Fillable INSTRUCTIONS FOR THE SUPPLEMENTAL INFORMATION REGARDING PARTIES FORM (Pinellas County Clerk of the Circuit Court and Comptroller)

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INSTRUCTIONS FOR THE SUPPLEMENTAL INFORMATION REGARDING PARTIES FORM (Pinellas County Clerk of the Circuit Court and Comptroller)

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INSTRUCTIONS FOR THE
SUPPLEMENTAL INFORMATION REGARDING PARTIES FORM
The Supplemental Information Regarding Parties form will aid the Court and the Clerk of
the Circuit Court in identifying related cases. This will help ensure that your related cases are
heard before the same judge at the same time and reduce the number of times you have to appear
in court.
When should this form be filed?
The Supplemental Information Regarding Parties form only needs to be completed and filed in
civil domestic violence cases, dissolution cases, paternity cases, or child support actions.
Who should complete and file the form?
The Supplemental Information Regarding Parties form must be completed and filed by the
Petitioner with the case-initiating documents. The Respondent may choose to complete and file
the form at a later date.
How should the form be completed?
The person completing the Supplemental Information Regarding Parties form should answer the
questions relating to them thoroughly and accurately. The person should also make a good faith
effort to complete the portion of the form relating to the opposing party.
What should I do next?
The Supplemental Information Regarding Parties form must be served on the opposing party.
Service must be in accordance with Florida Rule of Judicial Administration 2.516, except that
the Petitioner may choose to serve the form along with the case-initiating documents.
IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT,
IN AND FOR PASCO/PINELLAS COUNTY, FLORIDA
_____________________________
Petitioner, Case No.: ___________________
and Section: ___________________
______________________________
Respondent.
_______________________________/
SUPPLEMENTAL INFORMATION REGARDING PARTIES
The information provided in this form will assist the court and the Clerk of the Circuit
Court in identification of related cases pursuant to Florida Rule of Judicial Administration 2.545.
1. Petitioner’s Information:
a. Full Legal Name: _____________________________________________
b. Previous Names: _____________________________________________
(Maiden names, previous married or legal names, aliases (AKA’s))
c. Date of Birth: __________________ PID/SPN:
d. Information on Children:
i. __Petitioner does not have any minor children.
ii. __Petitioner has a minor child(ren) in common with Respondent.
(If you have checked this line, please complete page 2.)
iii. __Petitioner has a minor child(ren) NOT in common with Respondent.
(If you have checked this line, please complete page 3.)
2. Respondent’s Information:
a. Full Legal Name: _____________________________________________
b. Previous Names: _____________________________________________
(Maiden names, previous married or legal names, aliases (AKA’s))
c. Date of Birth: __________________ PID/SPN:
d. Information on Children:
i. __Respondent does not have any minor children.
ii. __Respondent has a minor child(ren) in common with Petitioner.
(If you have checked this line, please complete page 2.)
iii. __Respondent has a minor child(ren) NOT in common with Petitioner.
(If you have checked this line, please complete page 3.)
Case Number:
Section:
Sixth Circuit Administrative Order 2016-030 - Attachment A
Page 2 of 4
3. Minor Child(ren) In Common: The number of minor children In Common is _____.
Information about child #1: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
Information about child #2: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
Information about child #3: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
Information about child #4: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
Information about child #5: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
Information about child #6: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
If additional space is needed, please use another sheet of paper and attach it to this form.
Case Number:
Section:
Sixth Circuit Administrative Order 2016-030 - Attachment A
Page 3 of 4
4. Minor Child(ren) NOT In Common: The number of minor children NOT In
Common is _____.
Information about child #1: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
Information about child #2: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
Information about child #3: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
Information about child #4: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
Information about child #5: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
Information about child #6: Date of Birth: _________________ Sex: __________
Child’s Full Legal Name: _______________________________________________
Has the child’s name ever been changed? ___ Yes ___ No
If yes, list the child’s name before it was changed: _________________________
This is the child of (please check one): Petitioner Respondent
If additional space is needed, please use another sheet of paper and attach it to this form.
Case Number:
Section:
Sixth Circuit Administrative Order 2016-030 - Attachment A
Page 4 of 4
5. The undersigned party acknowledges a continuing duty to inform the court of any cases
in this or any other state that could affect the current proceeding.
Dated: _________________ ____________________________________
Party’s Signature
Printed Name: __________________________
Address: _______________________________
City, State, Zip: _________________________
Telephone Number: ______________________
Fax Number: ___________________________
E-mail Address(es): ______________________
If a nonlawyer helped you fill out this form, he/she must fill in ALL the blanks below:
This form was prepared for the {choose only one}: ( ) Petitioner ( ) Respondent.
This form was completed with the assistance of:
{name of individual} _____________________________________________________________
{name of business} ______________________________________________________________
{address} ______________________________________________________________________
{city} _______________________ {state} _____, {telephone number} _____________________
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INSTRUCTIONS FOR THE SUPPLEMENTAL INFORMATION REGARDING PARTIES FORM (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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