AOSC06-27").
[9] Privacy Committee Report, Recommendation Seven, at 53.
[10] Privacy Committee Report, Recommendation Eight, at 54.
[11] Privacy Committee Report, Recommendation Nine, at 55.
[12] Privacy Committee Report, Recommendation Ten, at 56.
[13] See Admin. Order AOSC06-20 at 19-20. Privacy Committee Recommendation Eight, addressing unauthorized filings, see Privacy Committee Report at 54, was referred to the Access Committee. The Access Committee was charged with studying the rules to "determine whether any sanctions [for unauthorized filings] need to be strengthened to further the goal of preventing gratuitous publication of extraneous and potentially damaging information." Admin. Order AOSC06-27 at 3.
[14] See, e.g., In re Amends. to Fla. Rules of App. Pro., 2 So. 3d 89, 90 n. 1 (Fla.2008) (stating that proposed new rule 9.050 (Maintaining Privacy of Personal Data) was referred to Access Committee).
[15] See Admin. Order No. AOSC09-3.
[16] Subdivision (b) of the rule, which we adopt on an interim basis, exempts filings in criminal and traffic proceedings.
[17] Privacy Committee Report, Recommendation Seven, at 53.
[18] The Court previously adopted a number of amendments to Florida Rule of Judicial Administration 2.420 (Public Access to Judicial Branch Records) also proposed by the Access Committee to implement other Privacy Committee recommendations. See In re Amends. to Fla. Rule of Jud. Admin. 2.420 & Fla. Rules of App. Pro., 31 So. 3d 756 (amending Rule of Judicial Administration 2.420 to provide comprehensive procedures for identifying and segregating confidential information in court records, for sealing and unsealing court records, and for reviewing orders issued under the rule.)
[19] The phrase "or authorized by statute, another rule, or court order" is meant to clarify that conflicting provisions of another rule of court, a statute, or a court order will control over the rule 2.425 requirements.
[20] In proposing this prohibition, the Rules of Judicial Administration Committee recognized that the standard business and banking practice is to use the last four digits of such numbers, but the committee determined it would be best to completely preclude the filing of such numbers because of their confidential status under rule 2.420(d)(1)(B)(iii). We agree that these highly sensitive and otherwise confidential personal identifying numbers should not be filed, unless exempt from the rule 2.425(a) limitations as provided in the rule.
[21] The composite comments of the Florida criminal justice organizations filed in this case include comments or resolutions in support of the exemption from the Florida Association of Criminal Defense Lawyers, the Miami-Dade County Association of Chiefs of Police, the Florida Prosecuting Attorneys Association, the Florida Public Defender Association, Inc., and the Florida Bar Criminal Law Section.
[22] The Criminal Procedure Rules Committee should oversee this project, and the committees' joint report should be filed with the Court by December 1, 2011.
[23] The Small Claims Rules Committee declined to offer conforming amendments to the Small Claims Rules. Rather, that committee asks the Court to postpone amending the Small Claims Rules until the committee has an opportunity to consider the version of rule 2.425 the Court adopts. Therefore, we defer adoption of pending amendments to the Small Claim Rules that are impacted by the adoption of rule 2.425 and have directed the Small Claims Rules Committee to use its fast-track procedures to file a report with conforming rule amendments by September 1, 2011. However, we adopt other pending amendments to the Small Claims Rules that will limit the filing of unnecessary personal information but are not directly affected by the adoption of new rule 2.425. They are new rule 7.140(e)(3), which requires the judge to assist an unrepresented party in the handling of private information, and forms 7.340 (Final Judgment) and 7.373 (Fact Information Sheet), which are amended to instruct that the Fact Information Sheet should not be filed with the Court.
We ask that in the future, when the Court seeks proposed rule amendments to address a given topic from a number of rules committees, each committee comply with the Court's request and individual committees not decline to act until proposals from other committees are acted upon. See, e.g., In re Amends. to Fla. Rules of Jud. Admin., Fla. Rules of Civil Pro., Fla. Rules of Crim. Pro., Fla. Rules of Civil Pro. for Involuntary Commitment of Sexually Violent Predators, Fla. Probate Rules, Fla. Rules of Traffic Court, Fla. Rules of Juv. Pro., Fla. Rules of App. Pro., & Fla. Family Law Rules of Pro.-Computation of Time, No. SC10-2299 (Fla. Petition filed Dec. 13, 2010) (Small Claims Rules Committee declining to propose amendments to Small Claims Rules until proposed Rule of Judicial Administration governing computation of time is adopted by the Court). Addressing all related proposals at the same time ensures consistency and conserves valuable judicial resources.
[24] Although the general provisions of new rule 2.425 prohibit the inclusion of any portion of a social security number in a court filing, as noted above, requirements in other rules or forms, such as the requirement that the last four digits of a social security number be included in certain documents, control over conflicting requirements in the new rule.
[25] We decline to adopt amendments to rules 3.211(c) (Competence to Proceed: Scope of Examination; Written Findings of Experts), 3.212(d) (Competence to Proceed: Hearing and Disposition; Release of Finding of Incompetence), 3.218(a) (Commitment of a Defendant Found Not Guilty by Reason of Insanity; Commitment; 6-Month Report), and 3.219(a) (Conditional Release; Release Plan) suggested by the Criminal Procedure Rules Committee. Instead, we amend those rules to provide: "The procedure for determinations of the confidential status of reports is governed by Rule of Judicial Administration 2.420." Further amendments to rule 2.420(d), which are urged in this case, were considered in In re Amends. to the Fla. Rule of Jud. Admin. 2.420, 68 So. 3d 228 (Fla.2011). See In re Implementation of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed November 19, 2010) (stating that suggested amendments to rule 2.420(d)(1)(B) will be considered in case number SC10-2242).
[26] Privacy Committee Report, Recommendation Ten, at 56.
[27] "The Media Organizations" include: Orlando Sentinel Communications Company, publisher of the Orlando Sentinel, and Sun-Sentinel Publishing Company, publisher of the South Florida Sun-Sentinel.
[28] Privacy Committee Report, Recommendation Nine, at 55.
[29] The rules committee felt that the affidavit could be entered into evidence if necessary at the hearing and that only at that point is it necessary to include the affidavit in the court record.
[30] See Amends. to the Fla. Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14 (Fla.2000) (providing that Court will seek input from advisory workgroup when making more substantial changes to the Supreme Court Approved Family Law Forms).
[31] We ask the rules committees, as part of their regular-cycle review, to conduct a thorough review of rules and forms not amended here to determine whether any of those rules or forms should to be amended to ensure consistency with the amendments we adopt here.
Quality Engineered Installation, Inc. v. Higley South, Inc. , 670 So. 2d 929 ( 1996 )
In Re Amendments to the Florida Rules of Appellate Procedure , 2 So. 3d 89 ( 2008 )
Simms v. State, Dept. of Health & Rehab. , 641 So. 2d 957 ( 1994 )
Demetree v. Stramondo , 621 So. 2d 740 ( 1993 )
In Re Amendments to Florida Rule of Judicial Administration ... , 31 So. 3d 756 ( 2010 )
In Re Amendments to Florida Rule of Judicial Administration ... , 68 So. 3d 228 ( 2011 )
Jim Appley's Tru-Arc, Inc. v. LIQUID EXT. SYS. LTD. P'SHIP , 526 So. 2d 177 ( 1988 )
Hott Interiors, Inc. v. Fostock , 721 So. 2d 1236 ( 1998 )
Rose Printing Co., Inc. v. D'Amato , 338 So. 2d 212 ( 1976 )
In Re: Amendments to the Florida Probate Rules , 139 So. 3d 875 ( 2014 )
In Re: Amendments to Florida Rule of Judicial ... , 153 So. 3d 896 ( 2014 )
In Re: Amendments to the Florida Rules of Civil Procedure - ... , 211 So. 3d 985 ( 2017 )
In Re: Amendments to the Florida Judicial Qualifications ... , 252 So. 3d 733 ( 2018 )