_____________________________________
______________________________________________________
______________________________________________________
Other party or his/her attorney:
Name: __________________________
Address: ________________________
City, State, Zip: __________________
Telephone Number: ______________
Fax Number: ____________________
E-mail Address(es): _______________
Other party or his/her attorney:
Name: _________________________
Address: ________________________
City, State, Zip: __________________
Telephone Number: ______________
Fax Number: ____________________
E-mail Address(es): _______________
Other party or his/her attorney:
Name: __________________________
Address: ________________________
City, State, Zip: ___________________
Telephone Number: _______________
Fax Number: _____________________
E-mail Address(es): ________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
document and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Signature of Party or his/her Attorney
Printed Name: __________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number:_______________________
Fax Number_____________________________
E-mail Address(es): _______________________
STATE OF FLORIDA
COUNTY OF _______________________
Sworn 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}
Florida Family Law Rules of Procedure Form 12.911(a), Subpoena for Hearing or Trial (Issued By Clerk) (03/17)