IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL
CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA.
FAMILY DIVISION
CASE NO.:
IN RE: THE MARRIAGE OF:
___________________________,
Petitioner,
TESTIMONY AT FINAL HEARING
-vs-
___________________________,
Respondent.
________________________________________
/
Directions: Please provide the court with all the information requested. Print the information clearly as this will assist the
courts in the collection of monies etc.
PETITIONER:
Name:____________________________________
Date of birth:_______________________________
Driver's license No#_________________________
Date of issue of D/L_________________________
Car tag no#________________________________
RESIDENCE:
Address:__________________________________
[city]______________[state]____zip__________
Home telephone no____________________
How long a Florida resident _____________
Since what date_______________________
EMPLOYMENT:
Name:___________________________________
Address:___________________________________
[city]________________[state]______[zip]______
Telephone no_______________________________
RESPONDENT:
Name:_______________________________________
Date of birth:_________________________________
Date of issue of D/L_________________________
Driver's license No#__________________________
Car tag no#__________________________________
RESIDENCE:
Address________________________________________
[city]______________[state]____zip________________
Home telephone no____________________________
How long a Florida resident _____________
Since what date_______________________
EMPLOYMENT:
Name:___________________________________
Address:___________________________________
[city]________________[state]______[zip]______
Telephone no_______________________________
MINOR CHILDREN- NAME
DOB
_____________________________, ________,
_____________________________, ________,
_____________________________, ________,
_____________________________, ________,
MARRIAGE INFORMATION
Date of Marriage: ________________ Place of Marriage___________________________________
Date of Separation: _______________ Separation Agreement________________________________
Is Marriage Irretrievably Broken? _______ (Why)________________________________________________
Is Wife’s former name to be restored?
_____ No
_____ Yes (write out name; no initials)______________________________________________________
EVIDENCE OF RESIDENCY
Name of Residency Witness [if applicable]: _____________________________________________________.
Driver's license No#_______________________________________________________________________
PRESENT AT FINAL HEARING
Petitioner: _______________________________ Attorney:__________________________
Respondent: ______________________________ Attorney:__________________________
APPROVED BY:
Dated:_______________________________
Circuit Judge
