Fillable Florida Family Law Rules of Procedure Form 12.928, (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Florida Family Law Rules of Procedure Form 12.928, (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(01/10)
Florida Family Law Rules of Procedure Form 12.928,
Cover Sheet for Family Court Cases (01/10)
When should this form be used?
The Cover Sheet for Family Court Cases and the information contained in it neither 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
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.
(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.
(C) Domestic Violence ‐ all matters relating to injunctions for protection against domestic
violence pursuant to section 741.30, Florida Statutes.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(01/10)
(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) 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.
(H) 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.
(I) 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.
(J) 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.
(K) 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.
(L) 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.
(M) Name Change ‐ all matters relating to name change, pursuant to section 68.07, Florida
Statutes.
(N) Paternity/Disestablishment of Paternity – all matters relating to paternity pursuant to
Chapter 742, Florida Statutes.
(O) Juvenile Delinquency ‐ all matters relating to juvenile delinquency pursuant to Chapter
985, Florida Statutes.
(P) Petition for Dependency ‐ all matters relating to petitions for dependency.
(Q) Shelter Petition – all matters relating to shelter petitions pursuant to Chapter 39, Florida
Statutes.
(R) Termination of Parental Rights Arising Out Of Chapter 39 – all matters relating to
termination of parental rights pursuant to Chapter 39, Florida Statutes.
(S) Adoption Arising Out Of Chapter 39 – all matters relating to adoption pursuant to
Chapter 39, Florida Statutes.
(T) CINS/FINS – all matters relating to children in need of services (and families in need of
services) pursuant to Chapter 984, Florida Statutes.
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.
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.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(01/10)
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (01/10)
_____________________________
_____________________________
___
___
___
___
___
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
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, 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) ___ Support IV‐D (Department of Revenue, Child Support
Enforcement)
(H) ___ Support Non‐IV‐D
(not
Department of Revenue, Child Support Enforcement)
(I) ___
UIFSA IV‐D
(Department of
Revenue,
Child Support Enforcement)
(J) ___ UIFSA Non‐IV‐D
(not
Department
of Revenue, Child Support Enforcement)
(K) ___ Other
Family Court
(L) ___ Adoption Arising Out
Of Chapter 63
(M) ___ Name Change
(N) ___ Paternity/Disestablishment of Paternity
(O) ___ Juvenile Delinquency
(P) ___ Petition for
Dependency
_______________________________________
_ ______________________
(Q) ___
___
___
Shelter Petition
(R) Termination of Parental Rights Arising Out Of Chapter 39
(S) Adoption Arising Out Of Chapter 39
(T) ___ CINS/FINS
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
_______________________________________
_
Attorney or party
FL Bar No.:
_____________________
(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,
w
hose address is
{street}___________________________ ,
{city} ,
{state} ,
{phone} , helped {name}_
,
w
ho is the [choose
one
only]
petitioner
or respondent,
fill out this
form.
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (01/10)
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Florida Family Law Rules of Procedure Form 12.928, (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Completed 5 July 2021

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