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
KEN BURKE, C.P.A.
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
PINELLAS COUNTY, FLORIDA
www.mypinellasclerk.org
6IMPLIFIED DISSOLUTION
OF MARRIAGE
FILING FEE: $414.00
OTHER REQUIREMENTS: Both parties are required to
appear at the time of filing
as well as at the final hearing.
Each party needs to bring a stamped,
self addressed envelope to the final
hearing.
COPIES REQUIRED: Originals to the Clerk.
1 set of copies for service.
1 set of copies for your records.
ADDITIONAL COSTS: $3.50 per Acknowledgement
(If you do not have your signature
notarized in the required spaces
before filing, the Deputy Clerk
can do this for you. Please DO NOT
SIGN until a Notary or Deputy
Clerk instructs you to do so.)
05/2015
SELF HELP CENTER
The Self Help Centers are the result of a collaborative effort between the Clerk’s Office, the Sixth Judicial Circuit,
the Community Law Program and the Clearwater Bar Association.
The purpose of the Clerk's Legal Self Help Centers is to assisW citizens representing
themselves in court (sometimes referred to as pro se persons) who do NOT have a private attorney.
&itizens who represent themselves in court and do not already have a private attorney representing them, can
now get affordable legal assistance.
OUR SERVICES INCLUDE:
x Schedule an appointment to consult with an attorney for a minimum of $15.00*
(Attorneys may assist with Family Law, Small Claims and Landlord/Tenant matters ONLY.)
x Purchase forms and packets for WKHcivil court actions OLVWHVDERYH
x Have documents notarized
x Make copies
Open Monday through Friday from 8:30 a.m. until 4:30 p.m.:
x
The Clearwater Self Help Center
The 1HZ&RXUWKRXVH
3 &RXUW6WUHHW,5RRP
Clearwater, FL 33756
Phone: (727) 464-5150
Fax: (727) 453-3423
o Appointments may be scheduled for:HGQHVGD\
Thursday and/or Friday.
o A Spanish interpreter provided by the
Hispanic Outreach Center is availableE\
DSSRLQWPHQWat theClearwater location
x
The St. Petersburg Self Help
Center
The St. Petersburg Judicial Building
545 First Avenue North5RRP
St Petersburg, FL 33701
Phone: (727) 582-7941
Fax: (727) 582-7945
o Appointments may be scheduled for
Monday WednesdayDQGRU)ULGD\
x The North County Branch Self Help Center
29582 U.S. 19 North
Clearwater, FL 33761
Phone: (727) 464-5150
Fax: (727) 453-3423
o Attorney appointments may be scheduled
for Tuesday only at this office.
Self Help Center Now Offering Online Scheduling of attorney consultation appointments for pro se litigants
that do not already have an attorney. To schedule an appointment online using a credit card, please visit
www.mypinellasclerk.org
and click on the SELF HELP CENTER link in the top menu.
*Attorney appointments may only be scheduled for a minimum of 15 minutes to a maximum of one hour. All appointments must be
scheduled in 15-minute increments, i.e., 15, 30, 45 or 60 minutes at a rate of $1 (one dollar) per minute, therefore payments will be $15, $30,
$45 or $60 accordingly.
Attorney consultation fees must be paid when the appointment time is scheduled. Payments must be E\FUHGLWFDUGFDVK check or money
order. Refunds will not be issued for missed appointments.
Ken Burke, CPA
Clerk of the Circuit Court
& Comptroller
Pinellas County, Florida
General Information for Self-Represented Litigants (09/13)
- 1 -
FAMILY LAW FORMS, COMMENTARY, AND INSTRUCTIONS
GENERAL INFORMATION FOR SELF-REPRESENTED LITIGANTS
(09/13)
You should read this General Information thoroughly before taking any other steps to file your case or
represent yourself in court. Most of this information is not repeated in the attached forms. This
information should provide you with an overview of the court system, its participants, and its processes.
It should be useful whether you want to represent yourself in a pending matter or have a better
understanding of the way family court works. This is not intended as a substitute for legal advice from
an attorney. Each case has its own particular set of circumstances, and an attorney may advise you of
what is best for you in your individual situation.
These instructions are not the only place that you can get information about how a family case works.
You may want to look at other books for more help. The Florida Statutes, Florida Family Law Rules of
Procedure, Florida Rules of Civil Procedure, and other legal information or books may be found at the
public library or in a law library at your county courthouse or a law school in your area. If you are filing a
petition for Name Change and/or Adoption, these instructions may not apply.
If the word(s) is printed in bold, this means that the word is being emphasized. Throughout these
instructions, you will also find words printed in bold and underlined. This means that the definitions of
these words may be found in the glossary of common family law terms at the end of this general
information section.
Commentary
1995 Adoption. To help the many people in family law court cases who do not have attorneys
to represent them (pro se litigants), the Florida Supreme Court added these simplified forms and
directions to the Florida Family Law Rules of Procedure. The directions refer to the Florida Family Law
Rules of Procedure or the Florida Rules of Civil Procedure. Many of the forms were adapted from the
forms accompanying the Florida Rules of Civil Procedure. Practitioners should refer to the committee
notes for those forms for rule history.
The forms were adopted by the Court pursuant to Family Law Rules of Procedure, 667 So. 2d
202 (Fla. 1995); In re Petition for Approval of Forms Pursuant to Rule 10-1.1(b) of the Rules Regulating
the Florida Bar—Stepparent Adoption Forms, 613 So. 2d 900 (Fla. 1992); Rules Regulating the Florida
Bar—Approval of Forms, 581 So. 2d 902 (Fla. 1991).
Although the forms are part of these rules, they are not all-inclusive, and additional forms, as
necessary, should be taken from the Florida Rules of Civil Procedure as provided in Florida Family Law
Rules of Procedure. Also, the following notice has been included to strongly encourage individuals to
seek the advice, when needed, of an attorney who is a member in good standing of the Florida Bar.
1997 Amendment. In 1997, the Florida Family Law Forms were completely revised to simplify
and correct the forms. Additionally, the appendices were eliminated, the instructions contained in the
appendices were incorporated into the forms, and the introduction following the Notice to Parties was
created. Minor changes were also made to the Notice to Parties set forth below.
General Information for Self-Represented Litigants (09/13)
- 2 -
NOTICE TO PARTIES WHO ARE NOT REPRESENTED BY AN ATTORNEY WHO IS A
MEMBER IN GOOD STANDING OF THE FLORIDA BAR
If you have questions or concerns about these forms, instructions, commentary, the use of the forms,
or your legal rights, it is strongly recommended that you talk to an attorney. If you do not know an
attorney, you should call the lawyer referral service listed in the yellow pages of the telephone book
under “Attorney.” If you do not have the money to hire an attorney, you should call the legal aid
office in your area.
Because the law does change, the forms and information about them may have become outdated.
You should be aware that changes may have taken place in the law or court rules that would affect
the accuracy of the forms or instructions.
In no event will the Florida Supreme Court, The Florida Bar, or anyone contributing to the production
of these forms or instructions be liable for any direct, indirect, or consequential damages resulting
from their use.
FAMILY LAW PROCEDURES
Communication with the court. Ex parte communication is communication with the judge with only
one party present. Judges are not allowed to engage in ex parte communication except in very limited
circumstances, so, absent specific authorization to the contrary, you should not try to speak with or
write to the judge in your case unless the other party
is present or has been properly notified. If you
have something you need to tell the judge, you must ask for a hearing and give notice to the other
party or file a written statement in the court file and send a copy of the written statement to the
other party.
Filing a case. A case begins with the filing of a petition
. A petition is a written request to the court for
some type of legal action. The person who originally asks for legal action is called the petitioner
and
remains the petitioner throughout the case.
A petition is given to the clerk of the circuit court
, whose office is usually located in the county
courthouse or a branch of the county courthouse. A case number is assigned and an official court file is
opened. Delivering the petition to the clerk’s office is called filing
a case. A filing fee is usually required.
Once a case has been filed, a copy must be given to (served on) the respondent. The person against
whom the original legal action is being requested is called the respondent
, because he or she is
expected to respond to the petition. The respondent remains the respondent throughout the case.
Service
. When one party files a petition, motion, or other pleading, the other party must be “served”
with a copy of the document. This means that the other party is given proper notice of the pending
action(s) and any scheduled hearings. Personal service of the petition and summons on the respondent
by a deputy sheriff or private process server is required in all original petitions and supplemental
petitions, unless constructive service is permitted by law. Personal service may also be required in
other actions by some judges. After initial service of the original or supplemental petition and summons
by a deputy sheriff or private process server, service of most motions and other documents or papers
filed in the case generally may be made by email, regular U.S. mail, or hand delivery. However, service
General Information for Self-Represented Litigants (09/13)
- 3 -
by certified mail
is required at other times so you have proof that the other party actually received the
papers. The instructions with each form will advise you of the type of service
required for that form. If
the other party is represented by an attorney, you should serve the attorney and send a copy to the
other party, except for original or supplemental petitions, which must be personally served on the
respondent.
Other than the original or supplemental petitions, any time you file additional pleadings or motions in
your case, you must provide a copy to the other party and include a certificate of service
. Likewise, the
other party must provide you with copies of everything that he or she files. Service of additional
documents is usually completed by U.S. mail. For more information, see the instructions for Certificate
of Service (General), Florida Supreme Court Approved Family Law Form 12.914.
Forms for service of process are included in the Florida Family Law Forms, along with more detailed
instructions and information regarding service. The instructions to those forms should be read carefully
to ensure that you have the other party properly served. If proper service is not obtained, the court
cannot hear your case.
Note: If you absolutely do not know where the other party to your case lives, or if the other party
resides in another state, you may be able to use constructive service
. However, if constructive service is
used, other than granting a divorce, the court may only grant limited relief, which cannot include either
alimony or child support. For more information on constructive service, see Notice of Action for
Dissolution of Marriage (No Child or Financial Support), Florida Supreme Court Approved Family Law
Form 12.913(a)(1), Notice of Action for Family Cases with Minor Child(ren), Florida Supreme Court
Approved Family Law Form 12.913(a)(2), Affidavit of Diligent Search and Inquiry, Florida Family Law
Rules of Procedure Form 12.913(b), and Affidavit of Diligent Search, Florida Family Law Rules of
Procedure Form 12.913(c).. Additionally, if the other party is in the military service of the United States,
additional steps for service may be required. See, for example, Memorandum for Certificate of Military
Service, Florida Supreme Court Approved Family Law Form 12.912(a). In sum, the law regarding
constructive service and service on an individual in the military is very complex and you may wish to
consult an attorney regarding these issues.
Default
... After being served with a petition or counterpetition, the other party has 20 days to file a
response. If a response to a petition is not filed, the petitioner may file a Motion for Default, Florida
Supreme Court Approved Family Law Form 12.922(a), with the clerk. This means that you may proceed
with your case and set a final hearing
, and a judge will make a decision, even if the other party will not
cooperate. For more information, see rule 12.080(c), Florida Family Law Rules of Procedure.
Answer
and Counterpetition... After being served, the respondent has 20 days to file an answer
admitting or denying each of the allegations contained in the petition. In addition to an answer, the
respondent may also file a counterpetition. In a counterpetition, the respondent may request the same
or some other relief or action not requested by the petitioner. If the respondent files a counterpetition,
the petitioner should then file an Answer to Counterpetition, Florida Supreme Court Approved Family
Law Form 12.903(d), and either admit or deny the allegations in the respondent’s counterpetition.
Mandatory disclosure
... Rule 12.285, Florida Family Law Rules of Procedure, requires each party in a
dissolution of marriage
to exchange certain information and documents, and file a Family Law Financial
Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). Failure to make this required
disclosure within the time required by the Florida Family Law Rules of Procedure may allow the court to
dismiss the case or to refuse to consider the pleadings of the party failing to comply. This requirement
also must be met in other family law cases, except adoptions, simplified dissolutions of marriage,
General Information for Self-Represented Litigants (09/13)
- 4 -
enforcement proceedings, contempt proceedings, and proceedings for injunctions for domestic or
repeat violence. The Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of
Procedure Form 12.932, lists the documents that must be given to the other party. For more
information see rule 12.285, Florida Family Law Rules of Procedure, and the instructions to the
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure Form
12.932.
Parenting Plan. If your case involves minor or dependent child(ren), a Parenting Plan shall be approved
or established by the court. Parenting Plan, Florida Supreme Court Approved Family Law Form,
12.995(a), Safety-Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b),
or Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form
12.995(c). The Parenting Plan shall be developed and agreed to by the parents and approved by a court.
If the parents cannot agree, or if the agreed Parenting Plan is not approved, the court must establish a
Parenting Plan. The Parenting Plan shall contain a time-sharing schedule and should address the issues
regarding the child(ren)’s education, health care, and physical, social, and emotional well-being.
Setting a hearing
or trial. Generally, the court will have hearings on motions, final hearings on
uncontested
or default cases, and trials on contested cases. Before setting your case for final hearing
or 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 jurisdiction. For further information, you should refer to the
instructions for the type of form you are filing.
Next, you must obtain a hearing or trial date so that the court may consider your request. You should
ask the clerk of court, or family law intake staff
about the local procedure for setting a hearing or trial,
which you should attend. These family law forms contain orders
and final judgments, which the judge
may use. You should ask the clerk of court or family law intake staff 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.
Below are explanations of symbols or parts of different family law forms...
{specify}, {date}, {name(s)}, {street}, {city}, {state}, {phone}
Throughout these forms, you will find hints such as those above. These tell you what to put in the
blank(s).
ሾ one only] [all that apply]
These show how many choices you should check. Sometimes you may check only one, while other times
you may check several choices. ( ) This also shows an area where you must make a choice. Check the
( ) in front of the choice that applies to you or your case.
IN THE CIRCUIT COURT OF THE (1)
JUDICIAL CIRCUIT,
IN AND FOR (2) COUNTY, FLORIDA
Case No.: (3)
Division: (4)
(5) ,
Petitioner,
and
(6) ,
General Information for Self-Represented Litigants (09/13)
- 5 -
Respondent.
Line 1 The clerk of court can tell you the number of your judicial circuit. Type or print it here.
Line 2 Type or print your county name on line (2).
Line 3 If you are filing an initial petition or pleading, the Clerk of the Court will assign a case number
after the case is filed. You should type or print this case number on all papers you file in this
case.
Line 4 The clerk of the court can tell you the name of the division in which your case is being filed, and
you should type or print it here. Divisions vary from court to court. For example, your case may
be filed in the civil division, the family division, or the juvenile division.
Line 5 Type or print the legal name of the person who originally filed the case on line 5. This person is
the petitioner because he/she is the one who filed the original petition.
Line 6 Type or print the other party’s legal name on line 6. The other party is the respondent because
he/she is responding to the petition.
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this petition and that the punishment for knowingly making a false statement includes fines
and/or imprisonment.
Dated: (1) (2)
Signature of Petitioner
Printed Name: (3)
Address: (4)
City, State, Zip: (5)
Telephone Number: (6)
Fax Number: (7)
Email Address:________________(8)_______________
Some forms require that your signature be witnessed. You must sign the form in the presence of a
notary public
or deputy clerk (employee of the clerk of the court’s office). When signing the form, you
must have a valid photo identification unless the notary knows you personally. You should completely
fill in all lines (1 & 3–8) except 2 with the requested information, if applicable. Line 2, the signature line,
must be signed in the presence of the notary public
or deputy clerk.
General Information for Self-Represented Litigants (09/13)
- 6 -
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or
clerk.]
Personally known
Produced identification
Type of identification produced
DO NOT SIGN OR FILL IN THIS PART OF ANY FORM. This section of the form is to be completed by the
notary public who is witnessing your signature.
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: {either Petitioner or Respondent; or Husband or Wife}
This form was completed with the assistance of:
{name of individual }________(1)________________________________________________________,
{name of business} _____________(2)____________________________________________________,
{address} (3) ___________________________________________,
{city} (4)______________,{state} (5), {telephone number} _(6)____________________.
This section should be completed by anyone who helps you fill out these forms but is not an attorney
who is a member in good standing of The Florida Bar, which means that he or she is not licensed to
practice law in Florida.
Line 1 The nonlawyer
who helps you should type or print his or her name on line 1.
Lines 2–6 The nonlawyer’s business name, address, (including street, city, state, and telephone
number) should be typed or printed on lines 2–6.
In addition, a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), should
be completed if a nonlawyer assists you. The disclosure is available as a family law form and should be
completed before the nonlawyer helps you. This is to be sure that you understand the role and
limitations of a nonlawyer. You and the nonlawyer should keep a copy of this disclosure for your
records.
General Information for Self-Represented Litigants (09/13)
- 7 -
FAMILY LAW GLOSSARY OF COMMON TERMS AND DEFINITIONS
Note: The following definitions are intended to be helpful, BUT they are not intended to constitute
legal advice or address every possible meaning of the term(s) contained in this glossary.
Affidavit - a written statement in which the facts stated are sworn or affirmed to be true.
Alimony-spousal support which may be ordered by the court in a proceeding for dissolution of marriage.
Types of alimony include: bridge-the-gap, durational, rehabilitative, or retroactive and may be either
temporary or permanent. The court may order periodic payments, payment in lump sum, or both. In
determining whether to award alimony, the court must determine whether either party has an actual
need for alimony and whether the other party has the ability to pay. The court must consider the
factors set forth in section 61.08, Florida Statutes, and must make certain written findings. An alimony
award may not leave the paying party with significantly less net income than that of the receiving party
without written findings of exceptional circumstances.
Answer - written response by a respondent that states whether he or she admits (agrees with) or denies
(disagrees with) the allegations in the petition. Any allegations not specifically denied are considered to
be admitted.
Appeal - asking a district court of appeal to review the decision in your case. There are strict procedural
and time requirements for filing an appeal.
Asset - everything owned by you or your spouse, including property, cars, furniture, bank accounts,
jewelry, life insurance policies, businesses, or retirement plans. An asset may be marital or nonmarital,
but that distinction is for the court to determine if you and your spouse do not agree.
Attorney - a person with special education and training in the field of law who is a member in good
standing of The Florida Bar and licensed to practice law in Florida. An attorney is the only person who is
allowed to give you legal advice. An attorney may file your case and represent you in court, or just
advise you of your rights before you file your own case. In addition to advising you of your rights, an
attorney may tell you what to expect and help prepare you for court. In family law matters, you are not
entitled to a court-appointed lawyer, like a public defender in a criminal case. However, legal assistance
is often available for those who are unable to hire a private attorney. You may consult the yellow pages
of the telephone directory for a listing of legal aid or lawyer referral services in your area, or ask your
local clerk of court or family law intake staff what services are available in your area. You may also
obtain information from the Florida Supreme Court’s Internet site located at http://www.flcourts.org.
Bond - money paid to the clerk of court by one party in a case, to be held and paid to an enjoined party
in the event that the first party causes loss or damage of property as a result of wrongfully enjoining the
other party.
Beneficiary Designation-Florida law provides that a beneficiary designation made by or on behalf of a
party providing for the payment or transference of an asset or benefit upon his or her death to the other
spouse is void when the final judgment dissolving or declaring a marriage invalid is signed, unless the
final judgment specifically states otherwise. Federal law and other statutory provisions may also apply.
This includes, but is not limited to, such assets as life insurance policies, annuities, employee benefit
plans, individual retirement accounts, and payable-on-death accounts. Whether or not to continue a
beneficiary designation is a complex area of the law and you may wish to consult with an attorney.
General Information for Self-Represented Litigants (09/13)
- 8 -
Bridge-the-Gap Alimony-spousal support which is ordered to assist a party to make the transition from
being married to being single. Bridge-the-Gap alimony is designed to assist a party with legitimate,
identifiable short-time needs; its length cannot exceed two years and it cannot be modified.
Central Depository-the office of the clerk of court that is responsible for collecting and disbursing court
ordered alimony and child support payments. The depository also keeps payment records and files
judgments if support is not paid.
Certificate of Service - a document that must be filed whenever a form you are using does not contain a
statement for you to fill in showing to whom you are sending copies of the form. Florida Supreme Court
Approved Family Law Form 12.914 is the certificate of service form and contains additional instructions.
Certified Copy - a copy of an order or final judgment, certified by the clerk of the circuit court to be an
authentic copy.
Certified Mail - mail which requires the receiving party to sign as proof that they received it.
Child Support - money paid from one parent to the other for the benefit of their dependent or minor
child(ren).
Clerk of the Circuit Court - elected official in whose office papers are filed, a case number is assigned,
and case files are maintained. The clerk’s office usually is located in the county courthouse.
Concurrent Custody-(for the purposes of a petition filed pursuant to chapter 751, Florida Statutes)
means that an eligible extended family member is awarded custodial rights to care for a child or children
concurrently with the child(ren)’s parent or parents.
Constructive Service - notification of the other party by newspaper publication or posting of notice at
designated places when the other party cannot be located for personal service. You may also be able to
use constructive service when the other party lives in another state. Constructive service is also called
“service by publication.” However, when constructive service is used, the relief the Court may grant is
limited; that relief cannot include either alimony or child support. For more information on service, see
the Instructions for Florida Family Law Rules of Procedure Forms 12.910(a) and 12.913(b) and Florida
Supreme Court Approved Family Law Form 12.913(a).
Contested Issues - any or all issues upon which the parties are unable to agree and which must be
resolved by the judge at a hearing or trial.
Contingent Asset - an asset that you may receive or get later, such as income, tax refund, accrued
vacation or sick leave, a bonus, or an inheritance.
Contingent Liability - a liability that you may owe later, such as payments for lawsuits, unpaid taxes, or
debts that you have agreed or guaranteed to pay if someone else does not.
Counterpetition - a written request to the court for legal action, which is filed by a respondent after
being served with a petition.
Custody Order - a judgment or order incorporating a Parenting Plan is a child custody determination for
the purposes of the Uniform Child Custody Jurisdiction and Enforcement Act, the International Child
Abduction Remedies Act, 42 U.S.C. ss. 11601 et seq., the Parental Kidnapping Prevention Act, and the
Convention on the Civil Aspects of International Child Abduction enacted at the Hague on October 25,
1980.
Default - a failure of a party to respond to the pleading of another party. This failure to respond may
allow the court to decide the case without input from the party who did not appear or respond.
General Information for Self-Represented Litigants (09/13)
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Delinquent - late.
Dependent Child(ren) - child(ren) who depend on their parent(s) for support either because they are
under the age of 18, have a mental or physical disability that prevents them from supporting
themselves, or are in high school, between the ages of 18 and 19, and performing in good faith with a
reasonable expectation of graduation before the age of 19.
Deputy Clerk - an employee of the office of the clerk of court, which is usually located in the county
courthouse or a branch of the county courthouse.
Dissolution of Marriage - divorce; a court action to end a marriage.
Durational Alimony-spousal support which is ordered to provide economic assistance for a set period of
time following a marriage of short or moderate duration or following a marriage of long duration if there
is no ongoing need for support on a permanent basis. Durational alimony terminates upon the death of
either party or upon remarriage of the party receiving support. It may be modified or terminated, but
cannot exceed the length of a marriage.
Electronic Communication -Contact, other than face-to-face contact, facilitated by tools such as
telephones, electronic mail or email, webcams, video-conferencing equipment, and software or other
wired or wireless technologies, or other means of communication to supplement fact-to face contact
between a parent and that parent’s minor child.
Enjoined - prohibited by the court from doing a specific act.
Ex Parte - communication with the judge by only one party. In order for a judge to speak with either
party, the other party must have been properly notified and have an opportunity to be heard. If you
have something you wish to tell the judge, you should ask for a hearing or file information in the clerk of
court’s office, with certification that a copy was sent to the other party.
Extended Family-(for the purposes of a petition filed pursuant to chapter 751, Florida Statutes) is a
person who is either:
1) A relative of a minor child within the third degree by blood or marriage to the parent; OR
2) The stepparent of a minor child if the stepparent is currently married to the parent of the child
and is not a party in a pending dissolution, separate maintenance, domestic violence, or other
civil or criminal proceeding in any court of competent jurisdiction involving one or both of the
child’s parents as an adverse party.
Family Law Intake Staff - a court’s employee(s) who is (are) available to assist you in filing a family law
case. Family law intake staff are not attorneys and cannot give legal advice. They may only assist you
with filling out the form(s). Your local clerk’s office can tell you if your county has such assistance
available.
Filing - delivering a petition, response, motion, or other pleading in a court case to the clerk of court’s
office.
Filing Fee - an amount of money, set by law, that the petitioner must pay when filing a case. If you
cannot afford to pay the fee, you must file an Application for Determination of Civil Indigent Status, to
ask the clerk to file your case without payment of the fee. This form can be obtained from the clerk’s
office.
Final Hearing - trial in your case.
Financial Affidavit - a sworn statement that contains information regarding your income, expenses,
assets, and liabilities.
Final Judgment - a written document signed by a judge and recorded in the clerk of the circuit court’s
office that contains the judge’s decision in your case.
Guardian ad Litem - a neutral person who may be appointed by the court to evaluate or investigate your
child’s situation, and file a report with the court about what is in the best interests of your child(ren).
General Information for Self-Represented Litigants (09/13)
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Guardians do not “work for” either party. The guardian may interview the parties, visit their homes,
visit the child(ren)’s school(s) and speak with teachers, or use other resources to make their
recommendation.
Hearing - a legal proceeding before a judge or designated officer (general magistrate or hearing officer)
on a motion.
Health Insurance-coverage under a fee-for-service arrangement, health care maintenance organization,
or preferred provider organization, and other types of coverage available to either parent, under which
medical services could be provided to a minor or dependent child.
Judge - an elected official who is responsible for deciding matters on which you and the other parties in
your case are unable to agree. A judge is a neutral person who is responsible for ensuring that your case
is resolved in a manner which is fair, equitable, and legal. A judge is prohibited by law from giving you
or the other party any legal advice, recommendations, or other assistance, and may not talk to either
party unless both parties are present, represented, or at a properly scheduled hearing.
Judicial Assistant - the judge’s personal staff assistant.
Liabilities - everything owed by you or your spouse, including mortgages, credit cards, or car loans. A
liability may be marital or nonmarital, but that distinction is for the court to determine if you and your
spouse do not agree.
Lump Sum Alimony - money ordered to be paid by one spouse to another in a limited number of
payments, often a single payment.
Mandatory Disclosure - items that must be disclosed by both parties except those exempted from
disclosure by Florida Family Law Rule 12.285.
Marital Asset - generally, anything that you and/or your spouse acquired or received (by gift or
purchase) during the marriage. For example, something you owned before your marriage may be
nonmarital. An asset may only be determined to be marital by agreement of the parties or
determination of the judge.
Marital Liability - generally, any debt that you and/or your spouse incurred during the marriage. A debt
may only be determined to be nonmarital by agreement of the parties or determination of the judge.
Mediator - a person who is trained and certified to assist parties in reaching an agreement before going
to court. Mediators do not take either party’s side and are not allowed to give legal advice. They are
only responsible for helping the parties reach an agreement and putting that agreement into writing. In
some areas, mediation of certain family law cases may be required before going to court.
Modification - a change made by the court in an order or final judgment.
Motion - a request made to the court, other than a petition.
No Contact - a court order directing a party not speak to, call, send mail to, visit, or go near his or her
spouse, ex-spouse, child(ren), or other family member.
Nonlawyer - a person who is not a member in good standing of The Florida Bar.
Nonmarital Asset - generally, anything owned separately by you or your spouse. An asset may only be
determined to be nonmarital by either agreement of the parties or determination of the judge.
Nonmarital Liability - generally, any debt that you or your spouse incurred before your marriage or
since your separation. A debt may only be determined to be nonmarital by either agreement of the
parties or determination of the judge.
Nonparty - a person who is not the petitioner or respondent in a court case.
Notary Public - a person authorized to witness signatures on court-related forms.
Obligee - a person to whom money, such as child support or alimony, is owed.
General Information for Self-Represented Litigants (09/13)
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Obligor - a person who is ordered by the court to pay money, such as child support or alimony.
Order - a written decision signed by a judge and filed in the clerk of the circuit court’s office, that
contains the judge’s decision on part of your case, usually on a motion.
Original Petition - see Petition
.
Parenting Course - a class that teaches parents how to help their child(ren) cope with divorce and other
family issues.
Parenting Plan – a document created to govern the relationship between the parents relating to the
decisions that must be made regarding the minor child(ren). The Parenting Plan must contain a time-
sharing schedule for the parents and child(ren) and shall address the issues concerning the minor
child(ren). The issues concerning the minor child(ren) may include, but are not limited to, the
child(ren)’s education, health care, and physical, social, and emotional well-being. In creating the Plan,
all circumstances between the parents, including their historic relationship, domestic violence, and
other factors must be taken into consideration. The Parenting Plan must be developed and agreed to by
the parents and approved by the court. If the parents cannot agree to a Parenting Plan, or if the parents
agreed to a plan that is not approved by the court, a Parenting Plan will be established by the court with
or without the use of parenting plan recommendations.
Parenting Plan Recommendation – A nonbinding recommendation concerning one or more elements of
a Parenting Plan made by a court-appointed mental health practitioner or other professional designated
pursuant to either section 61.20 or 61.401, Florida Statutes, or Florida Family Law Rule of Procedure
12.363.
Party - a person involved in a court case, either as a petitioner or respondent.
Paternity Action - A lawsuit used to determine whether a designated individual is the father of a specific
child or children.
Payor - an employer or other person who provides income to an obligor.
Permanent Alimony - spousal support ordered to provide for the needs and necessities of life as they
were established during the marriage for a party who lacks the financial ability to meet his or her needs
and necessities after dissolution of marriage. Permanent alimony is paid at a specified, periodic rate
until: modification by a court order; the death of either party; or the remarriage of the party receiving
alimony, whichever occurs first. Permanent alimony requires consideration of the factors set forth in
section 61.08(2), Florida Statutes, and must include certain written findings by the court.
Personal Service - when a summons and a copy of a petition (or other pleading) that has been filed with
the court are delivered by a deputy sheriff or private process server to the other party. Personal service
is required for all petitions and supplemental petitions.
Petition - a written request to the court for legal action, which begins a court case.
Petitioner - the person who files a petition that begins a court case.
Pleading - a formal written statement of exactly what a party wants the court to do in a lawsuit or court
action.
Pro Se or Self-Represented Litigant - a person who appears in court without the assistance of a lawyer.
Pro Se Coordinator - see Family Law Intake Staff
.
Rehabilitative Alimony - spousal support ordered to be paid for a limited period of time to allow one of
the parties an opportunity to complete a plan of education or training, according to a rehabilitative plan
accepted by the court, so that he or she may better support himself or herself after dissolution of
marriage.
General Information for Self-Represented Litigants (09/13)
- 12 -
Relocation- a change in the location of the principal residence of a parent or other person in accordance
with section 61.13001, Florida Statutes.
Respondent - the person who is served with a petition requesting some legal action against him or her.
Scientific Paternity Testing - a medical test to determine who the father of a child is.
Service - the delivery of legal documents to a party. Service must be in accordance with Florida Rule of
Judicial Administration 2.516.
Shared Parental Responsibility - an arrangement under which both parents have full parental rights and
responsibilities for their child(ren), and the parents make major decisions affecting the welfare of the
child(ren) jointly. Shared Parental Responsibility is presumptive in Florida.
Sole Parental Responsibility - a parenting arrangement under which the responsibility for the minor
child(ren) is given to one parent by the court, with or without rights of time-sharing to the other parent.
State Disbursement Unit- the unit established and operated by the Title IV-D agency to provide one
central address for the collection and disbursement of child support payments made in both
Department of Revenue and non-Department of Revenue cases, in which the obligation is paid through
an income deduction order.
Supervised Time-Sharing- a parenting arrangement under which time-sharing between a parent and his
or her child(ren) is supervised by either a friend, family member, or a supervised visitation center.
Supplemental Petition - a petition that may be filed by either party after the judge has made a decision
in a case and a final judgment or order has been entered. For example, a supplemental petition may be
used to request that the court modify the previously entered final judgment or order.
Supportive Relationship-a relationship, defined in section 61.14(1)(b)1, Florida Statutes, existing
between a spouse who receives alimony and a person with whom that spouse resides.
Time-Sharing Schedule – a timetable that must be included in the Parenting Plan that specifies the time,
including overnights and holidays, that a minor child or children will spend with each parent. The time-
sharing schedule shall either be developed and agreed to by the parents of a minor child or children and
is approved by the court, or established by the court if the parents cannot agree, or if their agreed-upon
schedule is not approved by the court.
Trial - the final hearing in a contested case.
Uncontested - any and all issues on which the parties are able to agree and which are part of a marital
settlement agreement.
Administrative Office of the Courts
The Sixth Judicial Circuit of Florida
(727)582-7200
How can I keep my address confidential in a court case if I am in fear
of domestic violence?
Question: I am in fear of domestic violence from my spouse or another party in my court case. What do I have to
do if I want to keep my address confidential?
Answer: In a domestic or repeat violence injunction case, the clerk of court has procedures in place to keep your
address confidential. If a party in the injunction case properly files their pleadings at the domestic violence desk, the
clerk will send you the copies of their pleadings so that you are properly notified of the filing and the hearing.
In most types of proceedings, the confidential address procedure through the clerk is not available
because parties
are required to copy other parties with pleadings filed in the case. In addition to sending copies of all pleadings, the
moving party must prepare a notice of hearing and send it to all parties in the case.
If you do not want the other party(s) to have your home address you can consider the following:
1. Obtain a post office box. The post office cannot reveal the true address of a post office box owner, who is
a p
rivate person and not a business, without a court order.
2. Ask your employer if you may use your work address to receive mail on your court case and as your
service address for personal service.
3. If you are a victim of domestic violence or the guardian of an adult, minor child or impaired person who is
a victim of domestic violence, you may inquire about the Address Confidentiality Program (ACP) with the
Florida Attorney General’s Office. You will be interviewed for acceptance into the program. Please call
the Florida Attorney General at 1-800-226-6667 (local # 850-414-3300, TDD/TTY users may use the
Florida Relay service at 1-800-955-8771) for information on setting up the interview.
How the program works:
If you are accepted into the ACP program you will be given a substitute address
to use for your mailing and legal process service address. The Attorney General will be the only one who
has your real address. All first class mail sent, or legal process served, to the substitute ACP address will
be forwarded to you by the Attorney General’s Office. Your acceptance into the program is for a set period
of time, is revocable, and must be renewed upon expiration. If you are accepted into the ACP program you
will be given an identification card. It is your responsibility to determine who will get your actual address
and who will get your ACP address. Government agencies are required to accept your ACP address but if
you have previously given your
actual address, they may not have to replace it with your substitute address
.
The courts may order you to reveal your true address during a court case. Be aware that many government
agencies
share information and if you have given your true address to one, it may be shared with other
agencies. Federal agencies and private businesses are not required to accept your ACP address but many
will do so. Certain agencies, such as law enforcement, have the right to access your true address for certain
reasons. A false or incorrect application under this program constitutes a second degree misdemeanor.
Sixth Judicial Circuit-Courts Information and Resource Center Reviewed 2/06
Instructions for Florida Family Law Rules of Procedure Form 12.900(a), Disclosure from Nonlawyer
(11/12)
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.
Florida Family Law Rules of Procedure Form 12.900(a), Disclosure From Nonlawyer (11/12)
IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT,
IN AND FOR PINELLAS COUNTY, FLORIDA
Case No.: ________________________
Division: ________________________
_______________________________,
Petitioner,
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 supervision 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 writing into the blanks on the form. Except for typing, {name} ____
,
may not tell me 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 questions 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.
Dated:
Signature of Party
Signature of NONLAWYER
Printed Name:
Name of Business:
Address:
Telephone Number:
Instructions for Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
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
x it involves the same parties, children, or issues and is pending when the family law
case is filed; or
x it affects the court’s jurisdiction to proceed; or
x an order in the related case may conflict with an order on the same issues in the
new case; or
x 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 initial 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
Instructions for Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
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.
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR
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 ________________________________________________________________________
Res ponde nt _ _ __ _ __ _ __ _ ___ __ _ __ _ __ _ _ ___ __ _ __ _ __ _ ____ _ ___ _ _ __ _ ___ __ _ __ _ __ __ _ ____ _ __ _
Case No.: _________________________________ Division: ________________________________
Type of Proceeding: [check all that apply]
____ Dissolution of Marriage ____ Paternity
____ Custody ____ Adoption
____ Child Support ____ Modification/Enforcement/Contempt Proceedings
____ Juvenile Dependency ____ Juvenile Delinquency
____ Termination of Parental Rights ____ Criminal
____ Domestic/Sexual/Dating/Repeat ____ Mental Health
Violence or Stalking Injunctions ____ Other {specify}___________________________
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
State where 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): __________________________________________________________________
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. 2
Case Name(s): _____________________________________________________________________
Petitioner ________________________________________________________________________
Respondent _______________________________________________________________________
Case No.: _________________________________ Division: ________________________________
Type of Proceeding: [check all that apply]
____ Dissolution of Marriage ____ Paternity
____ Custody ____ Adoption
____ Child Support ____ Modification/Enforcement/Contempt Proceedings
____ Juvenile Dependency ____ Juvenile Delinquency
____ Termination of Parental Rights ____ Criminal
____ Domestic/Sexual/Dating/Repeat ____ Mental Health
Violence or Stalking Injunctions ____Other {specify}__________________________
State where 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): __________________________________________________________________
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;
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
____ 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 ________________________________________________________________________
Res ponde nt _ _ __ _ __ _ __ _ ___ __ _ __ _ __ _ _ ___ __ _ __ _ __ _ ____ _ ___ _ _ __ _ ___ __ _ __ _ __ __ _ ____ _ __ _
Case No.: _________________________________ Division: ________________________________
Type of Proceeding: [check all that apply]
____ Dissolution of Marriage ____ Paternity
____ Custody ____ Adoption
____ Child Support ____ Modification/Enforcement/Contempt Proceedings
____ Juvenile Dependency ____ Juvenile Delinquency
____ Termination of Parental Rights ____ Criminal
____ Domestic/Sexual/Dating/Repeat ____ Mental Health
Violence or Stalking Injunctions ____Other {specify} __________________________
State where 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): __________________________________________________________________
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: ____________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. [check one only]
____ I do not request coordination of litigation in any of the cases listed above.
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
____ 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 determination of these cases
because:_______________________________________________________________________.
4. The Petitioner acknowledges a continuing duty to inform the court of any cases in this or any other
state that could affect the current proceeding.
Dated: _________________ ________________________________________
Petitioner’s Signature
Printed Name: ______________________________
Address: ________________________________
City, State, Zip: ___________________________
Telephone Number: _______________________
Fax Number: ____________________________
E-mail Address(es):________________________
CERTIFICATE OF SERVICE
I CERTIFY that I delivered a copy of this Notice of Related Cases to the _____________________ County
Sheriff’s Department or a certified process server for service on the Respondent, and [check all used]
( ) e-mailed ( ) mailed ( ) hand delivered, a copy to {name}________________________, who is the
[check all that apply] ( ) judge assigned to new case, ( ) chief judge or family law administrative
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:_____________________
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (11/13)
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} ___________________.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/13)
INSTRUCTIONS 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.
(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) Domestic Violence - all matters relating to injunctions for protection against domestic
violence pursuant to section 741.30, Florida Statutes.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/13)
(D) Dating Violence - all matters relating to injunctions for protection against dating
violence pursuant to section 784.046, Florida Statutes.
(E) Repeat Violence - all matters relating to injunctions for protection against repeat
violence pursuant to section 784.046, Florida Statutes.
(F) Sexual Violence - all matters relating to injunctions for protection against sexual
violence pursuant to section 784.046, Florida Statutes.
(G) Stalking-all matters relating to injunctions for protection against stalking pursuant to
section 784.0485, Florida Statutes
(H) 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.
(I) 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.
(J) 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.
(K) 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.
(L) 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.
(M) 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.
(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.
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases
(11/13)
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.
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)
COVER SHEET FOR FAMILY COURT CASES
I. Case Style
IN THE CIRCUIT COURT OF THE ______
JUDICIAL CIRCUIT,
IN AND FOR __________________
COUNTY, FLORIDA
Case No.: ________________
Judge: __________________
_____________________________
Petitioner
and
_____________________________
Respondent
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. 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 Revenue, Child Support Enforcement)
(I) ____ Support Non-IV-D (not Department of Revenue, Child Support Enforcement)
(J) ____ UIFSA IV-D (Department of Revenue, 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
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases (11/13)
(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
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 belief.
Signature_______________________________________
_ FL Bar No.: _____________________
Attorney or party (Bar number,if attorney)
_______________________________________
_ __________________________
(Type or print name) (E-mail Address(es))
____________________________
Date
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 }__________________.
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of
Marriage (02/18)
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:
x You and your spouse agree that the marriage cannot be saved.
x 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.
x 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.
x You are not seeking support (alimony) from your spouse, and vice versa.
x You are willing to give up your right to trial and appeal.
x You and your spouse are both willing to go into the clerk’s office to sign the petition (not
necessarily together).
x 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:
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of
Marriage (02/18)
x 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
x 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
x 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
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of
Marriage (02/18)
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.
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (02/18)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
In re the Marriage of:
Case No.:
Division:
,
Husband,
and
,
Wife.
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.
Florida 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):__________________________
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (02/18)
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}______________.
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} _____________________
Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(j),
NOTICE OF SOCIAL SECURITY NUMBER (11/15)
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 circuit court in the county where your case was 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, 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
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
Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(11/15)
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
Designation 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.
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.
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.
Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (11/15)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
NOTICE 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
children in common.
__ 2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage
in which the parties have minor children in common. The minor 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 social security numbers shall be limited to the purpose of administration of the Title IV-D
program for child support enforcement.
Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (11/15)
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
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 signed before me on by .
__________________
NOTARY PUBLIC or DEPUTY CLERK
___________________
[Print, type, or stamp commissioned name of notary or
clerk]
Personally known
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} _____,{zip code}_____________, {telephone number} _____________.
Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(j),
NOTICE OF SOCIAL SECURITY NUMBER (11/15)
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 circuit court in the county where your case was 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, 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
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
Instructions for Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number
(11/15)
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
Designation 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.
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.
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.
Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (11/15)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
NOTICE 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
children in common.
__ 2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage
in which the parties have minor children in common. The minor 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 social security numbers shall be limited to the purpose of administration of the Title IV-D
program for child support enforcement.
Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security Number (11/15)
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
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 signed before me on by .
__________________
NOTARY PUBLIC or DEPUTY CLERK
___________________
[Print, type, or stamp commissioned name of notary or
clerk]
Personally known
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} _____,{zip code}_____________, {telephone number} _____________.
Instructions for Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness
(02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(i),
AFFIDAVIT OF CORROBORATING WITNESS
(02/18)
When should this form be used?
This form may be used to corroborate residency in a dissolution of marriage proceeding. To get a
dissolution (divorce) in Florida, either party must have lived in Florida for at least 6 months before filing
the petition. Residency may be corroborated by a valid Florida’s driver’s license, Florida identification
card, or voter’s registration card (issue date of document must be at least 6 months before the date the
case is actually filed with the clerk of the circuit court), or the testimony or affidavit of someone other
than you or your spouse. This form is used to corroborate residency by affidavit. The person signing this
form must know that you have lived in the State of Florida for at least 6 months before the date you filed
your petition for dissolution of marriage.
This form should be typed or printed in black ink, and signed in the presence of a notary public 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 you 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, 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
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
Instructions for Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness
(02/18)
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
Designation 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.
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.
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 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.
Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness (02/18)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
In re: The Marriage of: Case No.:
Division:
,
Petitioner,
and
,
Respondent.
AFFIDAVIT OF CORROBORATING WITNESS
I, {full legal name} , being sworn, certify that the following
statements are true: I have known {name} ________ since
{approximate date} ; to the best of my understanding the petition in this action was
filed on {date} _____; and I know of my own personal knowledge that this person has
resided in the State of Florida for at least 6 months immediately prior to the date of filing of the petition.
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Dated:
Signature of Corroborating Witness
Printed Name:
Address:
City, State, Zip:
Telephone Number:
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or
clerk.]
____ Personally known
____ Produced identification
Type of identification produced
Florida Supreme Court Approved Family Law Form 12.902(i), Affidavit of Corroborating Witness (02/18)
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} _____ Affiant _____ Petitioner _____Respondent
This form was completed with the assistance of:
{name of individual} ____________________________________________,
{name of business} _______________________________________________________________,
{address} _______________________________________,
{city} ________ ,{state} _____, {zip code}___________, {telephone number} ______.
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 public 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 these 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 judgment.
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.
Instructions for Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for
Simplified Dissolution of Marriage (10/17)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR 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 together), 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.
SECTION 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:
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
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
n
ame 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
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
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:
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
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
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
Jewelry
Life insurance (cash surrender value)
Sporting and entertainment (T.V., stereo, etc.) equipment
Other assets
Total Assets to Husband
$
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
b
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 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 Wife
$
$
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
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, 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 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 follows:
.
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
______________________________________________________________________________
______________________________________________________________________________
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 signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
{Print, type, or stamp commissioned name of notary or
clerk.}
_____ Personally known
_____ 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} ________________ .
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
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 signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
{Print, type, or stamp commissioned name of notary or
clerk.}
_____ Personally known
_____ 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} ___________________.
Florida Family Law Rules of Procedure Form 12.902(f)(3), Marital Settlement Agreement for Simplified Dissolution
of Marriage (10/17)
Florida Family Law Rules of Procedure Form 12.900(a), Final Judgment of Simplified
Dissolution of Marriage (9/00)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
FINAL JUDGMENT OF SIMPLIFIED DISSOLUTION OF MARRIAGE
This cause came before this Court for a hearing on the parties= Petition for Simplified Dissolution
of Marriage. The Court, having reviewed the file and heard the testimony, makes these findings of fact and
reaches these conclusions of law:
1. The Court has jurisdiction over the subject matter and the parties.
2. At least one party has been a resident of the State of Florida for more than 6 months immediately
before filing the Petition for Simplified Dissolution of Marriage.
3. The parties have no minor or dependent children in common, and the wife is not pregnant.
4. The marriage between the parties is irretrievably broken. Therefore, the marriage between the
parties is dissolved, and the parties are restored to the status of being single.
5. Marital Settlement Agreement.
[ one only]
a. The parties have voluntarily entered into a Marital Settlement Agreement, and each
has filed the required Financial Affidavit. Therefore, the Marital Settlement Agreement is
filed as AExhibit A@ in this case and is ratified and made a part of this final judgment. The
parties are ordered to obey all of its provisions.
b. There is no marital property or marital debts to divide, as the parties previously have
divided all of their personal property. Therefore, each is awarded the personal property he
or she presently has in his or her possession. Each party shall be responsible for any debts
in his or her own name.
6. ( ) yes ( ) no The wife=s former name of {full legal name}
is restored.
7. The Court reserves jurisdiction to enforce the marital settlement agreement.
ORDERED on .
CIRCUIT JUDGE
Florida Family Law Rules of Procedure Form 12.900(a), Final Judgment of Simplified
Dissolution of Marriage (9/00)
COPIES TO:
Petitioner (or his or her attorney)
Respondent (or his or her attorney)
Other:
Instructions for Florida Family Law Rules of Procedure Form 12.999, Final Disposition Form (03/17)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.999
FINAL DISPOSITION FORM
(03/17)
When should this form be used?
This form is filed by the petitioner or respondent for the use of the clerk of the court for the purpose of
reporting judicial workload data under section 25.075, Florida Statutes. When your case is completed, the
petitioner or respondent must complete this form and file it with the clerk.
What should I do next?
This form must be typed or printed in black ink. After completing and signing this form, you should then file it
and keep a copy for your records.
A copy of this form must be e-mailed, mailed, or hand delivered to the other party(ies) in your case.
Instructions for completing this form
I. Case Style. Enter the name of the court, the case number assigned at the time of the filing of the
petition, counterpetition, or motion, the name of the judge assigned, and the names of the petitioner and
respondent.
II. Means of Final Disposition. Place an “x” on the appropriate line before the major category and the
appropriate subcategory, if applicable. The following are the definitions of the disposition categories.
A. Dismissed Before Hearing or Trial. The case is settled, voluntarily dismissed, or otherwise
disposed of before a hearing or trial is held.
B. Dismissed Under Settlement, Before Hearing or Trial. Before hearing or trial, the case is
voluntarily dismissed by the petitioner, respondent, or movant after a settlement.
C. Dismissal Under Mediated Settlement, Before Hearing or Trial. The case is voluntarily dismissed
by the petitioner or respondent after a settlement is reached with mediation before a hearing
or trial is held.
D. Other, Before Hearing or Trial. The case is dismissed before a hearing or trial in an action that
does not fall into one of the other disposition categories on this form.
E. Dismissal Before Hearing or Trial. The case is dismissed by a judge voluntarily after a hearing or
trial is held.
Instructions for Florida Family Law Rules of Procedure Form 12.999, Final Disposition Form (03/17)
F. Dismissed Under a Settlement, After Hearing or Trial. The case is voluntarily dismissed by the
petitioner, respondent, or movant after a settlement is reached without mediation after a
hearing or trial is held.
G. Dismissal Under a Mediated Settlement, After Hearing or Trial. The case is voluntarily dismissed
by the petitioner, respondent, or movant after a settlement is reached with mediation after a
hearing or trial.
H. Other, After Hearing or Trial. The case is dismissed after hearing in an action that does not fall
into the categories listed on this form.
I. Disposed by Default. A respondent chooses not to or fails to contest the petitioner’s allegations
and a judgment against the respondent is entered by the court.
J. Disposed by Judge. A judgment or disposition is reached by the judge in a case that is not
dismissed and in which no trial has been held. Includes stipulations by the parties, conditional
judgments, summary judgment after hearing, and any manner in which a judgment is entered,
excluding cases disposed of by default as in category I. above.
K. Disposed by Nonjury Trial. The case is disposed as a result of a contested trial in which there is
no jury and in which the judge determines both the issues of fact and the law in the case.
L. Disposed by Jury Trial. Any part of the case is disposed as a result of a jury trial (considered the
beginning of a jury trial to be when the jurors and alternates are selected and sworn).
M. Other. The case is consolidated, submitted to mediation or arbitration, transferred, or
otherwise disposed of by any other means not listed in categories (A) to (L).
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.
Florida Family Law Rules of Procedure Form 12.999, Final Disposition Form (03/17)
FINAL DISPOSITION FORM
I. Case Style
{Name of Court} __________________________________
{Petitioner} {Case number}
{Judge} _________________________
{Respondent}
II. Means of Final Disposition
Place an “x” on the line for the major category and one subcategory, f applicable only.
Dismissed before hearing/trial
Dismissed pursuant to settlement, before hearing or trial
Dismissed under a mediated settlement before hearing or trial
Other, before hearing or trial
Dismissed after hearing or trial
_ Dismissed pursuant to a settlement, after hearing or trial
_ Dismissed pursuant to a mediated settlement, after hearing or trial
_ Other after hearing or trial
Disposed by default
Disposed by judge
Disposed by nonjury trial
Disposed by jury trial
Other {specify} .
Date: ________________________
Signature of Attorney or Party
Printed Name:
Address:
City, State, Zip:
Telephone Number:
E-mail address(es):
Fax number:
Florida Family Law Rules of Procedure Form 12.999, Final Disposition Form (03/17)
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} .
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KEN BURKE, C.P.A. www.mypinellasclerk.org (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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