Florida Supreme Court Approved Family Law Form 12.915, Designation of Current Mailing and E-mail Address
(11/15)
IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT, IN AND FOR
PINELLAS COUNTY, FLORIDA
Case No.: ___________________________ ___
Division: ___________________________ ___
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
DESIGNATION OF CURRENT MAILING AND E-MAIL ADDRESS
I, {full legal name} ___________________________________________________, being sworn, certify
that my current mailing address is: {Street} __________________________________________________
{City} ________________________, {State} ___________________________, {Zip} __________________
{Telephone No.} ____________________________ {Fax No.} __________________________________
I designate as my current e-mail address(es): ________________________________________________
_____________________________________________________________________________________
I understand that I must keep the clerk’s office and the opposing party or parties notified of my current
mailing and e-mail address(es) and that all future papers in this lawsuit will be served at the address(es)
on record at the clerk’s office.
I certify that a copy of this document was ( ) e-mailed ( ) mailed ( ) faxed ( ) hand-delivered to
the person(s) listed below on {date} __________________________.
Other party or his/her attorney:
Name: ______________________________________
Address: ____________________________________
City, State, Zip: _______________________________
Fax Number: _________________________________
Designated E-mail Address(es): __________________
____________________________________________
