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FORM 12.984(c): INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Florida)

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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.984(c)
PARENTING COORDINATOR REPORT OF AN EMERGENCY (07/14)
When should this form be used?
A person appointed as a parenting coordinator must immediately inform the court of an
emergency situation pursuant to section 61.125(8), Florida Statutes. This form is used by the
parenting coordinator to report an emergency with or without notice to the parties. It is critical
to differentiate whether notice to the parties is required under the facts of any emergency.
Report With Notice. A parenting coordinator, upon information and belief, must immediately
inform the court by affidavit or verified report of an emergency in which a party obtains a final
order or injunction of protection against domestic violence or is arrested for an act of domestic
violence as provided under chapter 741, Florida Statutes
Report Without Notice. A parenting coordinator must immediately inform the court by affidavit
or verified report of an emergency situation if:
1. There is a reasonable cause to suspect that a child will suffer or is suffering abuse, neglect,
or abandonment as provided under chapter 39, Florida Statutes;
2. There is a reasonable cause to suspect a vulnerable adult has been or is being abused,
neglected, or exploited as provided under chapter 415, Florida Statutes;
3. A party, or someone acting on a party’s behalf, is expected to wrongfully remove or is
wrongfully removing the child from the jurisdiction of the court without prior court approval
or compliance with the requirements of section 61.13001, Florida Statutes. If the parenting
coordinator suspects that the parent has relocated within the state to avoid domestic
violence, the coordinator may not disclose the location of the parent and child unless
required by court order.
This form should be typed or printed in black ink.
What should I do next?
After completing and signing this form, you must file the original with the clerk of the circuit
court in the county in which the action is pending, provide a copy to the presiding judge, and
keep a copy for your records.
Report With Notice. If notice to the parties is required under section 61.125(8)(b), Florida
Statutes, you must also mail or hand deliver a copy of this form to attorney(s) for the parents or,
if not represented by an attorney, to the parents.
Report Without Notice. If notice to the parties is not required, you must mail or hand-deliver a
copy of this form to the Judge presiding over the case.
Instructions for Florida Family Law Rules of Procedure Form 12.984(c), Parenting Coordinator Report of an
Emergency (07/14)
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 more information, see section 61.125, Florida
Statutes; Florida Family Law Rule of Procedure 12.742; Rules for Qualified and Court Appointed
Parenting Coordinators; and the Order of Referral to Parenting Coordinator, Florida Family Law
Rules of Procedure Form 12.984(a).
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 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 Family Law Rules of Procedure Form 12.984(c), Parenting Coordinator Report of an
Emergency (07/14)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
PARENTING COORDINATOR REPORT OF AN EMERGENCY
The undersigned parenting coordinator reports an emergency to the court:
1. _____ With notice to the parties. A party has obtained a final order or injunction of protection
against domestic violence or has been arrested for an act of domestic violence as provided
under chapter 741, F.S.
2. _____ Without notice to the parties pursuant to section 61.125 (8)(a), Florida Statutes, because:
(choose all that apply)
a. _____ There is a reasonable cause to suspect that a child will suffer or is suffering abuse,
neglect, or abandonment as provided under chapter 39, Florida Statutes.
b. _____ There is a reasonable cause to suspect a vulnerable adult has or is being abused,
neglected, or exploited as provided under chapter 415, Florida Statutes.
c. _____ A party, or someone acting on a party’s behalf, is expected to wrongfully remove or is
wrongfully removing the child from the jurisdiction of the court without prior approval
or compliance with the requirements of section 61.13001, Florida Statutes.
3. Describe the emergency: ____________________________________________________________
_________________________________________________________________________________
____________________________________________________________________________.
VERIFICATION BY PARENTING COORDINATOR
I, _______________________________________________ (name of parenting coordinator) do hereby
swear or affirm that the facts contained in this Parenting Coordinator Report of an Emergency are true
and correct to the best of my knowledge and belief.
Florida Family Law Rules of Procedure Form 12.984(c), Parenting Coordinator Report of an Emergency (07/14)
Date :________________
Signature of Parenting Coordinator:__________________
Printed Name: ____________________________________
Address: _________________________________________
City, State, Zip: ____________________________________
Telephone Number: _______________________________
E-mail: __________________________________________
Professional License # (if applicable) ___________________
Professional Certification # (if applicable) ______________
STATE OF FLORIDA
COUNTY OF ______________________
Sw
orn 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 ___________________________________________________
Copies to:
_____Presiding Judge
_____P
etitioner
_____ A
ttorney for Petitioner
_____
Respondent
_____
Attorney for Respondent
_____
Other: ____________________________________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was completed with the assistance of:
{name of individual} _____________________________________________________________,
{name of business} _______________________________________________________________,
{address} ______________________________________________________________________,
{city} ____________________,{state} ______________,{telephone number} __________________.
Florida Family Law Rules of Procedure Form 12.984(c), Parenting Coordinator Report of an Emergency (07/14)
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FORM 12.984(c): INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Florida)

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Completed 10 January 2021

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