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FORM 12.928: INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Pasco County Clerk, FL)

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Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.928
COVER SHEET FOR FAMILY COURT CASES (11/20)
When should this form be used?
The Cover Sheet for Family Court Cases and the information contained in it does not replace nor
supplement the filing and service of pleadings or other documents as required by law. This form
shall be filed by the petitioner/party opening or reopening a case for the use of the clerk of the
circuit court for the purpose of reporting judicial workload data pursuant to Florida Statutes
section 25.075.
This form should be typed or printed in black ink. The petitioner must file this cover sheet with
the first pleading or motion filed to open or reopen a case in all domestic and juvenile cases.
What should I do next?
Follow these instructions for completing the form:
I. Case Style. Enter the name of the court, the appropriate case number assigned at the time
of filing of the original petition, the name of the judge assigned (if applicable), and the name
(last, first, middle initial) of the petitioner(s) and respondent(s).
II. Type of Action /Proceeding. Place a check beside the proceeding you are initiating. If you are
filing more than one type of proceeding, (such as a modification and an enforcement
proceeding) against the same party at the same time, then you must complete a separate
cover sheet for each action being filed.
(A) Initial Action/Petition
(B) Reopening Case. If you check “Reopening Case,” indicate whether you are filing a
modification or supplemental petition or an action for enforcement by placing a check
beside the appropriate action/petition.
1. Modification/Supplemental Petition
2. Motion for Civil Contempt/ Enforcement
3. Other – All reopening actions not involving modification/supplemental petitions or
petition enforcement.
III. Type of Case. Place a check beside the appropriate case. If the case fits more than one
category, select the most definitive. Definitions of the categories are provided below.
(A) Simplified Dissolution of Marriage‐ petitions for the termination of marriage pursuant to
Florida Family Law Rule of Procedure 12.105.
(B) Dissolution of Marriage ‐ petitions for the termination of marriage pursuant to Chapter
61, Florida Statutes, other than simplified dissolution.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
(C) Domestic Violence ‐ all matters relating to injunctions for protection against domestic
violence pursuant to section 741.30, Florida Statutes.
(D) Dating Violence ‐ all matters relating to injunctions for protection against dating
violence pursuant to section 784.046, Florida Statutes.
(E) Repeat Violence ‐ all matters relating to injunctions for protection against repeat
violence pursuant to section 784.046, Florida Statutes.
(F) Sexual Violence ‐ all matters relating to injunctions for protection against sexual
violence pursuant to section 784.046, Florida Statutes.
(G) Stalking-all matters relating to injunctions for protection against stalking pursuant to
section 784.0485, Florida Statutes
(H) Support ‐ IV‐D ‐ all matters relating to child or spousal support in which an application
for assistance has been filed with the Department of Revenue, Child Support
Enforcement under Title IV‐D, Social Security Act, except for such matters relating to
dissolution of marriage petitions (sections 409.2564, 409.2571, and 409.2597, Florida
Statutes), paternity, or UIFSA.
(I) Support‐Non IV‐D ‐ all matters relating to child or spousal support in which an
application for assistance has not been filed under Title IV‐D, Social Security Act.
(J) UIFSA‐ IV‐D ‐ all matters relating to Chapter 88, Florida Statutes, in which an application
for assistance has been filed under Title IV‐D, Social Security Act.
(K) UIFSA ‐ Non IV‐D ‐ all matters relating to Chapter 88, Florida Statutes, in which an
application for assistance has not been filed under Title IV‐D, Social Security Act.
(L) Other Family Court ‐ all matters involving time-sharing and/or parenting plans relating
to minor child(ren), support unconnected with dissolution of marriage, annulment,
delayed birth certificates pursuant to Florida Statutes section 382.0195, expedited
affirmation of parental status pursuant to Florida Statutes section 742.16, termination
of parental rights proceedings pursuant to Florida Statutes section 63.087, declaratory
judgment actions related to premarital, marital, post-marital agreements, or other
matters not included in the categories above.
(M) Adoption Arising Out Of Chapter 63 ‐ all matters relating to adoption pursuant to
Chapter 63, Florida Statutes, excluding any matters arising out of Chapter 39, Florida
Statutes.
(N) Name Change ‐ all matters relating to name change, pursuant to section 68.07, Florida
Statutes.
(O) Paternity/Disestablishment of Paternity – all matters relating to paternity pursuant to
Chapter 742, Florida Statutes.
(P) Juvenile Delinquency ‐ all matters relating to juvenile delinquency pursuant to Chapter
985, Florida Statutes.
(Q) Petition for Dependency ‐ all matters relating to petitions for dependency.
(R) Shelter Petition – all matters relating to shelter petitions pursuant to Chapter 39, Florida
Statutes.
(S) Termination of Parental Rights Arising Out Of Chapter 39 – all matters relating to
termination of parental rights pursuant to Chapter 39, Florida Statutes.
(T) Adoption Arising Out Of Chapter 39 – all matters relating to adoption pursuant to
Chapter 39, Florida Statutes.
(U) CINS/FINS – all matters relating to children in need of services (and families in need of
services) pursuant to Chapter 984, Florida Statutes.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
(V) Petition for Temporary or Concurrent Custody by Extended Family-all matters relating to
petitions for temporary or concurrent custody pursuant to Chapter 751.
(W) Emancipation of a Minor-all matters relating to emancipation of a minor pursuant to
Chapter 743.
ATTORNEY OR PARTY SIGNATURE. Sign the Cover Sheet for Family Court Cases. Print legibly the
name of the person signing the Cover Sheet for Family Court Cases. Attorneys must include a
Florida Bar number. Insert the date the Cover Sheet for Family Court Cases is signed. Signature is
a certification that filer has provided accurate information on the Cover Sheet for Family Court
Cases.
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 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.
A copy of this form must be filed with the court and served on the other party or his or her
attorney. The copy you are serving to the other party must be either mailed, e-mailed, or hand-
delivered to the opposing party or his or her attorney on the same day indicated on the
certificate of service. If it is mailed, it must be postmarked on the date indicated in the
certificate of service.
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.
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 Florida 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 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.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
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
email, 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.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants”
found at the beginning of these forms. For further information, see Rule 12.100, Florida Family
Law Rules of Procedure.
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
COVER SHEET FOR FAMILY COURT CASES
I. Case Style
IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT,
IN AND FOR __________________ COUNTY, FLORIDA
Case No.: ________________
Judge: __________________
_____________________________
Petitioner
and
_____________________________
Respondent
II. Type of Action/Proceeding. Place a check beside the proceeding you are initiating. If you are filing
more than one type of proceeding (such as a modification and an enforcement proceeding) against
the same party at the same time, then you must complete a separate cover sheet for each action
being filed. If you are reopening a case, choose one of the three options 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.
(A) ____ Simplified Dissolution of Marriage
(B) ____ Dissolution of Marriage
(C) ____ Domestic Violence
(D) ____ Dating Violence
(E) ____ Repeat Violence
(F) ____ Sexual Violence
(G) ____ Stalking
(H) ____ Support IV‐D (Department of Revenue, Child Support Enforcement)
(I) ____ Support Non‐IV‐D (not Department of Revenue, Child Support Enforcement)
(J) ____ UIFSA IV‐D (Department of Revenue, Child Support Enforcement)
(K) ____ UIFSA Non‐IV‐D (not Department of Revenue, Child Support Enforcement)
(L) ____ Other Family Court
(M) ____ Adoption Arising Out Of Chapter 63
(N) ____ Name Change
(O) ____ Paternity/Disestablishment of Paternity
(P) ____ Juvenile Delinquency
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/20)
(Q) ____ Petition for Dependency
(R) ____ Shelter Petition
(S) ____ Termination of Parental Rights Arising Out Of Chapter 39
(T) ____ Adoption Arising Out Of Chapter 39
(U) ____ CINS/FINS
(V) ____ Petition for Temporary or Concurrent Custody by Extended Family
(W) ____ Emancipation of a Minor
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 Court Cases and initial pleading/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) (E-mail Address(es))
____________________________
Date
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in
all blanks]
This form was prepared for the: {choose only one} _____Petitioner _____ Respondent
This form was completed with the assistance of:
{name of individual}____________________________________________________________,
{name of business} ______________________________________________________________,
{address} ___________________________________________________________________,
{city} __________________, {state} ____, {zip code} ______, {telephone number} _________.
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FORM 12.928: INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Pasco County Clerk, FL)

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Completed 23 June 2021

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