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FORM 12.902(f)(1): INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(f)(1)
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
(02/18)
When should this form be used?
This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor
Child(ren), Florida Supreme Court Approved Family Law Form 12.901(b)(1), has been filed and the parties
have reached an agreement on some or all of the issues at hand.
This form should be typed or printed in black ink. Both parties must sign the agreement 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).
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in bold underline in these instructions are defined there.
For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or
answer that were filed in this case.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. . If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
Special notes...
With this form you must also file a Child Support Guidelines Worksheet, Florida Family Law Rules of
Procedure Form 12.902(e), if not already filed.
This form does not act to transfer title to the property. Such transfer must be done by deed or
supplemental final judgment.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for
Dissolution of Marriage with Dependent or Minor Child(ren) (02/18)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
In re: The Marriage of:
,
Petitioner,
and
,
Respondent.
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE
WITH DEPENDENT OR MINOR CHILD(REN)
We, {Petitioner’s full legal name}_______________________________________________, and
{Respondent’s full legal name},_________________________________ being sworn, certify that the
following statements are true:
1.
We
were married to
each other on
{date}
.
2.
Because
of irreconcilable
differences
in
our
marriage
(no
chance
of
staying
together),
we
have
made this agreement to
settle once and
for all
what we
owe to
each other and
what we
can
expect
to
receive from
each
other.
Each of us
states
that
nothing
has been
held
back, that we
have
honestly
included everything
we
could
think of in
listing
our assets (everything
we
own and
that
is owed to
us) and
our debts (everything
we
owe), and
that we
believe the
other has been
open
and honest in writing
this agreement.
3.
We
have both filed a Family
Law Financial
Affidavit, Florida Family
Law Rules of Procedure Form
12.902(b) or (c).
Because we have voluntarily
made full and
fair disclosure to
each other of all
our
assets and
debts, we waive
any
further disclosure
under rule 12.285, Florida Family
Law Rules of
Procedure.
4.
Each of us
agrees
to
execute and
exchange any
papers that
might be needed
to
complete
this
agreement, including deeds, title certificates, etc.
S
ECTION I. MARITAL ASSETS AND LIABILITIES
A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any
personal item(s) not listed below is (are) the property of the party currently in possession of the
item(s).
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren)(02/18)
1. Petitioner shall receive as his/her own and Respondent shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name, or in
both spouses’ names.
Current Fair
Market Value
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Jewelry
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren)(02/18)
ASSETS: DESCRIPTION OF ITEM(S) PETITIONER SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name, or in
both spouses’ names.
Current Fair
Market Value
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Petitioner
$
2. Respondent shall receive as his/her own and Petitioner shall have no further rights or
responsibilities regarding these assets:
ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether the
name on any title/deed/account described below is in one spouse’s name , or in
both spouses’ names.
Current Fair
Market Value
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren)(02/18)
ASSETS: DESCRIPTION OF ITEM(S) RESPONDENT SHALL RECEIVE
Please describe each item as clearly as possible.
You do not need to list account numbers. Where applicable, include whether
the name on any title/deed/account described below is in one spouse’s name,
or in both spouses’ names.
Current Fair
Market Value
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
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Respondent
$
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren)(02/18)
B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows:
1. Petitioner shall pay as his/her own the following and will not at any time ask Respondent to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY PETITIONER
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note, or account described below is in one spouse’s name or in
both spouses’ names.
Monthly
Payment
Current
Amount
Owed
Mortgages on real estate: (Home)
$
$
(Other)
Charge/credit card accounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Petitioner
$
$
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren)(02/18)
2. Respondent shall pay as his/her own the following and will not at any time ask Petitioner to pay
these debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY RESPONDENT
Please describe each item as clearly as possible. You do not need to list
account numbers. Where applicable, include whether the name on any
mortgage, note or account described below is in one spouse’s name , or in
both spouses’ names.
Monthly
Payment
Current
Amount
Owed
Mortgages on real estate: (Home)
$
$
(Other)
Charge/credit card accounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Respondent
$
$
C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be
divided as follows:
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
.
D. Beneficiary Designation (Complete only if beneficiary designations continue after entry of Final
Judgment of Dissolution of Marriage.)
_____The spouses agree that the designation providing for the payment or transfer at death of an
interest in the assets set forth below to or for the benefit of the deceased party’s former spouse SHALL
NOT BE VOID as of the date of entry of the Final Judgment of Dissolution of Marriage.
The Final Judgment of Dissolution of Marriage shall provide that the designations set forth below remain
in full force and effect:
_____1. The _____Petitioner _____Respondent shall acquire or maintain the following assets for the
benefit of the other spouse or child(ren) to be paid upon his/her death outright or in trust. This provision
only applies if other assets fulfilling such requirement for the benefit of the other spouse or child(ren) do
not exist upon his/her death and unless precluded by statute. {Describe the assets with
specificity}:______________________________________________________________________
______________________________________________________________________________.
_____2. The _____Petitioner _____Respondent shall not unilaterally terminate or modify the ownership
of the following assets, or their disposition upon his/her death. {Describe the assets with
specificity}:______________________________________________________________________
______________________________________________________________________________.
SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the lines
provided.)
1. ____Each of us forever gives up any right to spousal support (alimony) that we may have.
OR
2. _____ Petitioner _____ Respondent (hereinafter “Obligor”) agrees to pay spousal support
(alimony) in the amount of $ ______every _____ week _____ other week _____month, or
____ other _____________, beginning {date} _________________and continuing until {date
or event} ___________________________________________________.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
___________________________________________________________________________
Explain type of alimony (such as, permanent, bridge-the-gap, durational, rehabilitative, and/or
lump sum) and any other specifics:__________________________________________________
3. _____ Other provisions relating to alimony, including any tax treatment and consequences:
______________________________________________________________________________.
4. Life insurance in the amount of $____________ to secure the above support, will be provided by
the Obligor.
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME-SHARING
1. The parties’ minor child(ren) are:
Name Birth date
2. The parties shall have time-sharing and parental responsibility in accordance with the Parenting
Plan attached as Exhibit _____.
SECTION IV. CHILD SUPPORT
1. _____ Petitioner ____ Respondent (hereinafter “Obligor”) will pay child support, under Florida’s
child support guidelines, section 61.30, Florida Statutes, to the other parent. The Child Support
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is completed and
attached.
Child support established at the rate of $_________ per month for the ______children {total
number of parties’ minor or dependent children} shall be paid commencing_________________
{month, day, year} and terminating ___________________ {month, day, year}. Child support
shall be paid in the amount of $ __________ per ___________ {week, month, other} which is
consistent with the Obligor’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children, child
support in the amount of $____________ for the remaining ____ children {total number of
remaining children} shall be paid commencing____________________ {month, day, year} and
terminating ________________________________________ {month, day, year}. This child
support shall be paid in the amount of $ ________ per ___________ {week, month, other}
consistent with Obligor’s current payroll cycle.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
{Insert schedule for the child support obligation, including the amount, and commencement
and termination dates, for the remaining minor or dependent children, which shall be payable
as the obligation for each child ceases. Please indicate whether the schedule _____appears
below or _____is attached as part of this form}
The Obligor shall pay child support until all the minor or dependent child(ren): reach the age of
18; become emancipated, marry, join the armed services, die, or become self-supporting; or
until further order of the court or agreement of the parties. The child support obligation shall
continue beyond the age of 18 and until high school graduation for any child who is: dependent
in fact; between the ages of 18 and 19; and is still in high school, performing in good faith with a
reasonable expectation of graduation before the age of 19.
If the child support amount above deviates from the guidelines by 5% or more, explain the
reason(s) here:
2. Retroactive Child Support or Arrearages.
There is currently retroactive child support in the amount of $_________________. There is an
arrearage of previously ordered unpaid child support in the amount of $______________.
The total of $ ___ in retroactive and unpaid child support shall be paid at the rate of
$ ____________ every _______ week _______ other week ________month, beginning
{date} ________________, until paid in full including statutory interest.
3. Health Insurance.
_____ Petitioner _____ Respondent will maintain health insurance for the parties’ minor
child(ren). The party providing coverage will provide insurance cards to the other party showing
coverage.
OR
_____ Health insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as follows:
a. _____Shared equally by the spouses. {Each spouse pays one-half}.
b. _____Prorated according to the child support guideline percentages.
c. _____Other {explain}: __________________________________________________
As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall
submit a request for reimbursement to the other party within 30 days, and the other party, within
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
_________________________________________________________________________
30 days of receipt, shall submit the applicable reimbursement for that expense, according to the
schedule of reimbursement set out in this paragraph.
4. Dental Insurance.
_____ Petitioner ____ Respondent will maintain dental insurance for the parties’ minor
child(ren). The party providing coverage will provide insurance cards to the other party showing
coverage.
OR
_____ Dental insurance is either not reasonable in cost or accessible to the child(ren) at this time.
Any uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows:
a. _____Shared equally by the spouses .{each spouse pays one-half}
b. _____Prorated according to the child support guideline percentages.
c. _____Other {explain}: __________________________________________________
As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall
submit a request for reimbursement to the other party within 30 days, and the other party, within
30 days of receipt, shall submit the applicable reimbursement for that expense, according to the
schedule of reimbursement set out in this paragraph.
5. Life Insurance. _____ Petitioner _____ Respondent will maintain life insurance for the benefit
of the parties’ minor child(ren) in the amount of $ ____________ until the youngest child
turns 18, becomes emancipated, marries, joins the armed services, or dies.
6. IRS Income Tax Exemption(s). The assignment of any tax exemptions for the child(ren) shall be
as follows: {explain} __________________________________________________________
The other parent will convey any applicable IRS form regarding the income tax exemption.
7. Other provisions relating to child support (e.g., uninsured medical/dental expenses, health or
dental insurance, life insurance to secure child support, orthodontic payments, college fund, etc.):
SECTION V. OTHER
.
SECTION VI. We have not agreed on the following issues:
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
__________________________________________
.
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.
Dated:
STATE OF FLORIDA
COUNTY OF ________________________
Sworn to or affirmed and signed before me on
Signature of Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): __________________
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] This form was prepared for the Petitioner
This form was completed with the assistance of:
{name of individual} ____________________________________________________________,
{name of business} _____________________________________________________________,
{address} _____________________________________________________,
{city} _______________,{state} ___,{zip code}__________, {telephone number} ___.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.
Dated:
STATE OF FLORIDA
COUNTY OF ___________________________
Sworn to or affirmed and signed before me on
Signature of Respondent
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es): __________________
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] This form was prepared for the Respondent
This form was completed with the assistance of:
{name of individual}_______________________________________________________,
{name of business} ________________________________________________________,
{address} _____________________________________________________,
{city} , {state} __, {zip code}_________, {telephone number} ________________.
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of
Marriage with Dependent or Minor Child(ren) (02/18)
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FORM 12.902(f)(1): INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 30 August 2021

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