Fillable IN THE INTEREST OF Child(ren) Petitioner, and (Florida)

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IN THE INTEREST OF Child(ren) Petitioner, and (Florida)

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________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA
Case No: ______________________
Division: ______________________
IN THE INTEREST OF
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_____________,
__________________________________,
Respondent/_______________.
ORDER GRANTING PETITION FOR
CONCURRENT CUSTODY BY EXTENDED FAMILY
This case came before this Court for a hearing on a Petition for Concurrent Custody by Extended
Family. The Court, having reviewed the file and heard the testimony, makes these findings of
fact and reaches these conclusions of law:
SECTION I. FINDINGS:
1. The Court has jurisdiction over the subject matter and the parties.
2. The minor child(ren) at issue in this matter are:
Name Date of Birth
3. The Petitioner, {full legal name} __________________________________________ is
the {extended family relationship}_______________________________ of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
4. The Petitioner currently has physical custody of the child(ren) and has had physical
custody of the child(ren) for at least 10 days in any 30-day period within the last 12
months.
5. The Petitioner does not have signed, written documentation from the parent(s) which is
sufficient to enable the custodian to do all the things necessary to care for the child(ren)
which are available to custodians who have an order for temporary custody by extended
family.
6. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent
____ Was served with the petition and failed to file an Answer
____ Is deceased as evidenced by: _______________________________________
7. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent
____ Was served with the petition and failed to file an Answer
____ Is deceased as evidenced by: _______________________________________
8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody.
SECTION II: CONCURRENT CUSTODY
1. The Petitioner,__________________________________________________, is granted
concurrent custody of the minor child(ren).
2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent.
3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor
child(ren), including but not limited to:
a. Consent to all necessary and reasonable medical and dental care for the child(ren),
including nonemergency surgery and psychiatric care;
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
b. 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: medical, dental, and
psychiatric records; birth certificates and other records; and educational records;
c. 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
d. Do all other things necessary for the care of the child(ren).
SECTION III. CHILD SUPPORT
{Insert the name or designation of the appropriate parent in the space provided}
1. The Petitioner _____ did _____ did not request the establishment of child support.
2. ____ If child support is requested, the parents have received personal or substituted
service of process, the petition requests an order for support of the child(ren), and there
is evidence of the parents’ ability to pay the support ordered.
_____ Parent {name or designation} _______________ and {if applicable}
_____ Parent {name or designation} ___________________
has the present ability to pay child support.
{Choose one only}
a.____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules
of Procedure Form 12.902(e) filed by
_____Parent {name or designation} _____________________
_____ Parent {name or designation} _______________
are correct;
OR
b.____ The Court makes the following findings:
Parent {name or designation} ______________________________’s net monthly income
is $____________, (Child Support Guidelines ____%).
Parent {name or designation} ____________________________’s net monthly income is
$_____________, (Child Support Guidelines ____%)
Monthly child care costs are $_________________.
Monthly health/dental insurance costs are $_____________.
OR
c._____ Parent {name or designation} _______________ is currently ordered to pay child
support to the other parent in the amount of $__________ per ____________ as
established in the case of (style of case and number} ____________________________.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
_______________________________________________________________________
_____ All of the child support or _____ a portion of the child support in the amount of
$___________ shall be redirected to the Petitioner.
3. Amount
a. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_______ per month for the _______children {total number of parties’
minor or dependent children} commencing _______________________ {month, day,
year} and terminating ________________________ {month, day, year}. Child support
shall be paid in the amount of $______________ per _____________ {week, month,
other} which is consistent with Parent {name or designation} ___________’s current
payroll cycle.
Upon the termination of child support for one of the parties’ children, child support in the
amount of $_____________ for the remaining _________ children {total number of
remaining children} shall be paid commencing __________________ {month, day, year}
and terminating _________________________ {month, day, year}. This child support
shall be paid in the amount of $_________ per _________ {week, month, other}
consistent with Parent {name or designation} ________________’s current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}
Parent {name or designation} _______________ shall pay child support until all of the
minor or dependent children: reach the age of 18, become emancipated, marry, join the
armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: ____________________________________
_______________________________________________________________________.
b. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_________ per month for the ________children {total number of parties’
minor or dependent children} commencing______________________ {month, day, year}
and terminating __________________ {month, day, year}. Child support shall be paid in
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
________________________________________________________________________
the amount of $__________per ______________{week, month, other} consistent with
Parent {name or designation} ______________________’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children,
child support in the amount of $__________ for the remaining ______ children {total
number of remaining children} shall be paid commencing _____________________
{month, day, year} and terminating ________________________ {month, day, year}. This
child support shall be paid in the amount of $______________ per _______________
{week, month, other} consistent with Parent {name or designation} _____________’s
current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}
Parent {name or designation} ___________________ shall pay child support until all of
the minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are:______________________________________
_______________________________________________________________________.
4. Retroactive Child Support and/or Arrearages
{If both parents are ordered to pay retroactive child support and/or arrearages, please
include a separate paragraph for each parent.}
a. _____ Parent {name or designation} ____________________________________
shall pay retroactive child support in the amount of $__________________ as of
{date} ________________ to the Petitioner. The retroactive child support shall be
paid in the amount of $___________ per month, payable _____in accordance with
the employer’s payroll cycle, and in any event at least once per month _____ other
{explain} _________________commencing {date} _______________, until paid in full
including statutory interest.
b. _____ Parent {name or designation} _______________ _____owes child support
arrearages in the amount of $__________ as of {date} ________________ to the
other parent. The child support arrearages shall be paid in the amount of $_______
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
per month, payable _____ in accordance with the parent’s employer’s payroll cycle,
and in any event at least once per month, or ___other {explain} _________________
commencing {date} _________________, until paid in full including statutory interest.
5. Insurance
{Indicate all that apply}
a. _____ Parent {name or designation} ____________________
shall be required to maintain _____ health and/or _____ dental insurance for the
parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren).
The party providing insurance shall be required to convey insurance cards
demonstrating said coverage to the Petitioner and other parent.
OR
_____ health and/or _____ dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.
b. _____ Reasonable and necessary uninsured medical/dental/prescription drug
costs for the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guidelines percentages.
_____ Other {explain
} ____________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or
parents within 30 days, and the parent or parents, within 30 days of receipt, shall
submit the applicable reimbursement for that expense.
SECTION IV. METHOD OF PAYMENT
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment
a. _____Parents shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with
any applicable fee required by statute.
OR
b. ____ The Petitioner and the Parents have requested and the court finds that it is
in the best interest of the child(ren) that support payments need not be directed
through either the State Disbursement Unit or the central depository at this time;
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
_______________________________________________________________
however, any party may subsequently apply, pursuant to section
61.13(1)(d)(3), Florida Statutes, to require payment through either the State
Disbursement Unit or the central depository.
2. Income Deduction
(If applicable)
a. _____ Immediate. _____Parent {name or designation} _____________ _____
Parent {name or designation} ___________, hereinafter, Obligor(s), shall pay
through income deduction, pursuant to a separate Income Deduction Order which
shall be effective immediately. Obligor(s) is(are) individually responsible for paying
this support obligation until all of said support is deducted from his/her income.
Until support payments are deducted, the Obligor(s) is (are) responsible for
making timely payments directly to the State Disbursement Unit or the Petitioner
as previously set forth in this Order.
b. _____ Deferred. Income deduction is ordered this day, but it shall not be effective
until a delinquency of $_____________, or, if not specified, an amount equal to
one month’s obligation occurs. Income deduction is not being implemented
immediately based on the following findings: Income deduction is not in the best
interests of the child(ren) because: {explain} ______________
_______________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an
Income Deduction Order,
AND
_____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the
clerk of court, and the Petitioner of any change in Payor(s) and/or health insurance
OR
_____ there is a signed, written agreement providing an alternative arrangement
between the Petitioner and Obligor(s) and, at the option of the IV-D agency, by
the IV-D agency in IV-D cases in which there is an assignment of support rights to
the state, reviewed and entered into the record by the court.
c. Bonus/one-time payments.
{Choose one only}
_____ All
_____ __________%
_____ No income paid in the form of a bonus or other similar one-time payment,
up to the amount of any arrearage or the remaining balance thereof owed
pursuant to this order, shall be forwarded to the Petitioner pursuant to the
payment method prescribed above.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
_________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________
d. Other provisions relating to method of payment: _______________________
________________________________________________________________.
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
{Choose one only}
1. The _____ Petitioner’s _____ Respondents’ request(s) for attorney’s fees, costs, and suit
money is (are) denied because _____________________________________________
_____________________________________________________________________.
2. _____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party
$_____________ in attorney’s fees, and $ ___________ in costs. The Court further finds
that the attorney’s fees are awarded based on the reasonable rate of
$________________ per hour and ______ reasonable hours. Other provisions relating to
attorney’s fees, costs, and suit money are as follows: __________________________
_______________________________________________________________________.
SECTION VI. OTHER PROVISIONS
1. Other Provisions _________________________________________________________
_______________________________________________________________________.
2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody.
3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent
or parents to obtain physical custody of the child(ren) at any time.
DONE AND ORDERED in _____________________, Florida on {date} ____________________
CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
I certify that a copy of this Order for Concurrent Custody was: _____ mailed _____ faxed and
mailed _____ e-mailed _____ hand-delivered to the parties and any entities listed below on
{date}________________________.
by____________________________.
{Clerk of court or designee}
Petitioner (or his or her attorney)
Respondents (or his or her attorneys)
_____State Disbursement Unit
_____Central Depository
_____Other _________________________________
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
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IN THE INTEREST OF Child(ren) Petitioner, and (Florida)

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Completed 10 January 2021

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