Fillable FORM 12.970(d),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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FORM 12.970(d),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(d),
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY
(02/18)
This form is to be completed and signed by a parent who agrees to grant concurrent custody of a minor
child or child(ren) to an extended family member and who agrees to waive service of process. Service of
process occurs when a summons and a copy of the petition (or other pleading) that has been filed with
the court are delivered by a deputy or private process server. “Concurrent custody” means that an eligible
extended family member is awarded custodial rights to care for a child or children concurrently with the
child(ren)’s parent or parents.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not
a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal
proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an
adverse party.
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 for Concurrent Custody by Extended Family, Florida Supreme Court
Approved Family Law Form 12.970(b) is filed and keep a copy for your records.
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.
Special notes. . .
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 must
also 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 12.970(d), Waiver of Service of Process and
Consent for Concurrent Custody by Extended Family (02/18)
_________________________________
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA
Case No: _______________________
IN RE: THE INTEREST OF
Division: _______________________
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,
__________________________________,
Respondent/_______________________.
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY
I, {full legal name} ________________________________, the legal parent of
{child(ren)’s name(s)} ______________________________________________, having received a copy of
the Petition for Concurrent Custody by Extended Family filed herein and waived service of process, freely
and voluntarily consent to the Petition filed by {Petitioner’s Name} ______________________________.
I realize that by signing this document, I am consenting to the Petitioner having temporary concurrent
custody of the minor child(ren) and that such concurrent custody is in the best interest of the child(ren).
Upon entry of an Order, the Petitioner shall be able to:
1.
Consent to
all
necessary and
reasonable medical and
dental care for the child(ren), including
nonemergency surgery and psychiatric care;
2.
Secure copies of the child(ren)’s records,
held
by
third
parties, that are necessary
for the care of
the child(ren), including, but not limited to:
a. Medical, dental, and psychiatric records;
a.
Birth Certificates and other records, and
b.
Educational records.
3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or
placed in special school programs, including exceptional education; and
4. Do all other things necessary for the care of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
_________________________________________
_________________________________________
_________________________________________
_________________________________________
I realize that the concurrent custody of my child(ren) by the Petitioner is temporary and that I may, at any
time, petition the court to return legal custody to me.
Dated: __________________________
STATE OF FLORIDA
COUNTY OF __________________________
Signature of Parent
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
Telephone Number: _________________________
Fax Number: _______________________________
Designated E-mail Address(es):_________________
Sworn to or affirmed and signed before me on _______________ by ___________________________.
NOTARY PUBLIC OR DEPUTY CLERK
Print, type, or stamp commissioned name of notary or
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the {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} ___________.
Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
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FORM 12.970(d),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 10 January 2021

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