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KEN BURKE, C.P.A.
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
PINELLAS COUNTY, FLORIDA
www.mypinellasclerk.org
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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
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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
Family Law Forms
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What this package contains:
Petition for Temporary&RQFXUUHQW custody of a minor child by an H[WHQGHGIDPLO\PHPEHU
Dperson who is a relative within the third degree or certain stepparents. The following
persons are relatives with in the third degree relationship: great-grandparents,
grandparent, parent, uncle, aunt, brother, sister, child, grandchild, great-grandchild,
nephew, or niece).
These forms are NOT
the same as a Probate Guardianship action.
Waiver and Consent forms, UCCJEA affidavit.
Process service forms, constructive service forms, notice of hearing, order on petition.
How this package may be used:
A member of a minor child’s extended family may use these forms to request temporary RU
FRQFXUUHQWFXVWRG\of that child. These forms are intended to be used in situations where WKH
SDUHQWVFRQVHQWWRWKLVor where specific acts or omissions of the parents, which demonstrates WKH
SDUHQWVKDYHabused, abandoned or neglected the child(ren) as defined in chapter 39, are stated.
This can be a complicated area of the law, if you have any questions concerning the use of these
forms or your legal rights, you are encouraged to seek legal advice from an attorney.
How this package may NOT be used:
To file for custody of a child you are not related to.
To file for custody of a minor child if either parent will contest it.
To file for the custody of a minor child that is the subject of a Dependency Action through the
Department of Children Youth and Families.
To file for custody of an adult.
By an unwed father in place of a paternity action. If the mother’s location is known, these forms
are inappropriate.
LAST UPDATE
11-2006
Revised 11-2006
Forms for Use With
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Index
Information:
x $SSHQGL[*HQHUDO,QIRUPDWLRQIRU3UR6H/LWLJDQWV
x +RZFDQ,NHHSP\DGGUHVVFRQILGHQWLDOLQDFRXUWFDVHLI,DPLQIHDURIGRPHVWLFYLROHQFH"
x $GGUHVVDQGWHOHSKRQHQXPEHUOLVW
Form No. Name of Form
FFLF 12.900(a) 'LVFORVXUHIURP1RQODZ\HU
FFLF- )DPLO\/DZ&RYHU6KHHW
FFLF-DE 3HWLWLRQIRU7HPSRUDU\&XVWRG\3HWLWLRQIRU&RQFXUUHQW&XVWRG\
FFLF 12.902(d) 8QLIRUP&KLOG&XVWRG\-XULVGLFWLRQDQG(QIRUFHPHQW$FW$IILGDYLW
Consent Forms:
FFLF-F  :DLYHUDQG&RQVHQWIRU7HPSRUDU\&XVWRG\
FFLF-G :DLYHUDQG&RQVHQWIRU&RQFXUUHQW&XVWRG\
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Personal Service:
FFLF 12.910(b) 3URFHVV6HUYLFH0HPRUDQGXP
FFLF 12.910(a) 6XPPRQV3HUVRQDO6HUYLFHRQDQ,QGLYLGXDO
FFLF 12.910(a) 6XPPRQV3HUVRQDO6HUYLFHRQDQ,QGLYLGXDO
%RWKQDWXUDODGRSWHGSDUHQWVPXVWEHVHUYHGRUVLJQFRQVHQWIRUP
Constructive Service:(can only be used if you cannot locate a parent, you are required to do a diligent search)
FFLF-/ 1RWLFHRI$FWLRQ
FFLF 12.913(b) $IILGDYLWRI'LOLJHQW6HDUFKDQG,QTXLU\
*%RWKQDWXUDODGRSWHGSDUHQWVPXVWEHVHUYHGRUVLJQFRQVHQWIRUP
Default:
FFLF 12.912(b) 1RQPLOLWDU\$IILGDYLW
FFLF 12.912(b) 1RQPLOLWDU\$IILGDYLW
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FFLF 12.922(a) 0RWLRQIRU'HIDXOW
FFLF 12.922(b) 'HIDXOW
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
Miscellaneous forms:
FFLF-HI 2UGHU*UDQWLQJ7HPSRUDU\&RQVXUUHQW&XVWRG\
FFLF 12.924 1RWLFHIRU7ULDO
FFLF 12.923 1RWLFHRI+HDULQJ*HQHUDO
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(DFKSDUHQWPXVWKDYHQRWLFHRIKHDULQJ
FFLF = Florida Supreme Court Approved Family Law Form/Florida Family Law Rules of Procedure Form
FFLF-L = Sixth Judicial Circuit Local Form
Updated 8-2006
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Prepared by Administrative Office of the Courts 7/2011 1 of 4
CASE PROGRESSION CHECKLIST
PETITION FOR TEMPORARY OR CONCURRENT
CUSTODY UNDER CHAPTER 751
This checklist has been prepared to assist you with the necessary procedure for bringing your
case to final hearing. This checklist lists the minimum requirements and, even though fairly
specific, may not be all-inclusive for every case. It is not intended, and should not be
substituted for proper legal advice from an attorney. You should, however, find that making
sure all necessary steps noted below are followed would reduce procedural difficulties and time
delays. Unless otherwise stated, all references to forms refer to the Florida Supreme Court
Approved Family Law Forms and can be located online at
http://www.flcourts.org/gen_public/family/forms_rules/index.shtml
I. INITIAL FILING:
A. Petition.
Petition for Temporary Custody by Extended Family – Form 12.970(a)
OR
Petition for Concurrent Custody by Extended Family – Form 12.970(b)
*Use only one of these forms
B. Required forms filed with initial petition.
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit - Form
12.902(d).
Non-military Affidavit - Form 12.912(b) (Required only for obtaining a default on
petitions that have been personally or constructively served, not required if both parents
have signed a waiver and consent) Please note one must be filed for each parent that
was served personally or by constructive service.
C. Required fees.
Filing fee paid or fee waiver granted by Court. If you seek a waiver of the filing fee you
must fill out an Application for Determination of Civil Indigent Status, which will be
processed by the Clerk’s Office. (This form is available on the Pinellas County Clerk of
Court website). http://www.pinellasclerk.org/aspInclude2/IndigencyApplication.pdf
Fee paid for process service by Pinellas County Sheriff, or fee waiver granted. (Separate
check or money order made payable to the Sheriff). If service is required outside of the
State of Florida, the party who filed the petition must obtain service procedure
information including fees from the county where the other party(s) resides. This
information, along with applicable fees, must be provided to the Clerk’s Office. The
Clerk’s Office will prepare the summons and forward the paperwork, and money order
for the service fees, to the address provided.
Prepared by Administrative Office of the Courts 7/2011 2 of 4
Constructive Service fees: If you qualify, your notice of action may be posted on the
courthouse wall for the required period of time (check with the clerk of court for more
information). If you do not qualify for posting, you will need to contact one of the
several approved newspapers (check with the clerk of court for more information) to
inquire about having the notice of your lawsuit published. The Notice of Action must be
published for 32 days. At the end of the publishing period, the newspaper will provide
you with an affidavit that indicates how long it was published and includes a copy of the
ad as it appeared in the newspaper.
D. Waiver and consent
Waiver and Service of Process and Consent for Temporary Custody by Extended Family
– Form 12.970(c). A separate Consent must be signed by each parent and notarized.
If you cannot obtain a Waiver and Consent Form, the parent(s) must be personally or
constructively served (see below). If you can obtain only one Waiver and Consent, the
other parent must be personally or constructively served.
OR
Waiver and Service of Process and Consent for Concurrent Custody by Extended Family
– Form 12.970(d). A separate Consent must be signed by each parent and notarized.
If you cannot obtain a Waiver and Consent Form, the parent(s) must be personally or
constructively served (see below). If you can obtain only one Waiver and Consent, the
other parent must be personally or constructively served.
*Use only one of these forms
If both parents have signed a Waiver and Consent, skip to section III to set the hearing.
II. SERVICE OF PROCESS:
Service of Process or Waiver and Consent: Each parent must either sign a waiver and
consent, or be served personally or constructively. Please note that constructive service
can be an extremely complicated area of the law and you are strongly advised to seek
legal advice if you must use this form of service. If the identity of one parent is
unknown, you will need to seek legal advice to determine the proper way to serve the
unknown parent.
A. Personal Service.
Process Service Memorandum - Form 12.910(b) -A separate Memorandum must be used
for each parent who must be served. Each parent must either be served, or sign a Waiver
and Consent form. If one, or both, parents reside outside of the state of Florida, you will
need to contact the County where the parent(s) reside to determine how paperwork is
served. You should find out what address the summons should be sent to, and the fees
for personal service. This information will be given to the clerk when you file along with
the money order for the service fee(s) so that your paperwork can be forwarded to the
proper agency for service on the parent(s).
Prepared by Administrative Office of the Courts 7/2011 3 of 4
Summons returned “served” and filed by Clerk - Form 12.910(a). You will need one for
each parent being served by the Sheriff or licensed process server.
After 20 days, plus 5 days for mailing, have passed from the day Respondent(s) was
served, check to see whether Respondent(s) filed an answer or any paper within the 25
day period. If yes, you may check this item. You must follow this procedure for both
parents if they were both served. (If both checked, skip to Section III; if no answer
filed, go to “B”.)
Summons returned “not served.” You will need to try to obtain a different address, such
as a work address.
Request clerk issue an alias (2
nd
time) or pluries (3
rd
or more) summons, if new address is
known. If you cannot locate the parent(s), see Constructive Service below.
(If proper service is not obtained, the court cannot hear your case.)
Constructive Service: If you are unable to locate one, or both, of the parents to have them
sign a Waiver and Consent, or be served personally by a sheriff or licensed process
server, then you can request the clerk of court to assist you with having your lawsuit
posted on the courthouse wall or published in one of several approved newspapers. (The
clerk of court can provide you with a list of approved newspapers where your suit can be
published). You will need a “Notice of Action” form. A Notice of Action for Temporary
or Concurrent Custody of a Minor Child Form can be located under the locally approved
forms on this Court’s website. This information must be posted or published for a period
of 32 days. You are expected to continue to search for the other party(s) in the case. If
you locate them, you are expected to have them personally served or obtain a Waiver and
Consent form.
Affidavit of Diligent Search and Inquiry – Form 12.913(b). You will need one of
these for each parent that is being served by constructive service.
If constructive service is used, the court may grant only limited relief. This is a
complicated area of the Law and you may wish to consult with an attorney before using
constructive service.
B. Default. Respondent(s) failed to answer or file any paper after service.
Motion for Default filed with Clerk - Form 12.922(a) (no sooner than 25 days after date
of service.) You will need one of these for each parent that is being served by
constructive service.
and
Default entered by Clerk – Form 12.922(b). The clerk of court cannot enter a default
against a party in the military service. If the clerk cannot enter the default because of
military service, you will need to motion the court to enter a default and set a hearing on
your motion.
Only now is the case potentially ready for setting for trial/final hearing.
Prepared by Administrative Office of the Courts 7/2011 4 of 4
III. SETTING A HEARING:
A. After waiver(s) are filed, answer is filed or the Clerk enters default, contact the following.
Note that both parents must have either signed a waiver and consent, answered, or had
a default entered against them before a hearing can be set.
Call the Courts Information and Resource Center at 727-582-7200. Your case may need
to be reviewed by a Unified Family Court case manager before your hearing can be set.
B. You may be instructed to prepare the Notice of Hearing-Form 12.923(please be sure to
fill out the certificate of service section on the bottom of the form).
If you are required to complete and file the notice of hearing, distribute as
follows:
- Original filed with Clerk’s Office
- Copy to each parent (must be received at least 5 days prior to the hearing
date).
- Copy maintained for your use (optional)
If you do not properly complete this step, your hearing could be delayed.
IV. FINAL HEARING:
A. Make arrangements for child care if applicable. Children not allowed to attend without
prior Order, per Fla. Fam. L. R. P. 12.407).
B. Bring to final hearing.
Stamped, pre-addressed envelopes for each party, one for each if before Judge, two for
each if before General Master.
Certified copies of all previous court orders affecting children (e.g. custody, visitation,
support, dependency.)
"If you are a person with a disability who needs any accommodation in order to participate
in a court proceeding, you are entitled, at no cost to you, to the provision of certain
assistance. Within two (2) working days of your receipt of any notice or order requiring
your presence at a hearing, please contact the Human Rights Office, 400 S. Ft. Harrison
Ave., Ste. 300, Clearwater, FL 33756, (727) 464-4062 (V/TDD).”
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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.
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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
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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,
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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) ,
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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.
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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.
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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.
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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.
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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).
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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)
- 11 -
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.
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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
1
THE MEDIATION PROCESS
INSTRUCTIONS FOR FAMILY LAW CASES
Authority: Pursuant to §44.1011 and 44.108 Fla. Stat., and Fla. Fam. L. R. P. 12.740, et seq., judges
have the authority to order all contested family matters and issues to mediation.
To help make mediation more accessible to all parties, Chapter 2004-265, Laws of Florida, amended
44.108 Florida Statutes. Through funding for the State Court System, the Sixth Judicial Circuit will
implement Fl Stat 44.108 with a mediation model that provides paid family and county civil mediation
services to certain parties.
Definition: Mediation is statutorily defined as “...[A] process whereby a neutral third person called a
mediator acts to encourage and facilitate the resolution of a dispute between two or more parties.”
It is an informal and nonadversarial process with the objective of helping the disputing parties reach a
mutually acceptable and voluntary agreement. In mediation, decision making authority rests with the
parties. The role of the mediator includes, but is not limited to, assisting the parties in identifying issues,
fostering joint problem solving, and exploring settlement alternatives.
The mediator has no decision making power. Any agreement reached will be by mutual consent of the
parties. A written agreement that is signed may be filed and submitted to the court with the parties
consent.
Special Rules or Procedures: For each case referred to family mediation, parties eligible for court
provided mediation shall select either privately retained mediation or court provided mediation services.
Parties not eligible for court provided mediation shall select their own mediator and hold a mediation
conference in accordance with the order of referral. In accordance with Family Law Rule of Procedure
12.741 (b)(6)(A) and Rule of Civil Procedure 1.710(f)(1), eligible and non-eligible parties may choose
their own mediator; however the selection must occur within ten(10) days of the order of referral.
Court Provided Mediation Services
Requirements:
To determine eligibility for court provided mediation, both parties must submit a
Family Law Financial Affidavit 12.902(b)-Short Form upon receipt of this notice that is no more
than six months old. The form can be obtained
http://www.flcourts.org/core/fileparse.php/293/urlt/902b.pdf
A general income statement, for the purpose of determining eligibility for court-provided
mediation only, is available from the mediation staff or online at
www.jud6.org/ContactInformation/AlternativeDisputeResolution.html
The financial affidavits must be notarized and mailed or emailed to the Mediation
Program either to our St Petersburg (for St Pete Judge cases) office 501 1
st
Avenue
No., Room 722, St Petersburg, FL 33701 or Email to: smorrison@jud6.org , or our
Clearwater office (for Clearwater Judge cases) at 315 Court St., Room 401,
Clearwater, FL 33756 or Email to: jpadoll@jud6.org.
1. After you submit the financial affidavit, contact the mediation office at (727) 464-4947 for a
determination of eligibility and the assignment of the mediator. The Program will select a family
mediator by rotation from the court contracted list. You shall have ten days to schedule the date,
time and location of the mediation conference with the mediator, and pay the clerk the required
mediation fee.
2. You shall contact the Mediation Program office with the above information within the specified ten
days. If you do not notify the Program within ten days, you will be given another ten days to select a
private mediator at an agreed upon rate of pay that you will pay directly to the mediator. If you fail to
notify the Program with this information within ten days, the Program will select a private mediator
2
by rotation, set the date, time and location of the mediation without contacting the parties, at the rate
of not more than $200.00 per hour.
Parties deemed otherwise eligible for court provided mediation may also opt instead to retain private
mediation, in which case the mediation fees below will not apply.
Mediation Fees
Fees are established by statute and are as follows:
$60.00 per person per session in family mediation when the parties’ combined gross income is less than
$50,000.00 per year.
$120.00 per person per session in family mediation when the parties’ combined gross income is greater
than $50,000.00 but less than $100,000.00 per year.
Any party may pay any other party’s mediation fee. A mediation fee collected from any party is
nonrefundable.
Parties must take a copy of the order of referral to one of the offices of the Clerk of Circuit Court in
Pinellas County and pay the designated fee in the order within ten days of receiving the order of referral.
Important: Keep and bring receipt of payment to the mediation conference.
Staff will also prepare notices reflecting your coordinated date and mediator that will be mailed to both
parties and the mediator.
Clerk of Circuit Court locations for payment of fees:
545 1
st
Avenue North, First Floor St. Petersburg, FL 33701 (727) 464-7000
or
315 Court Street, First Floor, Clearwater, FL 33756 (727) 464-7000
Private Mediation
If the parties choose their own private mediator, they may select a mutually acceptable mediator from the
list of certified mediators upon a stipulation with the court or by selecting a mediator who does not meet
the certification requirements, but who, in the opinion of the parties and upon review by the presiding
judge, is otherwise qualified by training or experience to mediate all or some of the issues in the particular
case. Parties must select a mediator and notify the Program of this selection within ten days of receipt of
the order of referral, or the Program will select a mediator for you. The parties and the mediator agree
upon a fee, and the parties pay the mediator at the time of the mediation.
The parties must coordinate with the mediator a date and time of mediation and notify the
Program. Staff will also prepare notices reflecting your coordinated date and mediator selection.
Mediation conferences generally last three hours and are scheduled from 9:00 a.m. until 12:00 p.m.
or 1:00 p.m. until 4:00 p.m., unless otherwise requested. Please see below for more detailed
information regarding our scheduling policies.
Procedures Applicable to Both Court-Provided Family Mediation and Private Family Mediation
Appearances: Unless otherwise stipulated by the parties, a named party must be physically present at
the mediation conference. In the discretion of the mediator, and with the agreement of the parties,
mediation may proceed in the absence of counsel unless otherwise ordered by the court.
The Conference: ATTORNEYS SHOULD SUBMIT A BRIEF WRITTEN SUMMARY OF THE
FACTS/ISSUES OF THE CASE TO THE MEDIATOR AT LEAST ONE WEEK BEFORE THE
SCHEDULED CONFERENCE. During the conference, counsel should be prepared to discuss the facts
and legal issues involved in the case and to generally help the parties evaluate the case. The ultimate
3
decision making authority of whether or not to settle the case rests with the parties, with the advice of
counsel.
IMPORTANT: The parties shall bring a copy of their financial affidavits to the mediation. If the case
involves child support, the parties shall bring to the mediation conference a Child Support Guidelines
Worksheet in substantial conformity with Florida Family Law Form 12.902 (e).
Upon motion or request of any party, the Court will not refer a case to mediation if it finds there
has been a history of domestic violence that would compromise the mediation process. The Court
on its own motion may determine that a case will not be referred to mediation because of a history
of domestic violence.
If the case involves parental responsibility and primary residence of the children, a parenting plan
proposal shall be exchanged between the parties five (5) to seven (7) days prior to the mediation
conference. The Florida Supreme Court approved parenting plans may be accessed at
www.jud6.org/ContactInformation/AlternativeDisputeResolution.html
Your mediator will be explaining the process in greater detail the day of the conference. In the meantime,
if you have any questions about these or any other court-ordered mediation procedures, you should call
the mediation program that is handling your case St. Petersburg (727) 582-7206.
PLEASE READ CAREFULLY
Scheduling, rescheduling and cancellations: The rules require that mediation be completed within 75
days of the initial mediation conference unless otherwise ordered by the court. The initial mediation
conference shall be held within sixty (60) days of the signed referral order.
The party or attorney who is requesting that a mediation session be rescheduled must obtain consent from
opposing counsel and the assigned mediator. The Program must also be notified of any rescheduling
attempts. If opposing counsel and/or the mediator do not give consent to reschedule the conference, the
attorney must apply for relief through the presiding judge prior to the scheduled conference. Cancellation
(with no attempt to reschedule) of the mediation conference will only be permitted where one or both
parties have applied for relief from the presiding judge and has had the case properly deferred or removed
from mediation. NO OTHER UNILATERAL CANCELLATION OR RESCHEDULING WILL BE
PERMITTED AND IS A VIOLATION OF THE COURT’S ORDER TO ATTEND.
Notifying the Mediator: The mediator must be notified at least forty-eight (48) hours in advance (not
including weekends and holidays) of any rescheduling or cancellation, for whatever reason. If the late
cancellations was due to a unilateral request through the court for a continuance or deferment, the moving
party may be assessed the entire cancellation fee. If the late rescheduling was due to a stipulation
between parties, any fee charged by the mediator (excludes cases involving a court mediator) will be
divided equally between or among them.
Settlement Prior to Mediation: Settlement before mediation is always encouraged but is still considered
a cancellation. Consequently, the forty-eight (48) hours notice requirement applies. It is the
responsibility of plaintiff’s counsel to notify the Program and the mediator in a timely manner of any
settlement before the initial conference. Written confirmation is required by the court order.
Payment: If the parties choose to utilize a court mediator, the fee of $60.00 or $120.00 per party
must be paid prior to the mediation conference. See page 1 for requirements regarding fees.. If the
parties choose their own private mediator in the absence of a written fee agreement providing for the
private mediator’s compensation, the mediator shall be paid at the rate of not more than $200.00 per hour.
Payment of the agreed fee is due to the mediator on the day of the mediation conference.
01/2016
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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 Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(a)
PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY
(02/18)
When should this form be used?
This form should be used by an extended family member to obtain temporary custody of a child or
children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent
seeking to establish parental responsibility or time-sharing with a child or children.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
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(ren)’s parents as an
adverse party.
You may file a Petition for Temporary Custody if:
You have the signed, notarized consents of the child(ren)’s legal parents;
OR
You are an extended family member who is caring full time for the child(ren) in the role of a substitute
parent and with whom the child(ren) is (are) presently living.
If one of the minor child(ren)’s parents objects to the Petition, the court shall grant the Petition only upon
a finding, by clear and convincing evidence, that the child(ren)’s parent or parents are unfit to provide for
the care and control of the child(ren). In determining that a parent is unfit, the court must find that the
parent has abused, abandoned, or neglected the child(ren), as defined in Chapter 39, Florida Statutes. If
you do not have the parents’ consents you should consult a family law attorney before you file your
papers.
If you do not meet the qualifications above, you should talk to an attorney about other options. You may
also report any suspected abuse, abandonment, or neglect to the appropriate authorities.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.
Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
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.
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
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.
What should I do next?
IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the
child(ren)’s parents , and the case is uncontested, you may contact the clerk, family law intake staff, or
judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using
a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other
appropriate notice of hearing form.
If one of the parents is deceased, you must file a certified copy of the proof of death.
IF YOU DO NOT HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from
the child(ren)’s parents, you must properly notify the parents of the petition. If you know where he or she
lives, you should use personal service. If you absolutely do not know where he or she lives after
conducting a diligent search, you may use constructive service. You must complete all of the searches
Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
listed in the Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form
12.913(c), and file the form with the clerk. You should seek legal advice on constructive service as this is
a complicated area of the law. If the identity of one parent is unknown, you will need to seek legal advice
to determine the proper way to serve an unknown parent. For more information, see Chapter 49, Florida
Statutes.
If personal service is used, the parents have 20 days to answer after being served with your petition. Your
case will generally proceed in one of the following ways:
DEFAULT. If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme
Court Approved Family Law Form 12.922(a), with the clerk of court. You must file a Notice for Trial, Florida
Supreme Court Approved Family Law Form 12.924. Then, if you have filed all of the required papers, you
may contact the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify
the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form.
CONTESTED. If either parent files an answer which disagrees with or denies anything in your petition and
you are unable to settle the disputed issues, you must file a Notice for Trial, Florida Supreme Court
Approved Family Law Form 12.924, to request a final hearing. Some circuits may require the completion
of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or
judicial assistant for instructions on how to set your case for trial (final hearing).
At any time, either or both of the child(ren)’s parents may petition the court to modify or terminate the
order granting temporary custody. The court shall terminate the order upon a finding that the parent is
a fit parent, or by the consent of the parties. The court may modify an order granting temporary custody
if the parties consent or if the modification is in the best interest of the child(ren).
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 751 and Chapter 39, Florida Statutes.
Special Notes. . .
If you do not have the money to pay the filing fee, you may obtain an application for Determination of
Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees
deferred.
With this petition, you must file the following and provide a copy to the other party:
x Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
x Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
x Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By
Extended Family (02/18)
x Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required
only for obtaining a default on petitions that have been personally or constructively served. Not
required if both parents have signed a waiver and consent)
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms must
also put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT,
IN AND FOR ___________________________ COUNTY, FLORIDA
Case No: _______________________
Division: _______________________
IN THE INTEREST OF
__________________________________,
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,
__________________________________,
Respondent/ _______________________.
PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY
Petitioner, {full legal name} _________________________________, being sworn, certifies that the
following information is true:
1. This is an action for temporary custody pursuant to Chapter 751, Florida Statutes.
2. Petitioner requests temporary custody of the following minor child(ren):
Name Date of Birth Current Address
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit,
Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition.
The affidavit includes the names and current addresses of the persons with whom the child(ren)
has(have) lived during the past 5 years, the places where the child(ren) has(have) lived during the
past 5 years, and information concerning any custody proceeding in this or any other state with
respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed
with the Petition, the case may be dismissed without hearing.
4. Petitioner is an extended family member who is: {Choose one only}
_____ Related to the minor child(ren) within the third degree by blood or marriage to a parent;
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
OR
_____ The stepparent of the minor child(ren), is married to Respondent {full legal name}
______________________ 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(ren)’s parents as an adverse party.
5. Petitioner’s relationship to the minor child(ren) is: ____________________________________.
6. The residence and post office address of the Petitioner is: ______________________________
____________________________________________________________________________.
7. Petitioner is a proper person to be awarded temporary custody because: {Choose one only}
_____ Petitioner has the signed, notarized consent from both of the child(ren)’s legal parents;
OR
_____ Petitioner is caring full time for the child(ren) in the role of a substitute parent and the
child(ren) currently live with the Petitioner.
If Petitioner does not have the signed consents from both parents or is not caring for the
child(ren) full time as a substitute parent, Petitioner cannot obtain temporary custody under
Chapter 751, Florida Statutes. Petitioner should consult an attorney about other options.
8. The legal parents of the child(ren) are:
a. __________________________, whose current address is: __________________________
___________________________________________________________________________
_________________________________________________________________________.
b. _______________________, whose current address is: ____________________________
________________________________________________________________________.
9. The Consents of Parent {full legal name}_____________________________ and/or Parent
{full legal name} ___________________________________ is/are attached to the Petition.
OR
{If Applicable} The Consent of Parent {full legal name} _______________________ is not attached
because that parent is deceased. A certified copy of the proof of death is attached.
OR
Consent has NOT been obtained from the parents. The specific acts or omissions of the parents
which demonstrate that the parents have abused, abandoned, or neglected the child(ren) as
defined in Chapter 39, Florida Statutes are: (attach additional sheets if necessary) ___________
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
10. Petitioner requests temporary custody be granted for the following period of time:
___________________________________________________________________________.
The reasons that support this request are: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
11. It is in the best interests of the child(ren) that the Petitioner have temporary custody of the
child(ren) for the following reasons: ________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
12. ORDER OF PROTECTION
a. _____Petitioner IS NOT aware of any temporary or permanent order for protection entered on
behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other
jurisdiction.
OR
b. _____Petitioner IS aware of the following temporary or permanent orders for protection
entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida
or any other jurisdiction. The court entering the order and the case number is:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
13. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS
a._____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the
minor child(ren).
OR
b._____Petitioner IS aware of the following temporary or permanent order for child support for
the minor child(ren). The court entering the order and the case number is:_________
_______________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
14. CHILD SUPPORT (Choose one only}
(You must have proof or waiver of service of process upon the parent(s) or a Waiver of Service of
Process and Consent for the court to consider an award for child support)
a._____ Petitioner requests the court to order the parents to pay child support.
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(02/18)
b._____Petitioner requests the court to redirect all or part of the parents’ existing child support
obligation(s) to the Petitioner.
c._____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligation(s) to the Petitioner, and to award the Petitioner retroactive child support .
15. Petitioner _____ requests _____ does not request that the court establish reasonable visitation
or a time-sharing schedule with the parents.
16. Other: ______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.
WHEREFORE, Petitioner requests that this Court grant the Petitioner temporary custody of the child(ren)
subject to this proceeding; award the Petitioner other relief as requested; and award any other relief that
the Court deems necessary.
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: _____________________________ _______________________________________
Signature of Petitioner
Printed Name: __________________________
Address: __________________________________
City, State, Zip Code: ________________________
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
deputy clerk.}
____ Personally known
____ Produced identification
Type of identification produced _________________________
Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family
(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 Petitioner.
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 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(b)
PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY
(02/18)
When should this form be used?
This form should be used by an extended family member to obtain concurrent custody of a child or
children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent
seeking to establish parental responsibility or time-sharing with a child or children. “Concurrent custody”
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.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
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(ren)’s parents as an
adverse party.
You may file a Petition for Concurrent Custody if:
You have the signed, notarized consents of the child(ren)’s legal parents;
OR
You are an extended family member who is caring full time for the child(ren) in the role of a substitute
parent and with whom the child(ren) is (are) presently living.
In addition, you must currently have physical custody of the child(ren) and have had physical custody of
the child(ren) for at least 10 days in any 30-day period within the last 12 months; and not have signed,
written documentation from a parent which is sufficient to enable you to do all the things necessary to
care for the child(ren).
If you do not meet the qualifications above, you should talk to an attorney about other options. You may
also report any suspected abuse, abandonment, or neglect to the appropriate authorities.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where you live and keep a copy for your records.
Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
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.
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
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.
What should I do next?
IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the
child(ren)’s parents , you may contact the clerk, family law intake staff, or judicial assistant, to set a final
hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General),
Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form.
If one of the parents is deceased, you must file a certified copy of the proof of death.
If one of the minor child(ren)’s parents objects to the Petition for Concurrent Custody in writing, the court
may not grant the petition even if the other parent consents, in writing, to the entry of the order. If a
Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By
Extended Family (02/18)
parent objects, you have the option of converting the Petition to a Petition for Temporary Custody by
Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a). If the Petition is not
converted into a Petition for Temporary Custody by Extended Family, it shall be dismissed without
prejudice.
At any time, the Petitioner or either or both of the child(ren)’s parents may move the court to terminate
the order granting concurrent custody. The court shall terminate the order upon a finding that either or
both of the child(ren)’s parents objects to the order. The fact that the order for concurrent custody has
been terminated does not preclude any person who is otherwise eligible to petition for temporary custody
from filing such petition.
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 751 and Chapter 39, Florida Statutes.
Special Notes. . .
If you do not have the money to pay the filing fee, you may obtain an application for Determination of
Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees
deferred.
With this petition, you must file the following and provide a copy to the other party:
x Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme
Court Approved Family Law Form 12.902(d).
x Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).
x Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.
x Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required
only for obtaining a default on petitions that have been personally or constructively served. Not
required if both parents have signed a waiver and consent.)
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms must
also put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(02/18)
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA
Case No: _______________________
Division: _______________________
IN THE INTEREST OF:
_________________________________,
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/____________________,
__________________________________,
Respondent/ ______________________.
PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY
Petitioner, {full legal name} _________________________________, being sworn, certifies that the
following information is true:
1. This is an action for concurrent custody pursuant to Chapter 751, Florida Statutes.
2. Petitioner requests concurrent custody of the following minor child(ren):
Name Date of Birth Current Address
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit,
Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition.
The affidavit includes the names and current addresses of the persons with whom the child(ren)
has (have) lived during the past 5 years, the places where the child(ren) has(have) lived during the
past 5 years, and information concerning any custody proceeding in this or any other state with
respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed
with the Petition, the case may be dismissed without a hearing.
4. Petitioner is an extended family member who is: {Choose one only}
_____ Related to the minor child(ren) within the third degree by blood or marriage to a parent;
OR
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(02/18)
_____ The stepparent of the minor child(ren), is married to Respondent {full legal name}
__________ 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(ren)’s parents as an adverse party.
5. Petitioner’s relationship to the minor child(ren) is: ____________________________________.
6. The residence and post office address of the Petitioner is: ______________________________
______________________________________________________________________________.
7. The legal parents are:
a. __________________________________________________, whose current address is:
_______________________________________________________________________;
b. ____________________________________________________, whose current address is:
___________________________________________________________________________.
8. Petitioner currently has physical custody of the child(ren) and has had physical custody of the
child(ren) for at least 10 days in any 30-day period within the last 12 months. Detail the time
periods during the past 12 months when the child(ren) have resided with the Petitioner:
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________.
9. Petitioner does not have signed, written documentation from a parent which is sufficient to
enable the Petitioner to do all of the things necessary to care for the child(ren).
10. {If applicable} Describe the type of documents, if any, provided by the parent or parents which
enables the Petitioner to act on behalf of the child(ren): __________________________
______________________________________________________________________________.
These documents are attached to this Petition as Exhibit ________.
11. Petitioner is unable to obtain or undertake the following services or actions without an order of
custody:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
12. The Consents of Parent {full legal name}___________________________ and/or Parent {full legal
name} _________________________________ is/are attached to the Petition.
OR
{If applicable} The Consent of Parent {full legal name} ______________________________ is not
attached because that parent is deceased. A certified copy of the proof of death is attached.
13. Petitioner requests concurrent custody be granted for the following period of time: _________
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(02/18)
_____________________________________________________________________________.
The reasons that support this request are: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
14. It is in the best interests of the child(ren) that the Petitioner have concurrent custody of the
child(ren) for the following reasons: _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
15. ORDER OF PROTECTION
a._____ Petitioner IS NOT aware of any temporary or permanent order for protection entered on
behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other
jurisdiction.
OR
b_____ Petitioner IS aware of the following temporary or permanent orders for protection
entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida
or any other jurisdiction. The court entering the order and the case number is: _______
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
16. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS
a._____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the
minor child(ren).
OR
b._____Petitioner IS aware of the following temporary or permanent order for child support for
the minor child(ren). The court entering the order and the case number is:__________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________.
17. CHILD SUPPORT (If Petitioner is seeking child support) {Choose one only}
(You must have proof of service upon or waiver of process by the parent(s) or a Waiver of Service
of Process and Consent for the court to consider an award for child support)
a.____ Petitioner requests the court to order the parents to pay child support.
b.____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligation(s) to the Petitioner.
c.____ Petitioner requests the court to redirect all or part of the parents’ existing child support
obligation(s) to the Petitioner, and to award the Petitioner retroactive child support.
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(02/18)
18. Petitioner ____ requests _____ does not request that the court establish reasonable visitation or
a time-sharing schedule with the parents.
19. Other _________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________.
WHEREFORE, Petitioner requests that this Court grant the Petitioner concurrent custody of the child(ren)
subject to this proceeding; award the Petitioner other relief as requested; and award any other relief that
the Court deems necessary.
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: _____________________________ _________________________________________
Signature of Petitioner
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
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
deputy clerk.
____ Personally known
____ Produced identification
Type of identification produced _________________________
Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family
(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 Petitioner.
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(d), Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) Affidavit (02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.902(d)
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT
(UCCJEA) AFFIDAVIT
(02/18)
When should this form be used?
This form should be used in any case involving parental responsibility for, custody of, or time-sharing or
visitation with, any minor child(ren). This affidavit is required even if the parental responsibility for,
custody of, or time-sharing or visitation with, the minor child(ren) is not in dispute.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should then file it with the clerk of the circuit court in the
county where the petition 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
Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction
and Enforcement Act (UCCJEA) Affidavit (02/18)
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 sections 61.501-61.542, Florida Statutes.
Special notes...
With this form, you must also file a Notice of Confidential Information within Court Filing, Florida Rules
of Judicial Administration Appendix to Rule 2.420 Form.
Effective October 1, 2008, terms such as custodial parent, noncustodial parent, primary residential
parent, secondary residential parent, and visitation were removed from Chapter 61, Florida Statutes;
however, because the UCCJEA uses the terms, custody and visitation, they are included in this form.
Parents must develop a Parenting Plan that includes, among other things, their time-sharing schedule
with the minor child(ren). If the parents cannot agree, a parenting plan will be established by the Court.
If you are the petitioner in an injunction for protection against domestic violence case and you have filed
a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(h), you should write confidential in any space on this form that would require you to write the
address where you are currently living.
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(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT
(UCCJEA) AFFIDAVIT
I, {full legal name} ____________, being sworn, certify that the following
statements are true:
1. The number of minor child(ren) subject to this proceeding is . The name, place of
birth, birth date, and sex of each child; the present address, periods of residence, and places
where each child has lived within the past five (5) years; and the name, present address, and
relationship to the child of each person with whom the child has lived during that time are:
THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 :
Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:
Child’s Residence for the past 5 years:
Dates
(From/To)
Address (including city and
state) where child lived
Name and present address of
person child lived with
Relationship
to child
/present*
____/____
____/____
____/____
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
____/____
____/____
* If you are the petitioner in an injunction for protection against domestic violence case and you have
filed a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form
12.980(h), you should write confidential in any space on this form that would require you to enter the
address where you are currently living.
THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :
Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:
Child’s Residence for the past 5 years:
Dates
(From/To)
Address (including city and
state) where child lived
Name and present address of
person child lived with
Relationship
to child
/present
____/____
____/____
____/____
____/____
____/____
THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :
Child’s Full Legal Name:
Place of Birth: Date of Birth: Sex:
Child’s Residence for the past 5 years:
Dates
(From/To)
Address (including city and
state) where child lived
Name and present address of
person child lived with
Relationship
to child
/present
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
____/____
____/____
____/____
____/____
____/____
2. Participation in custody or time-sharing proceeding(s):
[Choose only one]
______ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation or
custody proceeding in this or any other state, jurisdiction, or country, concerning parental
responsibility for, custody of, or time-sharing or visitation with a child subject to this
proceeding.
______ I HAVE participated as a party, witness, or in any capacity in any other litigation or
custody proceeding in this or another state, jurisdiction, or country, concerning parental
responsibility for, custody of, or time-sharing or visitation with a child subject to this proceeding.
Explain:
a. Name of each child:
b. Type of proceeding:
c. Court and state:
d. Date of court order or judgment (if any):
3. Information about custody or time-sharing proceeding(s):
[Choose only one]
______ I HAVE NO INFORMATION of any parental responsibility, custody, time-sharing, or
visitation proceeding pending in a court of this or any other state, jurisdiction, or country
concerning a child subject to this proceeding.
______ I HAVE THE FOLLOWING INFORMATION concerning a parental responsibility, custody,
time-sharing, or visitation proceeding pending in a court of this or another state concerning a
child subject to this proceeding, other than set out in item 2. Explain:
a. Name of each child involved in said litigation:
b. Type of proceeding:
c. Court and state:
d. Date of court order or judgment (if any):
e. Case Number: _______________________________________________________________
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
4. Persons not a party to this proceeding:
[Choose only one]
______ I DO NOT KNOW OF ANY PERSON in this or any other state, jurisdiction, or country, who
is not a party to this proceeding and who has physical custody or claims to have parental
responsibility for, custody of, or time-sharing or visitation with respect to any child subject to
this proceeding.
______ I KNOW THAT THE FOLLOWING NAMED PERSON(S), not a party to this proceeding, has
(have) physical custody or claim(s) to have parental responsibility for, custody of, , or time-
sharing or visitation with respect to any child subject to this proceeding:
a. Name and address of person:
_____ has physical custody
_____ claims parental responsibility or custody rights
_____ claims time-sharing or visitation
Name of each child:
Relationship to child, if any:________________________________________________________
b. Name and address of person:
_____ has physical custody
_____ claims parental responsibility or custody rights
_____ claims time-sharing or visitation
Name of each child:
Relationship to child, if any:________________________________________________________
c. Name and address of person:
_____ has physical custody
_____ claims parental responsibility or custody rights
_____claims time-sharing or visitation
Name of each child:
Relationship to child, if any:________________________________________________________
5. Knowledge of prior child support proceedings:
[Choose only one]
_____ The child(ren) described in this affidavit are NOT subject to existing child support
order(s) in this or any other state, jurisdiction, or country..
_____ The child(ren) described in this affidavit are subject to the following existing child
support order(s):
a. Name of each child: ______________________________________________________
b. Type of proceeding: ______________________________________________________
c. Court and address: _______________________________________________________
d. Date of court order/judgment (if any): ___________________________________________
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
e. Amount of child support ordered to be paid and by whom:
6. I acknowledge that I have a continuing duty to advise this Court of any parental responsibility,
custody, time-sharing or visitation , child support, or guardianship proceeding (including
dissolution of marriage, separate maintenance, child neglect, or dependency) concerning the
child(ren) in this state or any other state about which information is obtained during this
proceeding.
7. A completed Notice of Confidential Information within Court Filing, Florida Rules of Judicial
Administration Appendix to Rule 2.420 Form, is filed with this Affidavit.
I certify that a copy of this document was ( ) e-served ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on {date} .
Other party or his/her attorney:
Name:
Address:
City, State, Zip: ______
Fax Number:
Designated E-mail Address(es):____________________
_____________________________________________
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 Party
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):____________________
_____________________________________________
STATE OF FLORIDA
COUNTY OF ________________________
Sworn to or affirmed and signed before me on by .
NOTARY PUBLIC or DEPUTY CLERK
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement
Act (UCCJEA) Affidavit (02/18)
__________________________________________________
[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, 12.970(c), Waiver of Service of Process and
Consent for Extended Custody by Extended Family (02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM, 12.970(c),
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY
CUSTODY BY EXTENDED FAMILY
(02/18)
This form is to be completed and signed by a parent who agrees to grant temporary custody of a minor
child or child(ren) to an extended family member and agrees to waive service of process. Service of
process occurs when a summons and a copy of the petition (or other pleading) that has been filed with
the court are delivered by a deputy or private process server.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
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(ren)’s parents as an
adverse party.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where the Petition for Temporary Custody by Extended Family, Florida Supreme Court
Approved Family Law Form 12.970(a) is filed and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
Special notes. . .
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms must
also put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for
Temporary Custody By Extended Family (02/18)
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA
Case No: _______________________
Division: _______________________
IN THE INTEREST OF
_________________________________
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,
__________________________________,
Respondent/________________________.
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY
CUSTODY BY EXTENDED FAMILY
I, {full legal name} _____________________________________________, the legal parent of {child(ren)’s
name)s)} _____________________________________________, having received a copy of the Petition
for Temporary Custody by Extended Family filed herein and waived service of process, freely and
voluntarily consent to the Petition filed by: {Petitioner’s full legal name} ______________________.
I realize that by signing this document, I am consenting to the Petitioner having temporary legal custody
of the minor child(ren) and that such temporary custody is in the best interest of the child(ren). Upon
entry of an Order, the Petitioner shall be able to:
1. Consent to all necessary and reasonable medical and dental care for the child(ren), including
nonemergency surgery and psychiatric care;
2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of
the child(ren), including, but not limited to:
a. Medical, dental, and psychiatric records;
b. Birth Certificates and other records, and
c. Educational records.
3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or
placed in special school programs, including exceptional education; and
4. Do all other things necessary for the care of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for
Temporary Custody By Extended Family (02/18)
I realize that the custody of my child(ren) by the Petitioner is temporary and that I may, at any time,
petition the court to return legal custody to me.
Dated: __________________ _________________________________________
Signature of Parent
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
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
deputy 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 12.970(d), Waiver of Service of Process and
Consent for Concurrent Custody by Extended Family (02/18)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.970(d),
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY
(02/18)
This form is to be completed and signed by a parent who agrees to grant concurrent custody of a minor
child or child(ren) to an extended family member and who agrees to waive service of process. Service of
process occurs when a summons and a copy of the petition (or other pleading) that has been filed with
the court are delivered by a deputy or private process server. “Concurrent custody” 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.
An Extended Family Member is:
A relative of a minor child within the third degree by blood or marriage to the parent;
OR
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(ren)’s parents as an
adverse party.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in
the county where the Petition for Concurrent Custody by Extended Family, Florida Supreme Court
Approved Family Law Form 12.970(b) is filed and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
Special notes. . .
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms must
also put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT,
IN AND FOR _______________________________ COUNTY, FLORIDA
Case No: _______________________
IN RE: THE INTEREST OF
Division: _______________________
_________________________________
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_______________________,
__________________________________,
Respondent/_______________________.
WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT
CUSTODY BY EXTENDED FAMILY
I, {full legal name} ________________________________, the legal parent of
{child(ren)’s name(s)} ______________________________________________, having received a copy of
the Petition for Concurrent Custody by Extended Family filed herein and waived service of process, freely
and voluntarily consent to the Petition filed by {Petitioner’s Name} ______________________________.
I realize that by signing this document, I am consenting to the Petitioner having temporary concurrent
custody of the minor child(ren) and that such concurrent custody is in the best interest of the child(ren).
Upon entry of an Order, the Petitioner shall be able to:
1. Consent to all necessary and reasonable medical and dental care for the child(ren), including
nonemergency surgery and psychiatric care;
2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of
the child(ren), including, but not limited to:
a. Medical, dental, and psychiatric records;
a. Birth Certificates and other records, and
b. Educational records.
3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or
placed in special school programs, including exceptional education; and
4. Do all other things necessary for the care of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for
Concurrent Custody By Extended Family (02/18)
I realize that the concurrent custody of my child(ren) by the Petitioner is temporary and that I may, at any
time, petition the court to return legal custody to me.
Dated: __________________________ _________________________________________
Signature of Parent
Printed Name: _____________________________
Address: __________________________________
City, State, Zip Code: ________________________
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
deputy 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 Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an
Individual (03/17)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.910(a)
SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL
(03/17)
When should this form be used?
This form should be used to obtain personal service on the other party when you begin your lawsuit.
Service is required for all documents filed in your case. Service means giving a copy of the required papers
to the other party using the procedure that the law requires. Generally, there are two ways to make
service: (1) personal service, or (2) service by email, mail, or hand delivery. A third method for service is
called constructive service; however, the relief a court may grant may be limited in a case where
constructive service has been used.
The law requires that certain documents be served by personal service if personal service is possible.
Personal service means that a summons (this form) and a copy of the forms you are filing with the court
that must be personally served are delivered by a deputy sheriff or private process server
a. directly to the other party, or
b. to someone over the age of fifteen with whom the other party lives.
Personal service is required for all petitions, including petitions for modification. You cannot serve these
papers on the other party yourself or by mail or hand delivery. Personal service must be made by the
sheriff’s department in the county where the other party lives or works or by a private process server
certified in the county where the other party lives or works.
In many counties, there are private process servers who, for a fee, will personally serve the summons and
other documents that require personal service. You should look under process servers in the yellow pages
of the telephone book for a list of private process servers in your area. You may use a private process
server to serve any paper required to be personally served in a family law case except a petition for
injunction for protection against domestic or repeat violence.
How do I start?
When you begin your lawsuit, you need to complete this form (summons) and a Process Service
Memorandum, Florida Supreme Court Approved Family Law Form 12.910(b). The forms should be typed
or printed legibly in black ink. Next, you will need to take these forms and, if you have not already done
so, file your petition with the clerk of the circuit court in the county where you live. You should keep a
copy of the forms for your records. The clerk will sign the summons, and then the summons, a copy of the
papers to be served, and the process service memorandum must be delivered to the appropriate sheriff’s
office or to a private process server for service on the other party.
IF THE OTHER PARTY LIVES IN THE COUNTY WHERE SUIT IS FILED: Ask the clerk in your county about any
local procedures regarding service. Generally, if the other party lives in the county in which you are filing
suit and you want the sheriff’s department to serve the papers, you will file the summons along with a
Instructions for Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an
Individual (03/17)
Process Service Memorandum, Florida Supreme Court Approved Family Law Form 12.910(b), with the
clerk and the clerk will forward those papers to the sheriff for service. Make sure that you attach a copy
of the papers you want personally served to the summons. You may also need to provide the sheriff with
a stamped envelope addressed to you. This will allow the sheriff to send the proof of service to you, after
the sheriff serves your papers on the other party. However, in some counties the sheriff may send the
proof of service directly to the clerk. If you are instructed to supply a self-addressed, stamped envelope
and you receive the proof of service, you should file the proof of service with the clerk after you receive
it from the sheriff. Also, you will need to find out how much the sheriff charges to serve the papers.
Personal checks are not accepted. You should attach to the summons a cashier’s check or money order
made payable to the sheriff, and either give it to the clerk for delivery to the sheriff or send all of the
paperwork and the fee to the sheriff yourself. The clerk will tell you which procedure to use. The costs for
service may be waived if you are indigent.
If you want a private process server to serve the other party, you should still bring the summons to the
clerk’s office and have the clerk sign it for you. You should deliver the summons, along with the copy of
your initial petition and any other papers to be served, and a Process Service Memorandum, Florida
Supreme Court Approved Family Law Form 12.910(b), to the private process server. The private process
server will charge you a fee for serving the papers. After service is complete, proof of service by the
private process server must be filed with the clerk. You should discuss how this will occur with the private
process server.
IF THE OTHER PARTY LIVES IN ANOTHER COUNTY: If the other party lives in another county, service needs
to be made by a sheriff in the county where the other party lives or by a private process server certified
in the county where the other party lives. Make sure that you attach a copy of the papers you want
personally served to the summons as well as the Process Service Memorandum, Florida Supreme Court
Approved Family Law Form 12.910(b). If you want the sheriff to serve the papers, the clerk may send your
papers to that sheriff’s office for you, or you may have to send the papers yourself. The clerk will tell you
which procedure to use. Either way, you will need to provide the sheriff with a stamped envelope
addressed to you. This will allow the sheriff to send the proof of service to you, after the sheriff serves
your papers on the other party. You should file the proof of service with the clerk after you receive it from
the sheriff. Also, you will need to find out how much the sheriff charges to serve the papers. Personal
checks are not accepted. You should attach to the summons a cashier’s check or money order made
payable to the sheriff, and either give it to the clerk for delivery to the sheriff or send all of the paperwork
and the fee to the sheriff yourself. The clerk will tell you which procedure to use. The costs for service
may be waived if you are indigent.
If you want a private process server to serve the other party, you should still bring the summons to the
clerk’s office where the clerk will sign it for you. You should deliver the summons, along with the copy of
your initial petition and any other papers to be served, and a Process Service Memorandum, Florida
Supreme Court Approved Family Law Form 12.910(b), to the private process server. The private process
server will charge you a fee for serving the papers. After service is complete, proof of service by the
private process server must be filed with the clerk. You should discuss how this will occur with the private
process server.
IF THE OTHER PARTY CANNOT BE LOCATED OR DOES NOT LIVE IN FLORIDA: If, after you have made a
diligent effort to locate the other party, you absolutely cannot locate the other party, you may serve the
other party by publication. Service by publication is also known as constructive service. You may also be
able to use constructive service if the other party does not live in Florida. However, Florida courts have
only limited jurisdiction over a party who is served by constructive service and may have only limited
Instructions for Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an
Individual (03/17)
jurisdiction over a party living outside of Florida regardless of whether that party is served by
constructive or personal service; that is, the judge’s power to order the other party to do certain things
may be limited. For example, the judge may be able to grant your request for a divorce, but the judge
may not be able to address issues such as child support, spousal support (alimony), or division of property
or debts.
Regardless of the type of service used, if the other party once lived in Florida but is living outside of Florida
now, you should include in your petition a statement regarding the length of time the party lived in Florida,
if any, and when. For example: “Respondent last lived in Florida from {date} to
{date} .”
This area of the law is very complex and you may need to consult with an attorney regarding the proper
type of service to be used in your case if the other party does not live in Florida or cannot be located.
What happens when the papers are served on the other party?
The date and hour of service are written on the original summons and on all copies of it by the person
making the service. The person who delivers the summons and copies of the petition must file a proof of
service with the clerk or provide a proof of service to you for filing with the court. It is your responsibility
to make sure the proof of service has been returned to the clerk and placed in your case file.
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 regarding service of process, see chapters 48 and 49,
Florida Statutes, and Florida Family Law Rule of Procedure 12.070, as well as the instructions for 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 Service 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).
Special notes
If you have been unable to obtain proper service on the other party within 120 days after filing your
lawsuit, the court will dismiss your lawsuit against the other party unless you can show the court a good
reason why service was not made within 120 days. For this reason, if you had the local sheriff serve the
papers, you should check with the clerk every couple of weeks after completing the service papers to see
if service has been completed. You may need to supply the sheriff with a new or better address. If you
had a private process server or a sheriff in another county serve the papers, you should be in contact with
that person or sheriff until you receive proof of service from that person or sheriff. You should then file
the proof of service with the clerk immediately.
If the other party fails to respond, i.e., fails to file a written response with the court, within 20 days after
the service of the summons, you are entitled to request a default. See the instructions to Motion for
Default, Florida Supreme Court Approved Family Law Form 12.922 (a), and Default, Florida Supreme Court
Approved Family Law Form 12.922(b), for further information. You will need to file an Affidavit of Military
Service, Florida Supreme Court Approved Family Law Form 12.912(b), before a default may be granted.
Instructions for Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an
Individual (03/17)
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.
Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an Individual (03/17)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
SUMMONS: PERSONAL SERVICE ON AN INDIVIDUAL
ORDEN DE COMPARECENCIA: SERVICIO PERSONAL EN UN INDIVIDUO
CITATION: L’ASSIGNATION PERSONAL SUR UN INDIVIDUEL
TO/PARA/A: {enter other party’s full legal name} ,
{address (including city and state)/location for service} .
IMPORTANT
A lawsuit has been filed against you. You have 20 calendar days after this summons is served on you to
file a written response to the attached complaint/petition with the clerk of this circuit court, located at:
{street address} _______________________________________________________________________.
A phone call will not protect you. Your written response, including the case number given above and the
names of the parties, must be filed if you want the Court to hear your side of the case.
If you do not file your written response on time, you may lose the case, and your wages, money, and
property may be taken thereafter without further warning from the Court. There are other legal
requirements. You may want to call an attorney right away. If you do not know an attorney, you may call
an attorney referral service or a legal aid office (listed in the phone book).
If you choose to file a written response yourself, at the same time you file your written response to the
Court, you must also serve a copy of your written response on the party serving this summons at:
{Name and address of party serving summons}
.
If the party serving summons has designated email address(es) for service or is represented by an
attorney, you may designate email address(es) for service by or on you. Service must be in accordance
with Florida Rule of Judicial Administration 2.516.
Copies of all court documents in this case, including orders, are available at the Clerk of the Circuit
Court’s office. You may review these documents, upon request.
You must keep the Clerk of the Circuit Court’s office notified of your current address. (You may file
Designation of Current Mailing and Email Address, Florida Supreme Court Approved Family Law Form
Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an Individual (03/17)
12.915.) Future papers in this lawsuit will be mailed to the address on record at the clerk’s office.
WARNING: Rule 12.285, Florida Family Law Rules of Procedure, requires certain automatic disclosure
of documents and information. Failure to comply can result in sanctions, including dismissal or striking
of pleadings.
IMPORTANTE
Usted ha sido demandado legalmente. Tiene veinte (20) dias, contados a partir del recibo de esta
notificacion, para contestar la demanda adjunta, por escrito, y presentarla ante este tribunal. Localizado
en: . Una llamada telefonica no lo protegera. Si usted desea
que el tribunal considere su defensa, debe presentar su respuesta por escrito, incluyendo el numero del
caso y los nombres de las partes interesadas. Si usted no contesta la demanda a tiempo, pudiese perder
el caso y podria ser despojado de sus ingresos y propiedades, o privado de sus derechos, sin previo aviso
del tribunal. Existen otros requisitos legales. Si lo desea, usted puede consultar a un abogado
inmediatamente. Si no conoce a un abogado, puede llamar a una de las oficinas de asistencia legal que
aparecen en la guia telefonica.
Si desea responder a la demanda por su cuenta, al mismo tiempo en que presente su respuesta ante el
tribunal, usted debe enviar por correo o entregar una copia de su respuesta a la persona denominada
abajo.
Si usted elige presentar personalmente una respuesta por escrito, en el mismo momento que usted
presente su respuesta por escrito al Tribunal, usted debe enviar por correo o llevar una copia de su
respuesta por escrito a la parte entregando esta orden de comparencencia a:
Nombre y direccion de la parte que entrega la orden de comparencencia:
.
Copias de todos los documentos judiciales de este caso, incluyendo las ordenes, estan disponibles en la
oficina del Secretario de Juzgado del Circuito [Clerk of the Circuit Court’s office]. Estos documentos
pueden ser revisados a su solicitud.
Usted debe de manener informada a la oficina del Secretario de Juzgado del Circuito de su direccion
actual. (Usted puede presentar el Formulario: Ley de Familia de la Florida 12.915, Florida Supreme
Court Approved Family Law Form 12.915, [Designation of Current Mailing and Email Address].) Los
papelos que se presenten en el futuro en esta demanda judicial seran env ados por correo a la direccion
que este registrada en la oficina del Secretario.
ADVERTENCIA: Regla 12.285 (Rule 12.285), de las Reglas de Procedimiento de Ley de Familia de la
Florida [Florida Family Law Rules of Procedure], requiere cierta revelacion automatica de documentos
e informacion. El incumplimient, puede resultar en sanciones, incluyendo la desestimacion o anulacion
de los alegatos.
IMPORTANT
Des poursuites judiciaries ont ete entreprises contre vous. Vous avez 20 jours consecutifs a partir de la
date de l’assignation de cette citation pour deposer une reponse ecrite a la plainte ci-jointe aupres de ce
tribunal. Qui se trouve a: {L’Adresse} . Un simple coup de telephone est
insuffisant pour vous proteger; vous etes obliges de deposer votre reponse ecrite, avec mention du
numero de dossier ci-dessus et du nom des parties nommees ici, si vous souhaitez que le tribunal entende
Florida Family Law Rules of Procedure Form 12.910(a), Summons: Personal Service on an Individual (03/17)
votre cause. Si vous ne deposez pas votre reponse ecrite dans le delai requis, vous risquez de perdre la
cause ainsi que votre salaire, votre argent, et vos biens peuvent etre saisis par la suite, sans aucun preavis
ulterieur du tribunal. Il y a d’autres obligations juridiques et vous pouvez requerir les services immediats
d’un avocat. Si vous ne connaissez pas d’avocat, vous pourriez telephoner a un service de reference
d’avocats ou a un bureau d’assistance juridique (figurant a l’annuaire de telephones).
Si vous choisissez de deposer vous-meme une reponse ecrite, il vous faudra egalement, en meme temps
que cette formalite, faire parvenir ou expedier une copie au carbone ou une photocopie de votre reponse
ecrite a la partie qui vous depose cette citation.
Nom et adresse de la partie qui depose cette citation:
Les photocopies de tous les documents tribunals de cette cause, y compris des arrets, sont disponible
au bureau du greffier. Vous pouvez revue ces documents, sur demande.
Il faut aviser le greffier de votre adresse actuelle. (Vous pouvez deposer Florida Supreme Court
Approved Family Law Form 12.915, Designation of Current Mailing and Email Address.) Les documents
de l’avenir de ce proces seront envoyer a l’adresse que vous donnez au bureau du greffier.
ATTENTION: La regle 12.285, des regles de procedure du droit de la famille de la Floride exige que l’on
remette certains renseignements et certains documents a la partie adverse. Tout refus de les fournir
pourra donner lieu a des sanctions, y compris le rejet ou la suppression d’un ou de plusieurs actes de
procedure.
THE STATE OF FLORIDA
TO EACH SHERIFF OF THE STATE: You are commanded to serve this summons and a copy of the complaint
in this lawsuit on the above-named person.
DATED:
CLERK OF THE CIRCUIT COURT
(SEAL)
By:
Deputy Clerk
Instructions for Florida Supreme Court Approved Family Law Form 12.910(b), Process Service Memorandum
(11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.910(b),
PROCESS SERVICE MEMORANDUM (11/15)
When should this form be used?
You should use this form to give the sheriff’s department (or private process server) instructions for
serving the other party in your case with the Summons: Personal Service on an Individual, Florida Family
Law Rules of Procedure Form 12.910(a), and other papers to be served. On this form you can tell the
sheriff’s department the best times to find the person at work and/or at home. You can also include a
map to the other person’s home or work place to help the sheriff find the person and deliver the
summons. Do not forget to attach to the summons a copy of your initial petition and any other papers
you want personally served on the other party.
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 petition was filed and attach a copy to the
Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a).
You should also 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.
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. You should read the instructions for Summons: Personal Service on an
Individual, Florida Family Law Rules of Procedure Form 12.910(a), for additional information.
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
Instructions for Florida Supreme Court Approved Family Law Form 12.910(b), Process Service Memorandum
(11/15)
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.
Special notes...
If you fear that disclosing your address would put you in danger because you are the victim of sexual
battery, aggravated child abuse, stalking, aggravated stalking, harassment, aggravated battery, or
domestic violence, you should complete a Request for Confidential Filing of Address, Florida Supreme
Court Approved Family Law Form 12.980(h), file it with the clerk, and write confidential in the space
provided on the petition.
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.
Florida Supreme Court Approved Family Law Form 12.910(b), Process Service Memorandum (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
PROCESS SERVICE MEMORANDUM
TO: _____ Sheriff of ________________________ County, Florida; _____________________ Division
_____ Private process server: ______________________________________________________
Please serve the {name of document(s)} ______________________________________________________
_____________________________________________________________________________________
in the above-styled cause upon:
Party: {full legal name} __________________________________________________________________
Address or location for service: ___________________________________________________________
_____________________________________________________________________________________
Work Address: _________________________________________________________________________
_____________________________________________________________________________________
If the party to be served owns, has, and/or is known to have guns or other weapons, describe what type
of weapon(s): _________________________________________________________________________
SPECIAL INSTRUCTIONS: _________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Dated: ______________________ _______________________________________
Signature of Party
*Printed Name: __________________________
*Address: ______________________________
*City, State, Zip: __________________________
*Telephone Number: ______________________
*Fax Number: ___________________________
*Designated E-mail Address(es) _____________
_______________________________________
Florida Supreme Court Approved Family Law Form 12.910(b), Process Service Memorandum (11/15)
* Please see the Special Notes section in the instructions to this form regarding Florida Supreme Court
Approved Family Law Form 12.980(h), Request for Confidential Filing of Address, which may be used if
you need to keep your addresses or telephone numbers confidential for safety reasons.
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 Petitioner. This form was completed with the assistance
of:
{name of individual} ____________________________________________________________________,
{name of business} _____________________________________________________________________,
{address} ____________________________________________________________________________,
{city}_______________, {state} ____, {zip code} __________, {telephone number} ___________________
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which is also called service by
publication, only if you do not know where the parent(s) lives and you are XQDEOH to obtain
personal service or substitute service of process. However, please note that if you use
constructive service, the court may grant only limited relief because its jurisdiction is limited.
The order granting temporary custody of the minor child to the petitioner/respondent may not
include an order for the support of the minor child unless
the parent(s) has received personal or
substitute service of process, the petition requests an order of support of the child and there is
evidence of the parent’s ability to pay the support ordered. 127( This is a complicated area of
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this form with the
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to a qualified local newspaper to be published for four consecutive weeks. When in doubt, ask
the clerk which newspapers in your area are “qualified." The newspaper will charge you for this
service. If you cannot afford to pay the cost of publication of this notice in a qualified
newspaper, you may ask the clerk to post the notice at a place designated for such postings.
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the bottom of the last page of every form he or she helps you complete.
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{clerk’s address} ______________________________________________________________,
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Dated:
. CLERK OF THE CIRCUIT COURT
By:
Deputy Clerk
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[fill in DOO blanks]
I, {full legal name and trade name of nonlawyer}
,
a nonlawyer, located at {street}
, {city}________,
{state}
, {phone} , helped {name} ,
who is the petitioner, fill out this form.
PINELLAS
Instructions for Florida Family Law Rules of Procedure Form 12.913(b), Affidavit of Diligent Search and Inquiry
(11/12)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.913(b), AFFIDAVIT OF DILIGENT SEARCH AND INQUIRY (11/12)
When should this form be used?
This form is to be used with Notice of Action for Dissolution of Marriage (No Child or Financial
Support), Florida Supreme Court Approved Family Law Form 12.913(a)(1) and Notice of Action For
Family Cases With Minor Child(ren), Form 12.913(a)(2), to obtain constructive service
(also called
service by publication).
The other party is entitled to actual notice of the proceedings when possible. When it is necessary to
use constructive notice, it must be given in a way that is likely to provide actual notice. You must
disclose the last known address of the other party. A last known address cannot be unknown. This form
includes a checklist of places you can look for information on the location of the other party. While you
do not have to look in all of these places, the court must believe that you have made a very serious
effort to get information about the other party’s location and that you have followed up on any
information you received.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public
or deputy clerk. You should file the original and a Notice of Action for
Dissolution of Marriage (No Child or Financial Support), Florida Supreme Court Approved Family Law
Form 12.913(a)(1), or Notice of Action For Family Cases With Minor Child(ren), Form 12.913(a)(2), with
the clerk of the circuit court
in the county where your petition is filed. You should keep a copy for your
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. For further information, see rule 12.070, Florida Family Law Rules of
Procedure and chapter 49, 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 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 Family Law Rules of Procedure Form 12.913(b), Affidavit of Diligent Search and Inquiry (11/12)
IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT,
IN AND FOR PINELLAS COUNTY, FLORIDA
Case No.:
Division:
__
,
Petitioner,
and
____
,
Respondent.
AFFIDAVIT OF DILIGENT SEARCH AND INQUIRY
I, {full legal name}
, being sworn,
certify that the following information is true:
1. I have made diligent search and inquiry to discover the name and current residence of
Respondent: {Specify details of search} Refer to checklist below and identify all actions taken
(any additional information included such as the date the action was taken and the person
with whom you spoke is helpful) (attach additional sheet if necessary):
[Check all that apply]
____ United States Post Office inquiry through Freedom of Information Act for current address or any
relocations.
____ Last known employmentof Respondent, including name and address of employer. You should
also ask for any addresses to which W-2 Forms were mailed, and, if a pension or profit-sharing
plan exists, then for any addresses to which any pension or plan payment is and/or has been
mailed.
____ Unions from which Respondent may have worked or that governed his or her particular trade or
craft.
____ Regulatory agencies, including professional or occupational licensing.
____ Names and addresses of relatives and contacts with those relatives, and inquiry as to
Respondent’s last known address. You are to follow up any leads of any addresses where
Respondent may have moved. Relatives include, but are not limited to: parents, brothers,
sisters, aunts, uncles, cousins, nieces, nephews, grandparents, great-grandparents, former in-
laws, stepparents, stepchildren.
____ Information about the Respondent’s possible death and, if dead, the date and location of the
death.
____ Telephone listings in the last known locations of Respondent’s residence.
____ Internet at
http://www.switchboard.com
or other Internet databank locator service. Please
indicate if a public library assisted you in your search.
____ Law enforcement arrest and/or criminal records in the last known residential area of
Respondent.
____ Highway Patrol records in the state of Respondent’s last known address.
____ Department of Motor Vehicle records in the state of Respondent’s last known address.
Florida Family Law Rules of Procedure Form 12.913(b), Affidavit of Diligent Search and Inquiry (11/12)
____ Department of Corrections records in the state of Respondent’s last known address.
____ Title IV-D (child support enforcement) agency records in the state of Respondent’s last known
address.
____ Hospitals in the last known area of Respondent’s residence.
____ Utility companies, which include water, sewer, cable TV, and electric, in the last known area of
Respondent’s residence.
____ Letters to the Armed Forces of the U.S. and their response as to whether or not there is any
information about Respondent. (See Memorandum for Certificate of Military Service, Florida
Supreme Court Approved Family Law Form 12.912(a).)
____ Tax Assessor’s and Tax Collector’s Office in the area where Respondent last resided.
____ Other: {explain} ______________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. The age of Respondent is [Choose only one] ( ) known {enter age} _____ or ( ) unknown.
3. Respondent’s current residence
[Choose only one]]
a. ____Respondent’s current residence is unknown to me.
b. ____Respondent’s current residence is in some state or country other than Florida.
________________________________________________________________________
_
c. ____The Respondent, having residence in Florida, has been absent from Florida for
more than 60 days prior to the date of this affidavit, or conceals him/her self so that
process cannot be served personally upon him or her, and I believe there is no person in
the state upon whom service of process would bind this absent or concealed
Respondent.
4. Respondent’s last known address as of {date}____________________________________, was:
Address___________________________City_____________________State_________Zip_____
_
Telephone No. __________________Fax No._________________________.
Respondent’s last known employment, as of {date}_________________________________, was
Name of
Employer________________________________________________________________
Address_____________________________City_____________________State _____Zip_______
Telephone No.__________________ Fax No._________________________.
Florida Family Law Rules of Procedure Form 12.913(b), Affidavit of Diligent Search and Inquiry (11/12)
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 Petitioner
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: {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 12.912(b), Affidavit of Military Service (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.912(b), AFFIDAVIT OF MILITARY SERVICE (11/15)
When should this form be used?
An Affidavit of Military Service is required in every case where the Respondent has not filed an answer or
appearance. The purpose is to protect the men and women serving in the U.S. military from having a
court judgment entered against them without first receiving notice of the lawsuit and a chance to defend
the case.
You should use this form when ALL of the following statements are true:
x The other person in your case has been served, whether by personal service or constructive
service.
x The other person in your case has not responded to your petition.
x You are requesting that the court enter a default judgment against the other person.
This form should be typed or printed in black ink. After completing this form, you should sign the form
before a notary public or deputy clerk. You must file the original of this form with the clerk of the circuit
court when you file your Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a).
You must also attach copies of all verifications of nonmilitary service that you received from each branch
of the United States’ military service. You should 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.
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
procedures must always be followed once the initial election is made.
Instructions for Florida Supreme Court Approved Family Law Form 12.912(b), Affidavit of Military Service (11/15)
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.
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 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 12.912(b), Affidavit of Military Service (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
AFFIDAVIT OF MILITARY SERVICE
I, {full legal name} _____________________________________________________, am the Petitioner in
this case. To support my application for a default judgment and to comply with the Servicemembers Civil
Relief Act (SCRA) (formerly known as Soldiers’ and Sailors’ Civil Relief Act of 1940), I swear or affirm that
the following information is true:
{Please choose only one}
1. _____ I know of my own personal knowledge that the Respondent IS on active duty in the military
service of the United States.
2. _____ I know of my own personal knowledge that Respondent IS NOT now on active duty in the military
service of the United States, nor has the Respondent been on active military service of the United States
within a period of thirty (30) days immediately before this date. “Active Service” includes reserve
members of the Army, Navy, Air Force, Coast Guard, and Marines who have been ordered to report for
active duty and members of the Florida National Guard who have been ordered to report to active duty
for a period of more than thirty (30) days.
3. _____ I have contacted the military services of the United States and the U.S. Public Health Service and
have obtained certificates showing that the Respondent is not on active duty status. These certificates
are attached.
4. _____ I have attempted to determine the military status of the Respondent, but do not have sufficient
information. This is what I have done to determine whether or not Respondent is on active duty in the
United States military:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I have no reason to believe that s/he is on active duty at this time.
Florida Supreme Court Approved Family Law Form 12.912(b), Affidavit of Military Service (11/15)
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 Petitioner
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 Petitioner.
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 Forms 12.922(a), Motion for Default, and 12.922(b),
Default (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY
LAW FORMS 12.922(a), MOTION FOR DEFAULT, AND 12.922(b),
DEFAULT (11/15)
When should these forms be used?
If the other party has failed to file or serve any documents within 20 days after the date of service of your
petition, you may ask the clerk of the circuit court to enter a default against him or her by filling out this
form and filing it with the court. Generally, a default allows you to obtain an earlier final hearing to
finish your case. Once the default is signed by the clerk, you can request a trial or final hearing in your
case.
To obtain a default, you will need to complete Motion for Default, Florida Supreme Court Approved
Family Law Form 12.922(a). You will then need to file your motion for default along with the Default,
Florida Supreme Court Approved Family Law Form 12.922(b), so that the clerk can enter a default for you
if your motion is proper.
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 you filed your petition 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?
After the default has been entered, you must ask for a hearing, so that the judge can consider your
petition. To do this, you must contact the clerk’s office, family law intake staff, or judicial assistant to
schedule a hearing and file a Notice of Hearing (General), Florida Supreme Court Approved Family Law
Form 12.923, with the clerk. A copy of the notice of hearing must be mailed, e-mailed, or hand-
delivered to each party in the case. You must send a notice of final hearing to the defaulted party.
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
Instructions for Florida Supreme Court Approved Family Law Forms 12.922(a), Motion for Default, and 12.922(b),
Default (11/15)
review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through
the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started,
or Rules of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
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. For further information, see Florida Rules of Civil Procedure 1.500,
concerning defaults and Rule 1.140, concerning the time within which a party can file an answer or
other responsive pleading to a petition. See also Florida Family Law Rule of Procedure 12.080.
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 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 12.922(a), Motion for Default (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
MOTION FOR DEFAULT
TO THE CLERK OF THE CIRCUIT COURT:
PLEASE ENTER A DEFAULT AGAINST RESPONDENT WHO HAS FAILED TO RESPOND TO THE PETITION.
I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-
delivered to the person(s) listed below on {date} ______________________.
Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Designated E-mail Address(es):_____________________
______________________________________________
_____________________________________________
Signature of Party
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number:_____________________________
Fax Number:___________________________________
Designated E-mail Address(es):____________________
_____________________________________________
Florida Supreme Court Approved Family Law Form 12.922(a), Motion for Default (11/15)
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} ________________.
Florida Supreme Court Approved Family Law Form 12.922(b), Default (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
___________________________________,
Petitioner,
and
___________________________________,
Respondent,
DEFAULT
A default is entered in this action against Respondent for failure to serve or file a response or any
paper as is required by law.
Dated:
CLERK OF THE CIRCUIT COURT
(SEAL)
By: ___________________________________________
Deputy Clerk
I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-
delivered to the person(s) listed below on {date} ______________________.
Other party or his/her attorney:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Designated E-mail Address(es):_____________________
______________________________________________
_____________________________________________
Signature of Party
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Telephone Number:_____________________________
Fax Number:___________________________________
Designated E-mail Address(es):____________________
_____________________________________________
Florida Supreme Court Approved Family Law Form 12.922(b), Default (11/15)
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 12.923, Notice of Hearing
(General) (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.923,
NOTICE OF HEARING (GENERAL) (11/15)
When should this form be used?
Anytime you have set a hearing before a judge, you must send notice of the hearing to the other party.
IMPORTANT: If your hearing has been set before a general magistrate, you should use Notice of Hearing
Before General Magistrate, Florida Family Law Rules of Procedure Form 12.920(c). If your hearing has
been set before a child support enforcement hearing officer, you should use Notice of Hearing (Child
Support Hearing Officer), Florida Supreme Court Approved Family Law Form 12.921.
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 a
default has been entered, you must still send this form to the other party to notify the other party of the
final hearing.
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 procedures must always be followed once the initial election is made.
Instructions for Florida Supreme Court Approved Family Law Form 12.923, Notice of Hearing
(General) (11/15)
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. For further information on serving notices of hearing, see rule 1.090(d), Florida
Civil Rules of Procedure.
Special notes...
To set a hearing date and time, you will usually have to make a good-faith effort to coordinate a mutually
convenient date and time for you, the other parties in the case, and the judge, except in certain emergency
situations. Some circuits may have additional procedural requirements that you must follow when you
notify the court and other parties of your scheduled hearing. Therefore, before you complete this form,
you should contact the clerk’s office, family law intake staff, or judicial assistant for information regarding
the proper procedure to follow.
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.
Florida Supreme Court Approved Family Law Form 12.923, Notice of Hearing (General) (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
NOTICE OF HEARING (GENERAL)
[fill in all blanks]
TO: {name of other party}:
There will be a hearing before Judge {name} ,
on {date} _____ at {time} _____ m., in Room _____ of the __ ___
County Courthouse, on the following issues:
.
______ hour(s)/ _____ minutes have been reserved for this hearing.
This part is to be filled out by the court or to be filled in with information you obtained from the court:
If you are a person with a disability who needs any accommodation in order to participate in this
proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact:
{identify applicable court personnel by name, address, and telephone number} at least 7 days before
your scheduled court appearance, or immediately upon receiving this notification if the time before
the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711.
If you are represented by an attorney or plan to retain an attorney for this matter, you should notify the
attorney of this hearing.
If this matter is resolved, the moving party shall contact the judge’s office to cancel this hearing.
Florida Supreme Court Approved Family Law Form 12.923, Notice of Hearing (General) (11/15)
I certify that a copy of this document was ( ) e-mailed ( ) mailed ( ) faxed ( ) hand-delivered
to the person(s) listed below on {date} __________________________.
Other party or his/her attorney:
Name: ______________________________________
Address: ____________________________________
City, State, Zip: _______________________________
Fax Number: _________________________________
Designated E-mail Address(es): __________________
____________________________________________
_______
Signature of Party
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Designated E-mail Address(es): ____________________
_____________________________________________
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 12.924, Notice for Trial (11/15)
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.924, NOTICE FOR TRIAL (11/15)
When should this form be used?
Generally, the court will have trials (or final hearings) in contested cases. This form is to be used to
notify the court that your case is ready to be set for trial. Before setting your case for trial, certain
requirements such as completing mandatory disclosure and filing certain papers and having them
served on the other party must be met. These requirements vary depending on the type of case and
the procedures in your particular circuit. In some circuits you must complete mediation or a parenting
course before you can set a final hearing by using a Notice of Hearing (General), Florida Supreme Court
Approved Family Law Form 12.923, or other appropriate notice of hearing form. Other circuits may
require that you set the trial using an Order Setting Trial. Contact the clerk of the circuit court, family
law intake staff, or judicial assistant to determine how the judge assigned to your case sets trials. For
further information, you should refer to the instructions for the type of form you are filing.
This form should be typed or printed in black ink. After completing this form, you should file the original
with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleadings or documents electronically; however, they are not required to do so. If you choose
to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule
of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you
file. The rules and procedures should be carefully read and followed.
What should I do next?
A copy of this form must be mailed, e-mailed, or hand-delivered to the other party in your case.
Where can I look for more information?
Before proceeding, you should read General Information for Self-Represented Litigants found at the
beginning of these forms. For further information, see rule 12.440, Florida Family Law Rules of
Procedure.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
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
Instructions for Florida Supreme Court Approved Family Law Form 12.924, Notice for Trial (11/15)
the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started,
or Rules of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail,
the procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
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.
Special notes...
These family law forms contain orders and final judgments, which the judge may use. You should ask the
clerk of court, family law intake staff, or judicial assistant if you need to bring one of these forms with you
to the hearing or trial. If so, you should type or print the heading, including the circuit, county, case
number, division, and the parties’ names, and leave the rest blank for the judge to complete at your
hearing or trial.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Florida Supreme Court Approved Family Law Form 12.924, Notice for Trial (11/15)
IN THE CIRCUIT COURT OF THE _______________________ JUDICIAL CIRCUIT,
IN AND FOR ________________________ COUNTY, FLORIDA
Case No.: ___________________________ ___
Division:
__________________________________________________________________________________ ________
__________________________________,
Petitioner,
and
__________________________________,
Respondent,
NOTICE FOR TRIAL
Pursuant to Rule 12.440, Florida Family Law Rules of Procedure, the party signing below states that the
case is ready to be set for trial. The estimated time needed for the parties to present their cases is:
{hours} .
I certify that a copy of this document was ( ) e-mailed ( ) mailed ( ) faxed ( ) hand-delivered
to the person(s) listed below on {date} __________________________.
Other party or his/her attorney:
Name: ______________________________________
Address: ____________________________________
City, State, Zip: _______________________________
Fax Number: _________________________________
Designated E-mail Address(es): __________________
____________________________________________
_______
Signature of Party
Printed Name: _________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Fax Number: ___________________________________
Designated E-mail Address(es): ____________________
_____________________________________________
Florida Supreme Court Approved Family Law Form 12.924, Notice for Trial (11/15)
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} ________________
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA
Case No: ______________________
Division: ______________________
IN THE INTEREST OF
_________________________________
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_________________,
__________________________________,
Respondent/___________________.
ORDER GRANTING PETITION FOR
TEMPORARY CUSTODY BY EXTENDED FAMILY
This case came before this Court for a hearing on a Petition for Temporary Custody by Extended
Family. The Court, having reviewed the file and heard the testimony, makes these findings of
fact and reaches these conclusions of law:
SECTION I. FINDINGS:
1. The Court has jurisdiction over the subject matter and the parties.
2. The minor child(ren) at issue in this matter are:
Name Date of Birth
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. The Petitioner, {full legal name} _______________________________________ is the
{extended family relationship}_____________________________________________ of
the child(ren).
4. Parent {full legal name}, ____________________________________________ referred
to as {name or designation} _________________________________ of the child(ren):
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
{Choose one only}
a.____ Filed a Waiver and Consent
b.____ Was served with the petition and failed to file an Answer
c.____ Is deceased as evidenced by: _________________________________________
d.____ Objected to the petition. Based upon clear and convincing evidence, the Court
finds that the Parent {name or designation} ________________________ is unfit
to provide for the care and control of the child(ren). Specifically, the Parent has
abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida
Statutes. It is in the best interest of the child(ren) that the Petitioner have
temporary custody because: {facts in support of finding} ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
_________________________________________________________________.
5. Parent {full legal name}, _____________________________________________ referred
to as, {name or designation} _________________________________ of the child(ren):
{Choose one only}
a.____ Filed a Waiver and Consent
b.____ Was served with the petition and failed to file an Answer
c.____ Is deceased as evidenced by: _________________________________________
d.____ Objected to the petition. Based upon clear and convincing evidence, the Court
finds that Parent {name or designation} ________________________ is unfit to
provide for the care and control of the child(ren). Specifically, the Parent has
abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida
Statutes. It is in the best interest of the child(ren) that the Petitioner have
temporary custody because: {facts in support of finding} ___________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________.
6. It is in the best interest of the child(ren) for the Petitioner to have temporary custody.
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
SECTION II: TEMPORARY CUSTODY
1. The Petitioner, ________________________________________, is granted temporary
custody of the minor child(ren).
2. The Petitioner shall have all the rights and responsibilities of a legal parent.
3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor
child(ren), including but not limited to:
a. Consent to all necessary and reasonable medical and dental care for the child(ren),
including nonemergency surgery and psychiatric care;
b. Secure copies of the child(ren)’s records, held by third parties, that are necessary
for the care of the child(ren), including, but not limited to: medical, dental, and
psychiatric records; birth certificates and other records; and educational records;
c. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to
be tested or placed in special school programs, including exceptional education;
and
d. Do all other things necessary for the care of the child(ren).
SECTION III. TEMPORARY TIME-SHARING WITH MINOR CHILD(REN)
{Insert the name or designation of the appropriate parent in the spaces provided.}
The parent(s) shall have: {Choose one only}
1. ____ reasonable time-sharing with the minor child(ren) as agreed to by the parties,
subject to the following limitations: __________________________________________
_______________________________________________________________________.
2. ____ the following specified time-sharing schedule: {specify days and times} _______
______________________________________________________________________.
Parent {name or designation}_________________________’s Temporary Time-Sharing
Schedule.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
Parent {name or designation} ______________________________’s Temporary Time-
Sharing Schedule.
_______________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
_______________________________________________________________________
_______________________________________________________________________.
3. ____ Time-Sharing in accordance with the temporary Parenting Plan attached as
Exhibit ____.
4. Parent {name or designation} ___________________ shall have No Contact with the
minor child(ren) until further order of the Court, due to existing conditions that are
detrimental to the welfare of the minor child(ren): {explain} ______________________
_______________________________________________________________________
_______________________________________________________________________.
SECTION IV. CHILD SUPPORT
{Insert the name or designation of the appropriate parent in the spaces provided.}
1. The Petitioner _____ did _____ did not request the establishment of child support.
2. If child support is requested, the parents have received personal or substituted service of
process, the petition requests an order for support of the child(ren), and there is evidence of
the parents’ ability to pay the support ordered. Parent(s) {name or designation}
____________________________________ has the present ability to pay child support.
{Choose one only}
a. _____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law
Rules of Procedure Form 12.902(e) filed by Parent(s) {name or designation}
__________________________________________ are correct;
OR
b. _____ The Court makes the following findings:
Parent {name or designation} ______________________________’s net monthly income
is $____________, (Child Support Guidelines ____%).
Parent {name or designation} _____________________________’s net monthly income
is $_____________, (Child Support Guidelines ____%)
Monthly child care costs are $_________________.
Monthly health/dental insurance costs are $_____________.
OR
c. Parent {name or designation}__________________ is currently ordered to pay child
support to the other parent in the amount of $_________ per _______________ as
established in the case of {style of case and number} ____________________________.
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
_____ All of the child support or _____ a portion of the child support in the amount of
$____________ shall be redirected to the Petitioner.
3. Amount
a. Parent {name or designation}____________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child
support at the rate of $________ per month for the ______ children {total number of
parties’ minor or dependent children} commencing __________________ {month,
day, year} and terminating ________________________ {month, day, year}.
Child support shall be paid in the amount of $___________ per ___________ {week,
month, other} which is consistent with Parent {name or designation}__________’s
current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children,
child support in the amount of $__________ for the remaining_______ children {total
number of remaining children} shall be paid commencing ________________ {month,
day, year} and terminating _______________________ {month, day, year}. This child
support shall be paid in the amount of $____________ per ____________{week,
month, other} consistent with Parent {name or designation} ______________’s
current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent
children, which shall be payable as the obligation for each child ceases.}
Parent {name or designation}___________________ shall pay child support until all
minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court
or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith
with a reasonable expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: __________________________________
_____________________________________________________________________
____________________________________________________________________.
b. Parent {name or designation} _________________’s Obligation
Parent {name or designation} ____________________ shall be obligated to pay child
support at the rate of $_________ per month for the ______ children {total number
of parties’ minor or dependent children} commencing _____________ {month, day,
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
year} and terminating _____________________ {month, day, year}. Child support
shall be paid in the amount of $_________ per _____________ {week, month, other}
consistent with Parent {name or designation} _________________’s current payroll
cycle.
Upon the termination of the obligation of child support for one of the parties’
children, child support in the amount of $___________ for the remaining ______
children {total number of remaining children} shall be paid commencing
_______________ {month, day, year} and terminating ________________________
{month, day, year}. This child support shall be paid in the amount of $____________
per _____________{week, month, other} consistent with Parent {name or
designation} ______________’s current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent
children which shall be payable as the obligation for each child ceases.}
Parent {name or designation} _____________ shall pay child support until all of the
minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court
or agreement of the parties. The child support obligation shall continue beyond the
age of 18 and until high school graduation for any child who is dependent in fact,
between the ages of 18 and 19, and is still in high school, performing in good faith
with a reasonable expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: __________________________________
____________________________________________________________________
____________________________________________________________________.
4. Retroactive Child Support and/or Arrearages
{If both parents are ordered to pay retroactive child support and/or arrearages,
please include a separate paragraph for each parent.}
a. _____Parent {name or designation} ____________________ shall pay retroactive
child support in the amount of $_________ as of {date} ________________ to the
Petitioner. The retroactive child support shall be paid in the amount of $_________
per month, payable _____ in accordance with the employer’s payroll cycle, and in any
event at least once per month, or _____other {explain} ____________commencing
{date} ______________________, until paid in full including statutory interest.
b. _____ Parent {name or designation} _____________________ owes child support
arrearages in the amount of $__________ as of {date} ________________ to the
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
other parent. The child support arrearages shall be paid in the amount of $_______
per month, payable _____ in accordance with the parent’s employer’s payroll cycle,
and in any event at least once per month, or _____ other {explain} _______________
commencing {date} ______________________, until paid in full including statutory
interest.
5. Insurance
{Indicate all that apply}
a. Parent {name or designation} __________________ shall be required to maintain
_____ health and/or _____ dental insurance for the parties’ minor child(ren), so long
as reasonable in cost and accessible to the child(ren). The party providing insurance
shall be required to convey insurance cards demonstrating said coverage to the
Petitioner and other parent.
OR
_____ health and/or _____ dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.
b. ____ Reasonable and necessary uninsured medical/dental/prescription drug costs
for the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guidelines percentages.
_____ Other {explain
} ______________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or parents
within 30 days, and the parent or parents, within 30 days of receipt, shall submit the
applicable reimbursement for that expense.
SECTION V. METHOD OF PAYMENT
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment
a. ____Parent(s) shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with
any fee required by statute.
OR
b. ____ The Petitioner and the Parent(s) have requested and the Court finds that it
is in the best interest of the child(ren) that support payments need not be directed
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
through either the State Disbursement Unit or the central depository at this time;
however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3),
Florida Statutes, to require payment through either the State Disbursement Unit
or the central depository.
2. Income Deduction
(If applicable)
a. ____ Immediate.
_____ Parent {name or designation} _________________ and {if applicable}
_____ Parent {name or designation} _____________________________, hereinafter,
Obligor(s), shall pay through income deduction, pursuant to a separate Income
Deduction Order which shall be effective immediately. Obligor(s) is (are) individually
responsible for paying this support obligation until all of said support is deducted from
his/her income. Until support payments are deducted, the Obligor(s) is (are)
responsible for making timely payments directly to the State Disbursement Unit or
the Petitioner as previously set forth in this Order.
b. ____ Deferred. Income deduction is ordered this day, but it shall not be effective until
a delinquency of $_____________, or, if not specified, an amount equal to one
month’s obligation occurs. Income deduction is not being implemented immediately
based on the following findings: Income deduction is not in the best interests of the
child(ren) because: {explain} _____________________________________________
_____________________________________________________________________
____________________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an Income
Deduction Order,
AND
_____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the clerk
of court, and the Petitioner of any change in Payor(s) and/or health insurance OR
_____ there is a signed, written agreement providing an alternative arrangement
between the Petitioner and the Obligor(s) and, at the option of the IV-D agency, by
the IV-D agency in IV-D cases in which there is an assignment of support rights to the
state, reviewed and entered into the record by the court.
c. Bonus/one-time payments.
{Choose one only}
_____ All
_____ __________%
_____ No income paid in the form of a bonus or other similar one-time payment, up to
the amount of any arrearage or the remaining balance thereof owed pursuant to this
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
order, shall be forwarded to the Petitioner pursuant to the payment method prescribed
above.
d. Other provisions relating to method of payment: ___________________________
_______________________________________________________________________.
SECTION VI. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
{Choose one only}
1. The ____ Petitioner’s _____Respondents’ request(s) for attorney’s fees, costs, and suit
money is (are) denied because ______________________________________________
_______________________________________________________________________.
2. ____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party
$___________ in attorney’s fees, and $ ___________ in costs. The Court further finds
that the attorney’s fees are awarded based on the reasonable rate of
$________________ per hour and _________ reasonable hours. Other provisions
relating to attorney’s fees, costs, and suit money are as follows: ___________________
_______________________________________________________________________.
SECTION VII. OTHER PROVISIONS
1. Other Provisions ________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
2. The Court reserves jurisdiction to modify and enforce this Order for Temporary Custody.
DONE AND ORDERED in ______________________, Florida on {date} __________________
_____________________________
CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by
Extended Family (02/18)
I certify that a copy of this Order for Temporary Custody was _____ mailed _____ faxed and
mailed ____ e-mailed _____ hand-delivered to the parties and any entities listed below on {date}
_________________________.
by ________________________________
{Clerk of court or designee}.
Petitioner (or his or her attorney)
Respondents (or his or her attorney(s))
_____State Disbursement Unit
_____Central Depository
_____Other _________________________________
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT
IN AND FOR __________________________ COUNTY, FLORIDA
Case No: ______________________
Division: ______________________
IN THE INTEREST OF
________________________________
Child(ren)
__________________________________,
Petitioner,
and
__________________________________,
Respondent/_____________,
__________________________________,
Respondent/_______________.
ORDER GRANTING PETITION FOR
CONCURRENT CUSTODY BY EXTENDED FAMILY
This case came before this Court for a hearing on a Petition for Concurrent Custody by Extended
Family. The Court, having reviewed the file and heard the testimony, makes these findings of
fact and reaches these conclusions of law:
SECTION I. FINDINGS:
1. The Court has jurisdiction over the subject matter and the parties.
2. The minor child(ren) at issue in this matter are:
Name Date of Birth
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. The Petitioner, {full legal name} __________________________________________ is
the {extended family relationship}_______________________________ of the child(ren).
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
4. The Petitioner currently has physical custody of the child(ren) and has had physical
custody of the child(ren) for at least 10 days in any 30-day period within the last 12
months.
5. The Petitioner does not have signed, written documentation from the parent(s) which is
sufficient to enable the custodian to do all the things necessary to care for the child(ren)
which are available to custodians who have an order for temporary custody by extended
family.
6. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent
____ Was served with the petition and failed to file an Answer
____ Is deceased as evidenced by: _______________________________________
7. Parent {full legal name} _________________________________ of the child(ren):
{Choose one only}
____ Filed a Waiver and Consent
____ Was served with the petition and failed to file an Answer
____ Is deceased as evidenced by: _______________________________________
8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody.
SECTION II: CONCURRENT CUSTODY
1. The Petitioner,__________________________________________________, is granted
concurrent custody of the minor child(ren).
2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent.
3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor
child(ren), including but not limited to:
a. Consent to all necessary and reasonable medical and dental care for the child(ren),
including nonemergency surgery and psychiatric care;
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
b. Secure copies of the child(ren)’s records, held by third parties, that are necessary
for the care of the child(ren), including, but not limited to: medical, dental, and
psychiatric records; birth certificates and other records; and educational records;
c. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be
tested or placed in special school programs, including exceptional education; and
d. Do all other things necessary for the care of the child(ren).
SECTION III. CHILD SUPPORT
{Insert the name or designation of the appropriate parent in the space provided}
1. The Petitioner _____ did _____ did not request the establishment of child support.
2. ____ If child support is requested, the parents have received personal or substituted
service of process, the petition requests an order for support of the child(ren), and there
is evidence of the parents’ ability to pay the support ordered.
_____ Parent {name or designation} _______________ and {if applicable}
_____ Parent {name or designation} ___________________
has the present ability to pay child support.
{Choose one only}
a.____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules
of Procedure Form 12.902(e) filed by
_____Parent {name or designation} _____________________
_____ Parent {name or designation} _______________
are correct;
OR
b.____ The Court makes the following findings:
Parent {name or designation} ______________________________’s net monthly income
is $____________, (Child Support Guidelines ____%).
Parent {name or designation} ____________________________’s net monthly income is
$_____________, (Child Support Guidelines ____%)
Monthly child care costs are $_________________.
Monthly health/dental insurance costs are $_____________.
OR
c._____ Parent {name or designation} _______________ is currently ordered to pay child
support to the other parent in the amount of $__________ per ____________ as
established in the case of (style of case and number} ____________________________.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
_____ All of the child support or _____ a portion of the child support in the amount of
$___________ shall be redirected to the Petitioner.
3. Amount
a. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_______ per month for the _______children {total number of parties’
minor or dependent children} commencing _______________________ {month, day,
year} and terminating ________________________ {month, day, year}. Child support
shall be paid in the amount of $______________ per _____________ {week, month,
other} which is consistent with Parent {name or designation} ___________’s current
payroll cycle.
Upon the termination of child support for one of the parties’ children, child support in the
amount of $_____________ for the remaining _________ children {total number of
remaining children} shall be paid commencing __________________ {month, day, year}
and terminating _________________________ {month, day, year}. This child support
shall be paid in the amount of $_________ per _________ {week, month, other}
consistent with Parent {name or designation} ________________’s current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}
Parent {name or designation} _______________ shall pay child support until all of the
minor or dependent children: reach the age of 18, become emancipated, marry, join the
armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are: ____________________________________
_______________________________________________________________________
_______________________________________________________________________.
b. Parent {name or designation} __________________’s Obligation
Parent {name or designation} ________________ shall be obligated to pay child support
at the rate of $_________ per month for the ________children {total number of parties’
minor or dependent children} commencing______________________ {month, day, year}
and terminating __________________ {month, day, year}. Child support shall be paid in
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
the amount of $__________per ______________{week, month, other} consistent with
Parent {name or designation} ______________________’s current payroll cycle.
Upon the termination of the obligation of child support for one of the parties’ children,
child support in the amount of $__________ for the remaining ______ children {total
number of remaining children} shall be paid commencing _____________________
{month, day, year} and terminating ________________________ {month, day, year}. This
child support shall be paid in the amount of $______________ per _______________
{week, month, other} consistent with Parent {name or designation} _____________’s
current payroll cycle.
{Insert paragraph for the child support obligation, including the amount, and
commencement and termination dates, for the remaining minor or dependent children,
which shall be payable as the obligation for each child ceases.}
Parent {name or designation} ___________________ shall pay child support until all of
the minor or dependent children: reach the age of 18; become emancipated, marry, join
the armed services, die, or become self-supporting; or until further order of the court or
agreement of the parties. The child support obligation shall continue beyond the age of
18 and until high school graduation for any child who is dependent in fact, between the
ages of 18 and 19, and is still in high school, performing in good faith with a reasonable
expectation of graduation before the age of 19.
If the child support ordered deviates from the guidelines more than 5%, the factual
findings which support that deviation are:______________________________________
________________________________________________________________________
_______________________________________________________________________.
4. Retroactive Child Support and/or Arrearages
{If both parents are ordered to pay retroactive child support and/or arrearages, please
include a separate paragraph for each parent.}
a. _____ Parent {name or designation} ____________________________________
shall pay retroactive child support in the amount of $__________________ as of
{date} ________________ to the Petitioner. The retroactive child support shall be
paid in the amount of $___________ per month, payable _____in accordance with
the employer’s payroll cycle, and in any event at least once per month _____ other
{explain} _________________commencing {date} _______________, until paid in full
including statutory interest.
b. _____ Parent {name or designation} _______________ _____owes child support
arrearages in the amount of $__________ as of {date} ________________ to the
other parent. The child support arrearages shall be paid in the amount of $_______
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
per month, payable _____ in accordance with the parent’s employer’s payroll cycle,
and in any event at least once per month, or ___other {explain} _________________
commencing {date} _________________, until paid in full including statutory interest.
5. Insurance
{Indicate all that apply}
a. _____ Parent {name or designation} ____________________
shall be required to maintain _____ health and/or _____ dental insurance for the
parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren).
The party providing insurance shall be required to convey insurance cards
demonstrating said coverage to the Petitioner and other parent.
OR
_____ health and/or _____ dental insurance is either not reasonable in cost or
accessible to the child(ren) at this time.
b. _____ Reasonable and necessary uninsured medical/dental/prescription drug
costs for the minor child(ren) shall be assessed as follows:
_____ Shared equally by both parents.
_____ Prorated according to the child support guidelines percentages.
_____ Other {explain
} ____________________________________________
As to these uninsured medical/dental/prescription drug expenses, the party who
incurs the expense shall submit a request for reimbursement to the parent or
parents within 30 days, and the parent or parents, within 30 days of receipt, shall
submit the applicable reimbursement for that expense.
SECTION IV. METHOD OF PAYMENT
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows:
1. Place of Payment
a. _____Parents shall pay court-ordered support directly to either the State
Disbursement Unit or the central depository, as required by statute, along with
any applicable fee required by statute.
OR
b. ____ The Petitioner and the Parents have requested and the court finds that it is
in the best interest of the child(ren) that support payments need not be directed
through either the State Disbursement Unit or the central depository at this time;
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
however, any party may subsequently apply, pursuant to section
61.13(1)(d)(3), Florida Statutes, to require payment through either the State
Disbursement Unit or the central depository.
2. Income Deduction
(If applicable)
a. _____ Immediate. _____Parent {name or designation} _____________ _____
Parent {name or designation} ___________, hereinafter, Obligor(s), shall pay
through income deduction, pursuant to a separate Income Deduction Order which
shall be effective immediately. Obligor(s) is(are) individually responsible for paying
this support obligation until all of said support is deducted from his/her income.
Until support payments are deducted, the Obligor(s) is (are) responsible for
making timely payments directly to the State Disbursement Unit or the Petitioner
as previously set forth in this Order.
b. _____ Deferred. Income deduction is ordered this day, but it shall not be effective
until a delinquency of $_____________, or, if not specified, an amount equal to
one month’s obligation occurs. Income deduction is not being implemented
immediately based on the following findings: Income deduction is not in the best
interests of the child(ren) because: {explain} ______________
_______________________________________________________________
_______________________________________________________________.
AND
There is proof of timely payment of a previously ordered obligation without an
Income Deduction Order,
AND
_____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the
clerk of court, and the Petitioner of any change in Payor(s) and/or health insurance
OR
_____ there is a signed, written agreement providing an alternative arrangement
between the Petitioner and Obligor(s) and, at the option of the IV-D agency, by
the IV-D agency in IV-D cases in which there is an assignment of support rights to
the state, reviewed and entered into the record by the court.
c. Bonus/one-time payments.
{Choose one only}
_____ All
_____ __________%
_____ No income paid in the form of a bonus or other similar one-time payment,
up to the amount of any arrearage or the remaining balance thereof owed
pursuant to this order, shall be forwarded to the Petitioner pursuant to the
payment method prescribed above.
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
d. Other provisions relating to method of payment: _______________________
_________________________________________________________________
________________________________________________________________.
SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY
{Choose one only}
1. The _____ Petitioner’s _____ Respondents’ request(s) for attorney’s fees, costs, and suit
money is (are) denied because _____________________________________________
_____________________________________________________________________.
2. _____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit
money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party
$_____________ in attorney’s fees, and $ ___________ in costs. The Court further finds
that the attorney’s fees are awarded based on the reasonable rate of
$________________ per hour and ______ reasonable hours. Other provisions relating to
attorney’s fees, costs, and suit money are as follows: __________________________
_______________________________________________________________________.
SECTION VI. OTHER PROVISIONS
1. Other Provisions _________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________.
2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody.
3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent
or parents to obtain physical custody of the child(ren) at any time.
DONE AND ORDERED in _____________________, Florida on {date} ____________________
_____________________________
CIRCUIT JUDGE
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by
Extended Family (02/18)
I certify that a copy of this Order for Concurrent Custody was: _____ mailed _____ faxed and
mailed _____ e-mailed _____ hand-delivered to the parties and any entities listed below on
{date}________________________.
by____________________________.
{Clerk of court or designee}
Petitioner (or his or her attorney)
Respondents (or his or her attorneys)
_____State Disbursement Unit
_____Central Depository
_____Other _________________________________
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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