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Joseph Abruzzo Clerk of The Circuit Court & (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Jr
ACH
Want to learn more? Attend one of our free Self
Service Center DIY Workshops at the Main
Courthouse on the first Wednesday of each month
from 3:30pm to 4:30pm. Topic varies from month to
month. Visit www.mypalmbeachclerk.com for more
inform
ation.
Joseph Abruzzo
Clerk of The Circuit Court & Comptroller
Self Service Center
Your Guide Through The Courts
Packet #1
Revised 01/2021
Petition for Simplified Dissolution of Marriage
File completed forms in room: 3.22 (Main Branch)
Non-Refundable
$20.00
Self Service Center Services
All instructions and forms distributed by the Clerk of the Circuit Court & Comptroller are
provided as a public service to persons seeking to represent themselves in court without the
assistance of an attorney. These documents are meant to serve as a guide only, and to assist pro
se (self-represented) litigants with their cases. Any person using these instructions and/or forms
does so at his or her own risk, and the Clerk shall not be responsible for any losses incurred by
any person in reliance on the instructions and/or forms.
Below are a few of the services available at the Self Service Center:
(Please re
view current pricing as fees are subject to change without notice)
Navigator Appointments (for document preparation assistance) Free
Navigators d
o not provide legal advice but will assist you in completing the forms and
provide you with procedural information.
Community Resource Referral- pamphlets Free
Photocopies prior to filing $.15/page
Photocopies after filing $1.00/page
Deputy Clerk signing $3.50/signature
Notary signing $10.00/signature
Single forms $1.00/page
For more information, please go to www.mypalmbeachclerk.com, email us at
Selfservice@mypalmbeachclerk.com, or visit one of the following locations:
Palm Beach County Courthouse
205 N. Dixie Highwa
y, Rm #1.25
West Palm Beach, Florida 33401
Self Service line: 561-355-7048
South County Courthouse
200 W. Atlantic Ave.
Delra
y Beach, Florida 33444
561-274-1588
North County Courthouse
3188 PGA Blvd
P
alm Beach Gardens, Florida 33410
561-624-6650
West County Courthouse
2950 State Road 15, R
m. #S-100
Belle Glade, Florida 33430
561-996-4843
Additional Legal Resources:
Florida Rural Legal
Services
ww
w.frls.org
561-820-8902
L
egal Aid Society of
Palm B
each County
www.legalaidpbc.org
561-655-8
944
Lawyer Referral
Service
www.pa
lmbeachbar.org
561-687-3266
(to hire a
lawyer to represent you
in court or give you
legal advice)
Palm Beach County
Law Libra
ry
https://www.15thcircu
it.com/se
rvices/law-
library
561-355-2928
Self Service Packet #1 Page 2 of 52
Petition for Simplified Dissolution of Marriage (Packet #1)
When should this packet be used?
This packet should be used by spouses filing for a simplified dissolution of marriage. You or
your spouse must have lived in Florida for at least 6 months before filing for a dissolution in
Florida. You may file for a simplified dissolution of marriage in if all of the following are true:
o You and your spouse agree that the marriage cannot be saved;
o You and your spouse have no minor or dependent child(ren) together, the wife
does not have any minor or dependent children born during the marriage, and the
wife is not now pregnant;
o You and your spouse have worked out how the two of you will divide the things
that you both own (your assets), who will pay what part of the money you both
owe (your liabilities), and you are both satisfied with this division, or there are no
assets or debts to divide;
o You are not seeking support (alimony) from your spouse, and vice versa.
o You are willing to give up your right to trial and appeal;
o You and your spouse are both willing to sign the petition;
o You and your spouse are both willing to attend the final hearing at the same time.
If you do not meet the criteria above, you must file a regular Petition for Dissolution of
Marriage.
Fees:
Unless otherwise noted, fees may be paid by cash, credit card, personal check or money order
payable to Joseph Abruzzo, Clerk of The Circuit Court & Comptroller, Palm Beach County. If
you cannot afford to pay the filing fee, you may obtain an Application for Determination of Civil
Indigent Status from the clerk. Once submitted, the clerk will determine whether you are eligible
to have filing fees waived, per Florida Statute.
o Filing Fee $409.00
Self Service Packet #1 Page 3 of 52
FORMS CHECKLIST
Include in Initial Filing
Cover Sheet for Family Court Cases, Form 12.928, (Pages 9-10)
Petition for Simplified Dissolution of Marriage, Form 12.901(a), (Pages 14-16)
Notice of Related Cases, Form 12.900(h), (rev. 11/13) (Pages 18-21)
Notice of Social Security Number, Form 12.902(j), (Pages 24-25 & 28-29): One per party.
Date of Birth Form for Unified Family Ct., Administrative Order 5.109 (Pg. 30)
File if Applicable to Your Case: (if any of these forms are applicable to your case
they must be filed prior to requesting a final hearing. Read the individual instructions for each
form to determine if it is applicable to your case.)
Marital Settlement Agreement for Simplified Dissolution of Marriage, Form
12.902(f)(3), (Pages 32-40)
Disclosure from Nonlawyer, Form 12.900(a), (Pg. 42)
Notice of Designation of E-Mail Address for E-Service (Pages 44-45 & 47-48): Use this
form if you would like to receive notices and documents from the court and the other party to
your case by email or would like to change your email address of record with the court.
File to Obtain Trial/Final Hearing Date: You WILL NOT receive a hearing
with the Judge until your file this form. The court will notify the parties of their final hearing
date by mail.
Notice for Trial, Form 12.924, (Pages 51-52)
___
___
___
___
___
___
___
___
___
Self Service Packet #1 Page 4 of 52
Filing Instructions
• Paper/ Original Documents:
▪ You may file your paperwork either by visiting one of our four courthouse locations (see
Page 2 of our instructions) or by U.S. mail to:
Unified Family Court
P.O. Box 3597
West Palm Beach FL, 33402
▪ Make 2 copies of all the documents that you complete – one for yourself and one for the
other party.
▪ Next, file all your documents and copies, along with any applicable filing, summons and
service fees, with the Clerk of the Circuit Court & Comptroller’s office.
▪ If you mail your documents, make sure you provide an extra pre-addressed stamped
envelope with enough postage so that your copies may be returned.
• Electronic Documents:
▪ Self-represented litigants may file petitions or other pleadings or documents
electronically, but they are not required to do so. If you choose to file your pleadings or
other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525 and the procedures of the judicial circuit in which you
file. The rules and procedures should be carefully read and followed. Instructions
regarding e-filing are included in this packet.
▪ You must first register in the Florida E-Filing Portal. Directions, a manual, and a short
step by step video are available if you wish to learn to e-file your documents with the
Clerk of the Circuit Court & Comptroller instead of filing a hard copy. Go to:
www.mypalmbeachclerk.com - on the right side of the page click on the gold box
labelled “E-filing.” Then click on “Self-Represented Filers.” Please note certain
documents must be filed in original, hard copy format. A list of these documents is
available on our website.
Self Service Packet #1 Page 5 of 52
Instruction for Florida Family Law Rules of Procedure Form 12.928,
Cover Sheet for Family Court Cases (11/13)
When should this form be used?
The Cover Sheet for Family Court Cases and the information contained in it neither replace nor
supplement the filing and service of pleadings or other documents as required by law. This form
shall be filed by the petitioner/party opening or reopening a case for the use of the clerk of the
circuit court for the purpose of reporting judicial workload data pursuant to Florida Statutes
section 25.075.
This form should be typed or printed in black ink. The petitioner must file this cover sheet with
the first pleading or motion filed to open or reopen a case in all domestic and juvenile cases.
What should I do next?
Follow these instructions for completing the form:
I. Case Style. Enter the name of the court, the appropriate case number assigned at the time of
filing of the original petition, the name of the judge assigned (if applicable), and the name
(last, first, middle initial) of the petitioner(s) and respondent(s).
II. Type of Action /Proceeding. Place a check beside the proceeding you are initiating. If you
are simultaneously filing more than one type of proceeding against the same opposing party,
such as a modification and an enforcement proceeding, complete a separate cover sheet for
each action being filed.
(A) Initial Action/Petition
(B) Reopening Case. If you check “Reopening Case,” indicate whether you are filing a
modification or supplemental petition or an action for enforcement by placing a check
beside the appropriate action/petition.
1. Modification/Supplemental Petition
2. Motion for Civil Contempt/ Enforcement
3. Other – All reopening actions not involving modification/supplemental petitions or
petition enforcement.
III. Type of Case. Place a check beside the appropriate case. If the case fits more than one
category, select the most definitive. Definitions of the categories are provided below.
Self Service Packet #1 Page 6 of 52
(A) Simplified Dissolution of Marriage- petitions for the termination of marriage pursuant
to Florida Family Law Rule of Procedure 12.105.
(B) Dissolution of Marriage - petitions for the termination of marriage pursuant to Chapter
61, Florida Statutes, other than simplified dissolution.
(C) Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for
Family Court Cases (11/13)
(D) Domestic Violence - all matters relating to injunctions for protection against domestic
violence pursuant to section 741.30, Florida Statutes.
(E) Dating Violence - all matters relating to injunctions for protection against dating
violence pursuant to section 784.046, Florida Statutes.
(F) Repeat Violence - all matters relating to injunctions for protection against repeat
violence pursuant to section 784.046, Florida Statutes.
(G) Sexual Violence - all matters relating to injunctions for protection against sexual
violence pursuant to section 784.046, Florida Statutes.
(H) Stalking-all matters relating to injunctions for protection against stalking pursuant to
section 784.0485, Florida Statutes.
(I) Support - IV-D - all matters relating to child or spousal support in which an application
for assistance has been filed with the Department of Revenue, Child Support
Enforcement under Title IV-D, Social Security Act, except for such matters relating to
dissolution of marriage petitions (sections 409.2564, 409.2571, and 409.2597, Florida
Statutes), paternity, or UIFSA.
(J) Support-Non IV-D - all matters relating to child or spousal support in which an
application for assistance has not been filed under Title IV-D, Social Security Act.
(K) UIFSA- IV-D - all matters relating to Chapter 88, Florida Statutes, in which an
application for assistance has been filed under Title IV-D, Social Security Act.
(L) UIFSA - Non IV-D - all matters relating to Chapter 88, Florida Statutes, in which an
application for assistance has not been filed under Title IV-D, Social Security Act.
(M) Other Family Court - all matters involving time-sharing and/or parenting plans relating
to minor child(ren), support unconnected with dissolution of marriage, annulment,
delayed birth certificates pursuant to Florida Statutes section 382.0195, expedited
affirmation of parental status pursuant to Florida Statutes section 742.16, termination of
parental rights proceedings pursuant to Florida Statutes section 63.087, declaratory
judgment actions related to premarital, marital, post-marital agreements, or other
matters not included in the categories above. Adoption Arising Out Of Chapter 63 - all
matters relating to adoption pursuant to Chapter 63, Florida Statutes, excluding any
matters arising out of Chapter 39, Florida Statutes.
Self Service Packet #1 Page 7 of 52
(N) Name Change - all matters relating to name change, pursuant to section 68.07, Florida
Statutes.
(O) Paternity/Disestablishment of Paternity – all matters relating to paternity pursuant to
Chapter 742, Florida Statutes.
(P) Juvenile Delinquency - all matters relating to juvenile delinquency pursuant to Chapter
985, Florida Statutes.
(Q) Petition for Dependency - all matters relating to petitions for dependency.
(R) Shelter Petition – all matters relating to shelter petitions pursuant to Chapter 39, Florida
Statutes.
(S) Termination of Parental Rights Arising Out Of Chapter 39 – all matters relating to
termination of parental rights pursuant to Chapter 39, Florida Statutes.
(T) Adoption Arising Out Of Chapter 39 – all matters relating to adoption pursuant to
Chapter 39, Florida Statutes.
(U) CINS/FINS – all matters relating to children in need of services (and families in need of
services) pursuant to Chapter 984, Florida Statutes.
Attorney or Party Signature. Sign the Cover Sheet for Family Court Cases. Print legibly the
name of the person signing the Cover Sheet for Family Court Cases. Attorneys must include a
Florida Bar number. Insert the date the Cover Sheet for Family Court Cases is signed. Signature
is a certification that filer has provided accurate information on the Cover Sheet for Family Court
Cases.
Nonlawyer. Remember, a person who is not an attorney is called a nonlawyer. If a nonlawyer
helps you fill out these forms, that person must give you a copy of Disclosure from Nonlawyer,
Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A
nonlawyer helping you fill out these forms also must put his or her name, address, and telephone
number on the bottom of the last page of every form he or she helps you complete.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants”
found at the beginning of these forms. For further information, see Rule 12.100, Florida
Family Law Rules of Procedure.
Self Service Packet #1 Page 8 of 52
_____________________________
_____________________________
COVER SHEET FOR FAMILY COURT CASES
I. Case Style
IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
IN AND FOR PALM BEACH COUNTY, FLORIDA
Case N
o.:
Judge:
Petitioner
and
R
espondent
II. Type of Ac
tion/Proceeding. Place a check beside the proceeding you are initiating. If you are
simultaneously filing more than one type of proceeding against the same opposing party, such as
a modification and an enforcement proceeding, complete a separate cover sheet for each action
being filed. If you are reopening a case, choose one of the three options below it.
(A) ____ Initial Action/Petition
(B) ____ Reopening Case
1. ____ Modification/Supplemental Petition
2. ____ Motion for Civil Contempt/Enforcement
3. ____ Other
III. Type of Case. If the case fits more than one type of case, select the most definitive.
(A) ____ Simplified Dissolution of Marriage
(B) ____ Dissolution of Marriage
(C) ____ Domestic Violence
(D) ____ Dating Violence
(E) ____ Repeat Violence
(F) ____ Sexual Violence
(G) ____ Stalking
(H) ____ Support IV-D (Department of Rev
enue, Child Support Enforcement)
(I) ____ Support Non-IV-D (not Departme
nt of Revenue, Child Support Enforcement)
(J) ____ UIFSA IV-D (Department of Reve
nue, Child Support Enforcement)
(K) ____ UIFSA Non-IV-D (not Department of Revenue, Child Support Enforcement)
(L) ____ Other Family Court
(M)____ Adoption Arising Out Of Chapter 63
(N) ____ Name Change
(O) ____ Paternity/Disestablishment of Paternity
(P) ____ Juvenile Delinquency
(Q) ____ Petition for Dependency
(R) ____ Shelter Petition
(S) ____ Termination of Parental Rights Arising Out Of Chapter 39
(T) ____ Adoption Arising Out Of Chapter 39
(U) ____ CINS/FINS
Self Service Packet #1 (Page 9 of 52)
FL Family Law Rules of Procedure Form 12.928,
Cover Sheet for Family Court Cases (11/13) , Page 1 of 2
IV. Rule of Judicial Administration 2.545(d) requires that a Notice of Related Cases Form, Family
Law Form 12.900(h), be filed with the initial pleading/petition by the filing attorney or self-
represented litigant in order to notify the court of related cases. Is Form 12.900(h) being filed
with this Cover Sheet for Family Court Cases and initial pleading/petition?
____ No, to the best of my knowledge, no related cases exist.
____ Yes, all related cases are listed on Family Law Form 12.900(h).
ATTORNEY OR PARTY SIGNATURE
I
CERTIFY that the information I have provided in this cover sheet is accurate to the best of my
knowledge and bel
ief.
Signature:
Attorney or party
Type or print name
Date
FL Bar No.:
Bar num
ber, if attorney
E-mail Address(es)
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE
BLANKS BELOW: [fill i
n all blanks]
This form was prepared for the: {choose only one}
( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of ind
ividual} ,
{name of business} ,
{address} ,
{city}_________________________, {state}____________ , {telephone number} .
FL Family Law Rules of Procedure Form 12.928,
Cover Sheet for Family Court Cases (11/13)
Self Service Packet #1 (Page 10 of 52)
, Page 2 of 2
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.901(a)
PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE
(02/18)
When should this form be used?
This form should be used when a husband and wife are filing for a simplified dissolution of
marriage. You and/or your spouse must have lived in Florida for at least 6 months before filing
for a dissolution in Florida. You may file a simplified dissolution of marriage in Florida if all of
the following are true:
• You and your spouse agree that the marriage cannot be saved.
• You and your spouse have no minor or dependent child(ren) together, the wife does not
have any minor or dependent children born during the marriage, and the wife is not
now pregnant.
• You and your spouse have worked out how the two of you will divide the things that you
both own (your assets) and who will pay what part of the money you both owe (your
liabilities), and you are both satisfied with this division.
• You are not seeking support (alimony) from your spouse, and vice versa.
• You are willing to give up your right to trial and appeal.
• You and your spouse are both willing to go into the clerk’s office to sign the petition (not
necessarily together).
• You and your spouse are both willing to go to the final hearing (at the same time).
If you do not meet the criteria above, you must file a regular petition for dissolution of
marriage.
This petition should be typed or printed in black ink. Each of you must sign the petition.
What should I do next?
1. After completing this form, you should file it with the clerk of the circuit court in the county
where you live and keep a copy for your records.
You may document your agreement by signing a Marital Settlement Agreement, Florida
Family Law Rules of Procedure Form 12.902(f)(3) and filing it with the clerk of the circuit court
or you may agree that all of your assets (what you own) and liabilities (what you owe) have
been disposed of by oral agreement.
2. You must prove to the court that the husband and/or wife has (have) lived in Florida for more
than 6 months before filing the petition for dissolution of marriage. Residence can be proved
by:
Self Service Packet #1 Page 11 of 52
• a valid Florida driver’s license, Florida identification card, or voter registration card issued
to one of you at least 6 months prior to filing for dissolution of marriage; or
• the testimony of another person who knows that either you or your spouse has resided
in Florida for more than 6 months and is available to testify in court; or
• an affidavit. To prove residence by affidavit, use an Affidavit of Corroborating Witness,
Florida Supreme Court Approved Family Law Form 12.902(i). This form must be signed
by a person who knows that either you or your spouse has lived in Florida for more than
6 months before the date that you filed the petition for dissolution of marriage. This
affidavit may be signed in the presence of the clerk of the court or in the presence of a
notary public, who must affix his or her seal at the proper place on the affidavit.
3. You must pay the appropriate filing fees to the clerk of the circuit court. If you and your
spouse cannot afford to pay the filing fees, you may fill out an Application for Determination
of Civil Indigent Status, and file it with your petition for dissolution of marriage. You may
obtain this form from the clerk and he or she will determine whether you are eligible to have
filing fees waived.
4. You will need to complete a Family Court Cover Sheet, Florida Family Law Rules of Procedure
Form 12.928. The clerk’s office can provide this form.
5. Depending on your jurisdiction, you may either obtain a date and time for a court appearance
from the clerk of court, or a date and time will be provided to you by the court. On that date,
you and your spouse must appear together before a judge. Depending on your jurisdiction,
you will either complete a Final Judgment of Simplified Dissolution of Marriage, Florida
Family Law Rules of Procedure Form 12.990(a), and bring it with you to the hearing, or the
judge will prepare it at the hearing. At that time, if all of the papers are in order, the judge
may grant a final judgment dissolving your marriage under simplified dissolution of marriage
procedures by signing the final judgment.
6. If you fail to complete this procedure, the court may dismiss the case to clear its records.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants”
found at the beginning of these forms. The words that are in “bold underline” in these
instructions are defined there. For further information, see chapter 61, Florida Statutes, and
Rule 12.105, Florida Family Law Rules of Procedure.
Special notes...
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill
out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida
Self Service Packet #1 Page 12 of 52
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer
helping you fill out these forms also must put his or her name, address, and telephone number
on the bottom of the last page of every form he or she helps you complete.
Self Service Packet #1 Page 13 of 52
IN THE CIRCUIT COURT OF THE
FIFTEENTH
JUDICIAL CIRCUIT,
IN AND FOR
PALM BEACH
COUNTY, FLORIDA
In re the Marriage of:
,
Husband,
and
,
Wife.
Case No.:
Division:
PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE
We, {full legal name} , Husband,
and {full legal name} , Wife,
being sworn, certify that the following information is true:
[fill in all blanks]
1. We are both asking the Court for a dissolution of our marriage.
2. Husband lives in {name} County, {state} , and has lived
there since {date} . Wife lives in {name}
County, {state} , and has lived there since {date} .
3. We were married to each other on {date} in the city of {city}
in state of {state} , or country of {country} .
4. Our marriage is irretrievably broken.
5. We do not have any minor or dependent children together, the wife does not have any
minor or dependent children born during the marriage, and the wife is not pregnant.
6. We have divided our assets (what we own) and our liabilities (what we owe) by agreement.
We are satisfied with this agreement.
{Check one only}
( ) Our marital settlement agreement, Florida Family Law Rules of Procedure Form
12.902(f)(3), is attached. This agreement was signed freely and voluntarily by each of us
and we intend to be bound by it.
_________________
_______ __________________________
Self Service Packet #1 (Page 14 of 52)
, Page 1 of 3
FL Family Law Rules of Procedure Form 12.901(a),
Petition for Simplified Dissolution of Marriage (02/18)
( ) Our marital settlement agreement is not in writing. We prefer to keep our financial
agreements private.
7. {Check one only} ( ) yes ( ) no Wife wants to be known by her former name, which was
{full legal name} .
8. We each certify that we have not been threatened or pressured into signing this petition.
We each understand that the result of signing this petition may be a final judgment ending
our marriage and allowing no further relief.
9. We each understand that we both must come to the hearing to testify about the things we
are asking for in this petition.
10. We understand that we each may have legal rights as a result of our marriage and that by
signing this petition we may be giving up those rights.
11. We ask the Court to end our marriage and approve our marital settlement agreement.
Under penalties of perjury, which can include fines and/or imprisonment, I declare
that I have read this document and that the facts stated in it are true.
Dated:
Signature of HUSBAND
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):
Under penalties of perjury, which can include fines and/or imprisonment, I declare
that I have read this document and that the facts stated in it are true.
Dated:
Signature of WIFE
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):_
____________________________________________________________
__________________________
_________________________
Self Service Packet #1 (Page 15 of 52)
FL Family Law Rules of Procedure Form 12.901(a),
Petition for Simplified Dissolution of Marriage (02/18), Page 2 of 3
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS
BELOW: [fill in all blanks]
This form was prepared for: [choose one or both] ( ) Husband ( ) Wife
This form was completed with the assistance of:
{name of individual}
{name of business} _
{address}
{city} , {state} , {telephone number} .
FL Family Law Rules of Procedure Form 12.901(a),
Petition for Simplified Dissolution of Marriage (02/18)
________________________________________________________
________________________________________________________
_________________________________________________________________
_________________________ ______ ______________
Self Service Packet #1 (Page 16 of 52)
, Page 3 of 3
click to sign
signature
click to edit
Instructions for Florida Family Law Rules of Procedure Form 12.900(h)
Notice of Related Cases (11/13)
When should this form be used?
Florida Rule of Judicial Administration 2.545(d) requires the petitioner in a family law case to file with
the court a notice of related cases, if any. Your circuit may also require this form to be filed even if there
are no related cases. A case is considered related if
• it involves the same parties, children, or issues and is pending when the family law case is
filed; or
•
it affects the court’s jurisdiction to proceed; or
• an order in the related case may conflict with an order on the same issues in the new case; or
• an order in the new case may conflict with an order in the earlier case.
This form is used to provide the required notice to the court.
This form should be typed or printed in black ink. It must be filed with the clerk of the circuit court with
the init
ial pleading in the family law case.
What should I do next?
A copy of the form must be served on the presiding judges, either the chief judge or the family law
administrative judge, and all parties in the related cases. You should also keep a copy for your records.
Service must be in accordance with Florida Rule of Judicial Administration 2.516.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at
the beginning of these forms. The words that are in "bold underline" in these instructions are defined
there. For further information, see Florida Rule of Judicial Administration 2.545(d).
Special notes . . .
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law
Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these
forms must also put his or her name, address, and telephone number on the bottom of the last page of
every form he or she helps you complete.
Self Service Packet #1 Page 17 of 52
IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
IN AND FOR PALM BEACH COUNTY, FLORIDA
Case No.:
Division:
_____________________________,
Petitioner,
and
_____________________________,
Respondent.
NOTICE OF RELATED CASES
1. Petitioner submits this Notice of Related Cases as required by Florida Rule of Judicial Administration
2.545(d). A related case may be an open or closed civil, criminal, guardianship, domestic violence,
juvenile delinquency, juvenile dependency, or domestic relations case. A case is “related” to this
family law case if it involves any of the same parties, children, or issues and it is pending at the time
the party files a family case; if it affects the court’s jurisdiction to proceed; if an order in the related
case may conflict with an order on the same issues in the new case; or if an order in the new case may
conflict with an order in the earlier litigation.
[check one only]
___ There are no related cases.
___ The following are the related cases (add additional pages if necessary):
Related Case No. 1
Case Name(
s):
Petitioner:
Respondent:
Case No.: Division:
Type of Proceeding: [check all that apply]
____ Dissolution of Marriage
Custody
Child Support
Juvenile Dependency
Termination of Parental Rights
Domestic/Sexual/Dating/Repeat
Violence or St
alking Injunctions
____ Paternity
Adoption
Modification/Enforcement/Contempt Proceedings
Juvenile Delinquency
Criminal
Mental Health
Other {specify}
____ ____
____ ____
____ ____
____ ____
____ ____
State where case was decided or is pending: ____ Florida ____ O
ther: {specify}
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion
County, Florida):
Titl
e of last Court Order/Judgment (if any):
Date of Court Order/Judgment (if any):
Relationship of cases [check all that apply]:
Self Service Packet #1 (Page 18 of 52)
), Page 1 of 4
FL Family Law Rules of Procedure Form 12.900(h),
Notice of Related Cases (11/13
____ pending case involves same parties, children, or issues;
may affect court’s jurisdiction;
order in related case may conflict with an order in this case;
order in this case may conflict with previous order in related case.
Statement as to the relationship of the cases:
Relat
ed Case No. 2
Case Name(s):
Petitioner:
Respondent:
Case No.:
Division:
Type of Proceeding: [check all that apply]
____
____
____
Dissolution of Marriage
Custody
Child Support
Juvenile Dependency
Termination of Parental Rights
Dome
stic/Sexual/Dating/Repeat
Violenc
e or Stalking Injunctions
____ ____ Paternity
Adoption
Modification/Enforcement/Contempt Proceedings
Juvenile Delinquency
Criminal
Mental He
alth
Other {specify}
____ ____
____ ____
____ ____
____ ____
____ ____
____
State wh
ere case was decided or is pending: Flori
da Other: {specify}
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion
County, Flori
da):
Title of last Court Order/Judgment (if any):
Date of Court Order/Judgment (if any):
Relationship of cases [check all that apply]:
pending case involves same parties, children, or issues;
may affect court’s jurisdiction;
order in related case may conflict with an order in this case;
order in this case may conflict with previous order in related case.
Statement as to the relationship of the cases:
Related Case No. 3
Case Name(s):
Petitioner:
Respondent:
Case No.:
Division:
Type of Proceeding: [check all that apply]
Dissolution of Marriage Paternity
____ ____
____
____
____
____
____ ____
Self Service Packet #1 (Page 19 of 52)
FL Family Law Rules of Procedure Form 12.900(h),
Notice of Related Cases (11/13), Page 2 of 4
____ Custody
Child Support
Juvenile Dependency
Termination of Parental Rights
Domestic/Sexual/Dating/Repeat
Violen
ce or Stalking Injunctions
____ Adoption
Modification/Enforcement/Contempt Proceedings
Juvenile Delinquency
Criminal
Mental Health
Other {sp
ecify}
____ ____
____ ____
____ ____
____ ____
____
State whe
re case was decided or is pending: Florida Other: {specify}
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion
County, Florida):
Ti
tle of last Court Order/Judgment (if any):
Date of Court Order/Judgment (if any):
Relationship of cases [check all that apply]:
pending case involves same parties, children, or issues;
may affect court’s jurisdiction;
order in related case may conflict with an order in this case;
order in this case may conflict with previous order in related case.
Statement as to the relationship of the cases:
2. [check one only]
I do not request coordination of litigation in any of the cases listed above.
I do request coordination of the following cases:
3. [check all that apply]
Assignment to one judge
Coordination of existing cases will conserve judicial resources and promote an efficient
determinat
ion of these cases because:
4. The Petitioner acknowledges a continuing duty to inform the court of any cases in this or any other
state t
hat could affect the current proceeding.
Dated:
Petitioner’s Signature
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):
____ ____
____
____
____
____
____
____
____
____
_________________
Self Service Packet #1 (Page 20 of 52)
FL Family Law Rules of Procedure Form 12.900(h),
Notice of Related Cases (11/13), Page 3 of 4
CERTIFICATE OF SERVICE
I CERTIFY that I delivered a copy of this No
tice of Related Cases to the
County Sheriff’s Department or a certified process server for service on the Respondent, and [check all
used] ( ) e-mai
led ( ) mailed ( ) hand delivered, a copy to {name} ,
who is the [che
ck all that apply] ( ) judge assigned to new case, ( ) chief judge or family law
administrati
ve judge, ( ) {name}__________________________________ a party to the related case,
( ) {name} ___________________________,a party to the related case on {date}
Signature of Petitioner/Attorney for Petitioner
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es):
Florida Bar Number:
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE
BLANKS BELOW:
[fill
in all blanks] 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}
FL Family Law Rules of Procedure Form 12.900(h),
Notice of Related Cases (11/13)
Self Service Packet #1 (Page 21 of 52)
, Page 4 of 4
click to sign
signature
click to edit
click to sign
signature
click to edit
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(j),
NOTICE OF SOCIAL SECURITY NUMBER
(06/18)
When should this form be used?
This form must be completed and filed by each party in all paternity, child support, and dissolution of
marriage cases, regardless of whether the case involves a minor child(ren) and/or property.
This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the ci
rcuit court in the county where your case was filed and keep a copy for your records.
CONFIDENTIAL INFORMATION
Under Rule 2.420 of the Florida Rules of Judicial Administration, Social Security Numbers are confidential;
however, this information is required by the Florida Statutes. A Notice of Confidential Information within
Court Filing must be filed with the Notice of Social Security Number. This Notice is an appendix to rule
2.420.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
WWhat should I do next?
A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not
served on him or her with your initial papers.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Self Service Packet #1 Page 22 of 52
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO
. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designatio
n of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
WWhere can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information, see chapter 61, Florida Statutes.
Special notes...
If this is a domestic violence case and you want to keep your address confidential for safety reasons,
do not enter the address, telephone, fax, or e-mail information at the bottom of this form. Instead, file
a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(i).
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms,
that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Self Service Packet #1 Page 23 of 52
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
IN THE CIRCUIT COURT OF THE
FIFTEENTH
JUDICIAL CIRCUIT,
IN AND FOR
PALM BEACH
COUNTY, FLORIDA
Case No.:
Division:
Petitioner,
and
Respondent.
NNOTICE OF SOCIAL SECURITY NUMBER
I, {full legal name} ___________________________________________________________, certify that
my social security number is ___________________________, as required by the
applicable section of
the Florida Statutes. My date of birth is ______________________________.
[Choose one only]
__ 1. This notice is being filed in a dissolution of marriage case in which the parties have no minor
or dependent child(ren) in common.
2. This notice is being filed in a paternity or child suppor
t case, or in a dissolution of marriage
in which the parties have minor o
r dependent children in common. The minor or dependent
child(ren)'s name(s), date(s) of birth, and social security number(s) is/are:
__
Name Birth date Social Security Number
{Attach additional pages if necessary.}
Disclosure of s
ocial security numbers shall be limited to the purpose of administration of the Title IV-D
program for child support enforcement.
Self Service Packet #1 (Page 24 of 52)
FL Supreme Ct Approved Family Law Form 12.902(j),
Notice of Social Security Number (6/18), Page 1 of 2
_____________________________________________
----------------------------------
----------------------------------
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
notice and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated: ___________________ _____________________________________________
Signature of Party
Printed Na
me:
Address:
City, State, Zip:
Telephone Number:
Fax Number
:
Designated E-mail Address(es): ____________________
STATE OF FLORIDA
COUNTY OF --------------------------------
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization,
this
.
--- day
of ------------, --------
, by ------------------------------------.
[Notary Seal] Notary Public or Deputy Clerk
Name typed, printed or stamped
My Commission Expires: ------------
------- Personally Known OR --------
Produced Identification
Type of Identification Produced -------------------------------------------
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] 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}
FL Supreme Ct Approved Family Law Form 12.902(j),
Self Service Packet #1 (Page 25 of 52)
Notice of Social Security Number (6/18), Page 2 of 2
_____, {zip code}_____________, {telephone number} _______
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(j),
NOTICE OF SOCIAL SECURITY NUMBER
(06/18)
When should this form be used?
This form must be completed and filed by each party in all paternity, child support, and dissolution of
marriage cases, regardless of whether the case involves a minor child(ren) and/or property.
This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the ci
rcuit court in the county where your case was filed and keep a copy for your records.
CONFIDENTIAL INFORMATION
Under Rule 2.420 of the Florida Rules of Judicial Administration, Social Security Numbers are confidential;
however, this information is required by the Florida Statutes. A Notice of Confidential Information within
Court Filing must be filed with the Notice of Social Security Number. This Notice is an appendix to rule
2.420.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
WWhat should I do next?
A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not
served on him or her with your initial papers.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Self Service Packet #1 Page 26 of 52
Administration. If you elect to participate in electronic service, which means serving or receiving pleadings
by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of
Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of
Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the
A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO
. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designatio
n of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears. Please
CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court
Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme
Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
WWhere can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information, see chapter 61, Florida Statutes.
Special notes...
If this is a domestic violence case and you want to keep your address confidential for safety reasons,
do not enter the address, telephone, fax, or e-mail information at the bottom of this form. Instead, file
a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(i).
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms,
that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Self Service Packet #1 Page 27 of 52
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
IN THE CIRCUIT COURT OF THE
FIFTEENTH
JUDICIAL CIRCUIT,
IN AND FOR
PALM BEACH
COUNTY, FLORIDA
Case No.:
Division:
Petitioner,
and
Respondent.
NNOTICE OF SOCIAL SECURITY NUMBER
I, {full legal name} ___________________________________________________________, certify that
my social security number is ___________________________, as required
by the applicable section of
the Florida Statutes. My date of birth is ____________________________
__.
[Choose one only]
__ 1. This notice is being filed in a dissolution of marriage case in which the parties have no minor
or dependent child(ren) in common.
2. This notice is being filed in a paternit
y or child support case, or in a dissolution of marriage
in which the parties have min
or or dependent children in common. The minor or dependent
child(ren)'s name(s), date(s) of birth, and social security number(s) is/are:
__
Name Birth date Social Security Number
{Attach additional pages if necessary.}
Disclos
ure of social security numbers shall be limited to the purpose of administration of the Title IV-D
program for child support enforcement.
Self Service Packet #1 (Page 28 of 52)
FL Supreme Ct Approved Family Law Form 12.902(j),
Notice of Social Security Number (6/18), Page 1 of 2
_____________________________________________
----------------------------------
----------------------------------
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
notice and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated: ___________________ _____________________________________________
Signature of Party
Printed Name
:
Address:
City, State, Zip:
Telephone Number:
Fax Number
:
Designated E-mail Address(es): ____________________
STATE OF FLORIDA
COUNTY OF --------------------------------
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization
,
this
.
--- day of ------------, -------- , by ------------------------------------.
[Notary Seal] Notary Public or Deputy Clerk
Name typed, printed or stamped
My Commission Expires: ------------
------- Personally Known OR -------- Produced Identification
Type of Identification Produced -------------------------------------------
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST F
ILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ______ Petitioner _____ Respondent
This form was completed with the assistance of:
{name of indi
vidual}___________________________________________________________________,
{name of business} ____________________________________
________________________________,
{address} ____________________________________
___________________________________,
{city} ______________, {state} _____, {zip code}_____________, {telephone number}
FL Supreme Ct Approved Family Law Form 12.902(j),
Notice of Social Security Number (6/18)
_______
Self Service Packet #1 (Page 29 of 52)
, Page 2 of 2
IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT
IN
AND
FOR
PALM BEACH COUNTY, FLORIDA
CaseNo:
Divi
,
Petitioner,
and
,
Respondent.
Date
of
Birth Form for Unified Family Court
Instructions
Pursuant to Administrative Order 5 .109, this form is to be completed and filed with the Clerk's Office in
all new and reopened Unified Family Court ("UFC") cases. UFC case types include but are not limited to
all family, juvenile, mental health, domestic violence and guardianship cases. A detailed list
of
UFC case
types can be found in Administrative Order 5.101.
Sensitive Information in this document (month and day
of
birth/names
of
minors) will
be
redacted
by
the
Clerk
and
will not
be
accessible
by
the
general public.
Information
Petitioner's Name
Petitioner's D.O.B
Petitioner's Address
Petitioner's D.O.B
Petitioner's D.O.B
Petitioner's D.O.B
Child's Name
Child's D.O.B
Child's Name
Child's D.O.B
Child's Name
Child's D.O.B
Child's Name
Child's D.O.B
Child's Name
Child's D.O.B
*Please attach an additional page for additional Party or Child
Filed by:
Type/Print
your
name
Self Service Packet #1 (Page 30 of 52)
Attention
:
Jasvioocrjh
Bh~llar,
Cht
et
,D~
:
isi
n, of
Trame
Operatio-rni
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.902(f)(3)
MARITAL SETTLEMENT AGREEMENT FOR
SIMPLIFIED DISSOLUTION OF MARRIAGE (10/17)
When should this form be used?
This form should be used when a Petition for Simplified Dissolution of Marriage, Florida Family Law Rules
of Procedure Form 12.901(a), has been filed and the parties have reached an agreement on all of the
issues at hand.
This form should be typed or printed in black ink. Both parties must sign the agreement and have their
signatures witnessed by a notary publi
c or deputy clerk. After completing this form, you should file the
original with the clerk of the circuit court in the county where the petition was filed and keep a copy for
your records. You should then refer to the instructions for your petition, answer, or answer and
counterpetition concerning the procedures for setting a hearing or trial (final hearing).
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of the
se forms. The words that are in bold underline in these instructions are defined there.
For further information, see chapter 61, Florida Statutes, and the instructions for the petition which was
filed in this case.
Special notes...
This form does not act to transfer title to the property. Such transfer must be done by deed or
supplemental final j
udgment.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must gi
ve you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form
he or she helps you complete.
Self Service Packet #1 Page 31 of 52
IN THE CIRCUIT COURT OF THE
FIFTEENTH
JUDICIAL CIRCUIT,
IN AND FOR
PALM BEACH
COUNTY, FLORIDA
Case No.:
Division:
In re: the Marriage of:
_________________,
Petitioner,
and
______________
___,
Respondent.
MARITAL SETTLEMENT AGREEMENT FOR
SIMPLIFIED DISSOLUTION OF MARRIAGE
We, {Husband’s full legal name}_______________________________,and {Wife’s full legal name}
________________________________________
__,being sworn, certify that the following statements
are true:
1. We were married to each other on {date} .
2. Because of irreconcilable differences in our marriage (no chance of staying toget
her), we have
made this agreement to settle once and for all what we owe to each other and what we can
expect to receive from each other. Each of us states that nothing has been held back, that we
have honestly included everything we could think of in listing our assets (everything we own and
that is owed to us) and our debts (everything we owe), and that we believe the other has been
open and honest in writing this agreement.
3. Each of us agrees to execute and exchange any documents that might be needed to complete
this agreement, including deeds, title certificates, etc.
S
ECTION I. MARITAL ASSETS AND LIABILITIES
A. Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any
personal item(s) not listed below
is the property of the party currently in possession of the item(s).
1. Wife shall receive as her own and Husband shall have no further rights or responsibilities
regarding these assets:
Self Service Packet #1 (Page 32 of 52)
, Page 1 of 9
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17)
click to sign
signature
click to edit
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE
To avoid confusion at a later date, describe each item as clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any title/deed/account described
below is wife’s, husband’s, or both.
Current Fair
Market Value
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Self Service Packet #1 (Page 33 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 2 of 9
click to sign
signature
click to edit
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Wife $
2. Husband shall receive as his own and Wife shall have no further rights or responsibilities
regarding these assets:
Self Service Packet #1 (Page 34 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 3 of 9
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE
To avoid confusion at a later date, describe each item as clearly as possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any title/deed/account described
below is wife’s, husband’s or both.
Current Fair
Market Value
Cash (on hand)
$
Cash (in banks/credit unions)
Stocks/Bonds
Notes (money owed to you in writing)
Money owed to you (not evidenced by a note)
Real estate: (Home)
(Other)
Business interests
Automobiles
Boats
Other vehicles
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.)
Furniture & furnishings in home
Furniture & furnishings elsewhere
Collectibles
Self Service Packet #1 (Page 35 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 4 of 9
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Husband $
Self Service Packet #1 (Page 36 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 5 of 9
B. Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows:
1. Wife shall pay as her own the following and will not at any time ask Husband to pay these
debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE
To avoid confusion at a later date, describe each item as clearly as
possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any mortgage, note, or
account described below is wife’s, husband’s, or both.
Monthly
Payment
Current
Amount
Owed
Mortgages on real estate: (Home) $ $
(Other)
Charge/credit card acc
ounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Wife $ $
Self Service Packet #1 (Page 37 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 6 of 9
click to sign
signature
click to edit
2. Husband shall pay as his own the following and will not at any time ask Wife to pay these
debts/bills:
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND
To avoid confusion at a later date, des
cribe each item as clearly as
possible.
LIST ONLY THE LAST FOUR DIGITS OF ACCOUNT NUMBERS.
Where applicable, include whether the name on any mortgage, note, or
account described below is wife’s, husband’s, or both.
Monthly
Payment
Current
Amount
Owed
Mortgages on real estat
e: (Home) $ $
(Other)
Charge/cre
dit card accounts
Auto loan
Auto loan
Bank/credit union loans
Money you owe (not evidenced by a note)
Judgments
Other
Total Debts to Be Paid by Husband $ $
C. Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be
divided as follow
s:
.
Self Service Packet #1 (Page 38 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 7 of 9
______________________________________________________________________________
______________________________________________________________________________
----------------------------------
----------------------------------
SECTION II. SPOUSAL SUPPORT (ALIMONY) Each of us forever gives up any right to spousal support
(alimony) that we may have.
SECTION III. OTHER
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this
agreement and intend to be bound by it.
Dated: ______ ___________
Signature of Husband
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
E-mail Address(es): ______________________________
STATE OF FLORIDA
COUNTY OF
--------------------------------
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization,
this --- day of ------------, -------- , by ------------------------------------.
[Notary Seal] Notary Public or Deputy Clerk
Name typed, printed or stamped
My Commission Expires: ------------
------- Personally Known OR -------- Produced Identification
Type of Identification Produced -------------------------------------------
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks]
This form was prepared for the Husband who is 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 _______________ .
Self Service Packet #1 (Page 39 of 52)
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17), Page 8 of 9
----------------------------------
----------------------------------
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied
with this agreement and intend to be bound by it.
Dated:
Signature of Wife
Printed Name: __________________________________
Address: ____________________________
__________
City, State, Zip: _______________________________
__
Telephone number: _____________________________
Fax Number
____________________________________________
E-mail Address(es): _____________________________
STATE OF FLORIDA
COUNTY OF --------------------------------
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization,
this --- day of ------------, -------- , by ------------------------------------.
[Notary Seal] Notary Public or Deputy Clerk
Name typed, printed or stamped
My Commission Expires: ------------
------- Personally Known OR -------- Produced Identification
Type of Identification Produced -------------------------------------------
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks]
This form was prepared for the Wife who is 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 ___________________.
FL Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement
Agreement for Simplified Dissolution of Marriage (10/17)
Self Service Packet #1 (Page 40 of 52)
, Page 9 of 9
Instructions for Florida Family Law Rules of Procedure Form 12.900(a),
Disclosure from Nonlawyer (11/12)
When should this form be used?
This form must be used when anyone who is not a lawyer in good standing with The Florida Bar
helps you complete any Florida Family Law Form. Attorneys who are licensed to practice in
other states but not Florida, or who have been disbarred or suspended from the practice of law in
Florida, are nonlawyers for the purposes of the Florida Family Law Forms and instructions.
The nonlawyer must complete this form and both of you are to sign it before the nonlawyer
assists you in completing any Family Law Form.
In addition, on any other form with which a nonlawyer helps you, the nonlawyer shall complete
the nonlawyer section located at the bottom of the form unless otherwise specified in the
instructions to the form. This is to protect you and be sure that you are informed in advance of
the nonlawyer’s limitations.
What should I do next?
A copy of this disclosure, signed by both the nonlawyer and the person, must be given to the
person to retain and the nonlawyer must keep a copy in the person’s file. The nonlawyer shall
also keep copies for at least 6 years of all forms given to the person being assisted.
Special Notes
This disclosure form does not act as or constitute a waiver, disclaimer, or limitation of liability.
Self Service Packet #1 Page 41 of 52
click to sign
signature
click to edit
IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
IN AND FOR PALM BEACH COUNTY, FLORIDA
Case No.: ______________________________
Division: _______________________________
_______________________________,
Petitio
ner,
and
_________
______________________,
Respondent.
DISCLOSURE FROM NONLAWYER
{Name} __________________________________________ told me that he/she is a nonlawyer
and may not give legal advice, cannot tell me what my rights or remedies are, cannot tell me how to
testify in court, and cannot represent me in court.
Rule 10-2.1(b) of the Rules Regulating The Florida Bar defines a paralegal as a person who
works under the superv
ision of a member of The Florida Bar and who performs specifically delegated
substantive legal work for which a member of The Florida Bar is responsible. Only persons who meet the
definition may call themselves paralegals. {Name} , informed me that he/she is not
a paralegal as defined by the rule and cannot call himself/herself a paralegal.
{Name} , told me that he/she may only type the factual information provided
by me in writin
g into the blanks on the form. Except for typing, {name} ,
may not tell m
e what to put in the form and may not complete the form for me. However, if using a form
approved by the Supreme Court of Florida, {name} ,
may ask me factual qu
estions to fill in the blanks on the form and may also tell me how to file the form.
[choose one only]
____ I can read English.
____ I cannot read English, but this disclosure was read to me [fill in both blanks] by
{name}
in
{language} ,which I understand.
Da
ted:
Signature of Party:
Signature of NONLAWYER:
Printed Name:
Name of Business:
Address:
Telephone Number:
FL Family Law Rules of Procedure Form 12.900(a),
Disclosure of Nonlawyer (11/12)
Self Service Packet #1 (Page 42 of 52)
, Page 1 of 1
E-SERVICE INSTRUCTIONS FOR SELF REPRESENTED PARTIES
Pursuant to the Florida Rule of Judicial Administration 2.516, self-represented parties involved in any
type of case in any Florida court, may, but are not required to, serve on the opposing party's attorney court
documents by e-mail.
E-mail Service to/from an Opposing Party: Self-represented parties opting to serve court documents by e-
mail
may do so by designating a primary e-mail address (and up to 2 secondary e-mail addresses) for
receiving service in that proceeding. This designation only informs the other side of your email address.
Once a party has filed an e-mail address designation in a proceeding, all court documents required or
permitted to be served on a party must be served by e-mail unless the parties otherwise agree or a court
orders otherwise.
E-Mail Service from Participating Judges: Self-represented parties who want to receive court orders and
other co
urt documents from judges who use e-mail service MUST register with the 15th Judicial Circuit's
online services system at www.15thcircuit.com/html/onlineservices. You will NOT receive court
documents from participating judges unless and until you register with the 15th Judicial Circuit's online
system.
Form of Email: E-mail service is made by attaching a copy of the document to be served in PDF format
to an e-
mail. The e-mail’s subject line must state “SERVICE OF COURT DOCUMENT” in all capital
letters, followed by the case number of the relevant proceeding. The body of the e-mail must identify the:
(1) court in which the proceeding is pending; (2) case number; (3) name of the initial party on each side;
(3) title of each document served with that e-mail; (4) sender’s name; (5) sender’s telephone number. The
e-mail and attachments together may not exceed 5 megabytes in size; e-mails that exceed the size
requirement must be divided into separate e-mails (no one of which may exceed 5 megabytes) and labeled
sequentially in the subject line. Documents served by e-mail may be signed by "/s/", "/s" or "s/" as long as
the document filed with the Clerk's Office is signed in accordance with the applicable rule of procedure.
Service Dates: Service by e-mail is deemed complete on the date it is sent. E-mail service is treated as
service by m
ail for the computation of time. When, in addition to service by e-mail, the sender also
utilizes another means of service provided for in the Rules of Judicial Administration, the computation of
time will be based on the method of service that has the shortest response time.
Filing of Documents: The Rules of Judicial Administration require that all documents be filed with the
court eith
er before service on the opposing party or immediately thereafter. Documents are deemed filed
when they are filed with the clerk of court. If the sender learns that the e-mail did not reach the address of
the person to be served, the sender must immediately send another copy by e-mail, or serve by a means
authorized by subdivision (b)(2) of the Rules of Judicial Administration.
Self Service Packet #1 Page 43 of 52
IN THE CIRCUIT/COUNTY COURT OF THE FIFTEENTH JUDICIAL CIRCUIT
IN AND FOR PALM BEACH COUNTY, FLORIDA
CASE NO.:
,
Plaintiff/
Petitioner
v.
,
Defendant/Respondent.
NO
TICE OF DESIGNATION OF EMAIL ADDRESS FOR E-SERVICE
I, (full legal name) , designate my e-mail
address(es) below (up to 3 different email address) to opt in E-service in this case.
Primarily Email Address: ____________________________________________________
Secondary Email Address: __________________
_______________________________
Other Ema
il Address: ____________________________________________________
1. By completing this
form I am authorizing the Court, the Clerk of the Fifteenth Judicial
Circuit of Florida and the opposing part
y to send copies of orders/judgment, notices or
other written communications or pleadings to me through my designated e-mail and NOT
through regular U.S. Mail.
2. 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 orders/judgment, notices or
other written communications or pleadings in this lawsuit will be served at the email
address(es) provided above.
3. I will ensure the software filters have been removed from my computer, so it does not
interfere with my ability t
o receive any of the above documents.
I certify that a copy of this document was {check all used}: ( ) 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:
E-Mail Address(es):
Dated:
Self Service Packet #1 (Page 44 of 52)
15th Judicial Circuit Approved Local Form, Designation of
Email Address for Self Represented Litigants (1/17), Page 1 of 2
Signature of Party
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE
BLANKS BELOW:
[fill in all blanks] 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}
{street}
{city} , {state} {telephone number}
15th Judicial Circuit Approved Local Form, Designation of
Self Service Packet #1 (Page 45 of 52)
Email Address for Self Represented Litigants (1/17), Page 2 of 2
E-SERVICE INSTRUCTIONS FOR SELF REPRESENTED PARTIES
Pursuant to the Florida Rule of Judicial Administration 2.516, self-represented parties involved in any
type of case in any Florida court, may, but are not required to, serve on the opposing party's attorney court
documents by e-mail.
E-mail Service to/from an Opposing Party: Self-represented parties opting to serve court documents by e-
mail
may do so by designating a primary e-mail address (and up to 2 secondary e-mail addresses) for
receiving service in that proceeding. This designation only informs the other side of your email address.
Once a party has filed an e-mail address designation in a proceeding, all court documents required or
permitted to be served on a party must be served by e-mail unless the parties otherwise agree or a court
orders otherwise.
E-Mail Service from Participating Judges: Self-represented parties who want to receive court orders and
other co
urt documents from judges who use e-mail service MUST register with the 15th Judicial Circuit's
online services system at www.15thcircuit.com/html/onlineservices. You will NOT receive court
documents from participating judges unless and until you register with the 15th Judicial Circuit's online
system.
Form of Email: E-mail service is made by attaching a copy of the document to be served in PDF format
to an e-
mail. The e-mail’s subject line must state “SERVICE OF COURT DOCUMENT” in all capital
letters, followed by the case number of the relevant proceeding. The body of the e-mail must identify the:
(1) court in which the proceeding is pending; (2) case number; (3) name of the initial party on each side;
(3) title of each document served with that e-mail; (4) sender’s name; (5) sender’s telephone number. The
e-mail and attachments together may not exceed 5 megabytes in size; e-mails that exceed the size
requirement must be divided into separate e-mails (no one of which may exceed 5 megabytes) and labeled
sequentially in the subject line. Documents served by e-mail may be signed by "/s/", "/s" or "s/" as long as
the document filed with the Clerk's Office is signed in accordance with the applicable rule of procedure.
Service Dates: Service by e-mail is deemed complete on the date it is sent. E-mail service is treated as
service by m
ail for the computation of time. When, in addition to service by e-mail, the sender also
utilizes another means of service provided for in the Rules of Judicial Administration, the computation of
time will be based on the method of service that has the shortest response time.
Filing of Documents: The Rules of Judicial Administration require that all documents be filed with the
court eith
er before service on the opposing party or immediately thereafter. Documents are deemed filed
when they are filed with the clerk of court. If the sender learns that the e-mail did not reach the address of
the person to be served, the sender must immediately send another copy by e-mail, or serve by a means
authorized by subdivision (b)(2) of the Rules of Judicial Administration.
Self Service Packet #1 Page 46 of 52
IN THE CIRCUIT/COUNTY COURT OF THE FIFTEENTH JUDICIAL CIRCUIT
IN AND FOR PALM BEACH COUNTY, FLORIDA
CASE NO.:
,
Plaintiff/
Petitioner
v.
,
Defendant/Respondent.
NO
TICE OF DESIGNATION OF EMAIL ADDRESS FOR E-SERVICE
I, (full legal name) , designate my e-mail
address(es) below (up to 3 diffe
rent email address) to opt in E-service in this case.
Primarily Email Address: ____________________________________________________
Secondary Email Address: __________________
_______________________________
Other Email Address: ____________________________________________________
1. By completing this
form I am authorizing the Court, the Clerk of the Fifteenth Judicial
Circuit of Florida and the opposing
party to send copies of orders/judgment, notices or
other written communications or pleadings to me through my designated e-mail and NOT
through regular U.S. Mail.
2. 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 orders/judgment, notices or
other written communications or pleadings in this lawsuit will be served at the email
address(es) provided above.
3. I will ensure the software filters have been removed from my computer, so it does not
interfere with my ability t
o receive any of the above documents.
I certify that a copy of this document was {check all used}: ( ) e-mailed ( ) mailed ( ) faxed
( ) hand-deliver
ed to the person(s) listed below on {date} .
Other party or his/h
er attorney
Name:
Address:
City, State, Zip:
Fax Number:
E-Mail Address(es):
Dated:
Self Service Packet #1 (Page 47 of 52)
15th Judicial Circuit Approved Local Form, Designation of Email
Address for Self Represented Litigants (1/17), Page 1 of 2
Signature of Party
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE
BLANKS BELOW:
[fill in all blanks] 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}
{street}
{city} , {state} {telephone number}
15th Judicial Circuit Approved Local Form, Designation of Email
Address for Self Represented Litigants (1/17)
Self Service Packet #1 (Page 48 of 52)
, Page 2 of 2
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED
FAMILY LAW FORM 12.924
NOTICE FOR TRIAL
(06/18)
When should this form be used?
Generally, the court will have trials (or final hearings) in contested cases. This form is to be used to
notify the court that your case is ready to be set for trial. Before setting your case for trial, certain
requirements such as completing mandatory disclosure and filing certain papers and having them
served on the other party must be met. These requirements vary depending on the type of case and the
procedures in your particular circuit. In some circuits you must complete mediation or a parenting
course before you can set a final hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form. Other circuits may
require that you set the trial using an Order Setting Trial. Contact the clerk of the circuit court, family
law intake staff, or judicial assistant to determine how the judge assigned to your case sets trials. For
further information, you should refer to the instructions for the type of form you are filing.
This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
What should I do next?
A copy of this form must be mailed, e-mailed, or hand-delivered to the other party in your case.
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information, see rule 12.440, Florida Family Law Rules of
Procedure.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
Self Service Packet #1 Page 49 of 52
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida
Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the
Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court
in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO
. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designatio
n of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
Special notes...
These family law forms contain orders and final judgments, which the judge may use. You should ask
the clerk of court, family law intake staff, or judicial assistant if you need to bring one of these forms
with you to the hearing or trial. If so, you should type or print the heading, including the circuit, county,
case number, division, and the parties’ names, and leave the rest blank for the judge to complete at
your hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms,
that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Self Service Packet #1 Page 50 of 52
_____________________________________________
IN THE CIRCUIT COURT OF THE
FIFTEENTH
JUDICIAL CIRCUIT,
IN AND FOR
PALM BEACH
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
NOTICE FOR TRIAL
Pursuant to Rule 12.440, Florida Family Law Rules of Procedure, the party signing below states that the
case is ready to be set for trial.
The estimated time required for the parties to present their cases is: {hours} or
{days} __________________.
The trial is on ______
the original action or ______ a subsequent proceeding.
There are issues to be tried by jury. _____ Yes or _____ No.
I certify that a copy of this docume
nt was ____ mailed _____ faxed and mailed
e-mailed _____ _____ hand-delivered to the p
erson(s) listed below on {date} .
Other pa
rty or
his/her attorney:
Name:
Address:
City, State, Zip: ______
Fax Number:
Designated E-mail Address(es): ______________________
Signature of Party
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number
:
Designated E-mail Address(es): ____________________
Self Service Packet #1 (Page 51 of 52)
FL Supreme Ct. Approved Family Law Form 12.924,
Notice for Trial (06/18), Page 1 of 2
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] 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} _____,{zip code}_______, {telephone number} .
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

















FL Supreme Ct. Approved Family Law Form 12.924,
Notice for Trial (06/18)
Self Service Packet #1 (Page 52 of 52)
, Page 2 of 2
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Joseph Abruzzo Clerk of The Circuit Court & (Clerk of the Circuit Court & Comptroller, Palm Beach County)

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Completed 5 July 2021

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