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FloridaFamilyLawRulesofProcedureForm12.928,CoverSheetforFamilyCourtCases(01/10)

CoverSheetforDomesticViolenceCourtCases



I. CaseStyle



INTHECIRCUITCOURTOFTHE&KhZd,JUDICIALCIRCUIT, 

INANDFORhs>

KhEdz͕&>KZ/



 CaseNo.:______________

__

 /ǀŝƐŝŽŶ:

_____________________________

 Petitioner



 and



 Respondent



II. Type of Action/Proceeding.Place a check beside the proceeding you are initiating. If you are simultaneously filing more than

one type of proceedingagainst thesameopposing party,suchasa modification and anenforcement proceeding,complete a

separatecoversheetforeachactionbeingfiled.Ifyouarereopeningacase,ch

ooseoneofthethreeopt

ionsbelowit.



(A) ___InitialAction/Petition

(B) ___ReopeningCase

1. ___Modification/SupplementalPetition

2. ___MotionforCivilContempt/Enforcement

3. ___Other



III. TypeofCase.Ifthecasefitsmorethanonetypeofcase,selectthemostdefinitive.

;Ϳ ŽŵĞƐƚŝĐsŝŽůĞ

ŶĐĞ

;Ϳ ĂƚŝŶŐsŝŽůĞŶĐĞ

;Ϳ ZĞƉĞĂƚsŝŽůĞŶĐĞ

;Ϳ ^ĞǆƵĂůsŝŽůĞŶĐĞ



IV. RuleofJudicialAdministration2.545(d)requiresthataNoticeofRelatedCasesForm,FamilyLawForm12.900(h),befiled

with the initial pleading/petition by the filing attorney or self‐represented litigant in order to notify the court of related

cases.IsForm12.900(h)beingfiledwiththisCoverSheetforFamilyCo

urtCasesandinitialpleadin

g/petition?

 ___No,tothebestofmyknowledge,norelatedcasesexist.

 ___Yes,allrelatedcasesarelistedonFamilyLawForm12.900(h).



ATTORNEYORPARTYSIGNATURE



ICERTIFYthattheinformationIhaveprovidedinthiscoversheetisaccuratetothebestofmyknowledgeandbelief.



Signature________________________________________FLBarNo.:_____________________

 Attorneyorparty (Barnumber,ifattorney)



________________________________________ ______________________

 (Typeorprintname) Date



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[chooseoneonly]___

petitioneror___respondent,filloutthisform.

;Ϳ ^ƚĂůŬŝŶŐsŝŽůĞŶĐĞ

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__ CoverSheetforDomesticViolenceCourtCases I. CaseStyle INTHECIRCUITCOURTOFTHE&KhZd,JUDICIALCIRCUIT, INANDFORhs KhEdz&KZ Petitioner (Duval County Clerk of Courts)

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Completed 9 January 2021

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