Page 2
of2
Sixth Circuit's Approved Family Law Form for Motion for Contempt in Domestic Violence Cases in Pinellas
The Clerk of the Court will mail the Notice of Hearing to the other party. I certify the following is
the correct address for the other party:
Other party or his/her
attorney:
Name:
Address:
City, State, Zip Code:
_
I understand
that
I
am
swearing
or
affirming
under oath to the
truthfulness
of the
claims
made above and that the
punishment
for knowingly making a false
statement
includes
fines
and/or imprisonment.
Dated:
_
Signature of Party ______________________________
Printed N
arne:
___________________________________________
(If
your
address
is
confidential please write
"Confidential"
and be sure to keep
your
address updated
with the
Clerk
so you will
receive
your paperwork.)
Address:.
_
City, State, Zip:________________________________________________
STATE OF FLORIDA
COUNTY OF PINELLAS
Telephone Number
:_______________
Fax Number:
_
Sworn to or affirmed and signed before me on by
___________
NOTARY PUBLIC or DEPUTY CLERK
Personally known
_;
Produced identification
Type of identification produced
[Print, type, or stamp commissioned name of notary or clerk.]
_
IF A NONLAWYER
HELPED
YOU FILL OUT THIS
FORM
,
HE/SHE MUST FILL IN
THE
BLANKS
BELOW:
[fill in all blanks]
I, {full legal name and trade name of nonlawyer} ,
___________
a nonlawyer, located at {street} , {city} ,
_
{state} , {phone} , helped {name} ,
_
who is the [I one
only]
petitioner or
respondent, fill out this form.