Case Title: In Re: Amendments To The Florida Supreme Court Approved Family Law Forms

Citation: 

Docket Number: SC08-2058

State: florida

Court: Florida Supreme Court

Date: 2010-12-16T00:00:00Z

Document:
____________ 
 
____________ 
 
 
 
 
 
 
 
 
 
Supreme Court of Florida 
No. SC08-2058 
IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT 
APPROVED FAMILY LAW FORMS. 
[March 26, 2009] 
PER CURIAM. 
During the 2008 legislative session, the Legislature amended numerous 
sections of chapter 61, Florida Statutes, redesignating it “Dissolution of Marriage; 
Support; Time-sharing,” and amended various sections of chapters 409, 414, 445, 
741, 742, 753, and 827, Florida Statutes.  See ch. 2008-61, Laws of Fla. (effective 
October 1, 2008). In general, this legislation removes references to the concepts of 
“custody,” “primary or secondary residential parent,” “visitation,” and the like, and 
instead incorporates the concepts of “time-sharing” and a “parenting plan.”  The 
statutes now require the court to approve or establish a “parenting plan” which 
governs how divorced parents will share the responsibilities of childrearing and 
decision making with regard to the child and sets forth a “time-sharing” schedule.  
Ch. 2008-61, §§ 2, 8, Laws of Fla. (amending §§ 61.046 and 61.13, Fla. Stat. 
(2007)). This legislation affects the Florida Supreme Court Approved Family Law 
Forms.  
 
 
                                          
 
Pursuant to the procedures approved by this Court in Amendments to the 
Florida Family Law Rules of Procedure & Family Law Forms, 810 So. 2d 1, 14 
(Fla. 2000), this Court has internally reviewed the Florida Supreme Court 
Approved Family Law Forms and determined that both new forms and 
amendments to existing forms are necessary as a result of the legislation.  Input on 
this issue was received from the Advisory Workgroup on the Florida Supreme 
Court Approved Family Law Forms, which provided valuable assistance. 
The majority of the amendments to existing forms simply conform them to 
the change in terminology accomplished by chapter 2008-61 and incorporate the 
concepts of time-sharing and the parenting plan.1  Two of the new forms are 
1. Other minor and editorial changes are also made to these forms.  Forms 
amended are General Information for Self-Represented Litigants; 12.901(b)(1) 
(Petition for Dissolution of Marriage with Dependent or Minor Child(ren)); 
12.902(d) (Uniform Child Custody Jurisdiction and Enforcement Act Affidavit 
(UCCJEA)); 12.902(f)(1) (Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren)); 12.903(a) (Answer, Waiver, and 
Request for Copy of Final Judgment of Dissolution of Marriage); 12.903(b) 
(Answer to Petition for Dissolution of Marriage); 12.903(c)(1) (Answer to Petition 
and Counterpetition for Dissolution of Marriage with Dependent or Minor 
Child(ren)); 12.903(e) (Answer to Supplemental Petition); 12.904(a) (Petition for 
Support Unconnected with Dissolution of Marriage with Dependent or Minor 
Child(ren)); 12.905(a) (Supplemental Petition to Modify Custody or Visitation and 
Other Relief); 12.905(d) (Supplemental Petition for Temporary 
Modification/Amendment of Custody for Child(ren) of Custodial Parent Activated, 
Deployed, or Temporarily Assigned to Military Service); 12.940(d) (Motion to 
Modify or Dissolve Temporary Injunction); 12.941(a) (Verified Motion for 
Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of 
Passport Services); 12.941(b) (Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (Ex Parte)); 12.941(c) (Temporary 
2 
 
 
                                                                                                                                        
parenting plan forms, form 12.995(a) (Parenting Plan (non-supervised)), and form 
12.995(b) (Parenting Plan (supervised/safety focused)).  The third new form is 
form 12.993(d) (Supplemental Temporary Judgment for Modification of Parenting 
Issues for Children of Military Parents) in accord with various amendments to 
section 61.13002, Florida Statutes. See ch. 2008-61, § 10, Laws of Fla. 
The new and amended forms are adopted as set forth in the appendix to this 
opinion, fully engrossed, effective for immediate use.  Due to the number of 
amendments and new forms, we direct that they be published for comment.  A 
Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport 
Services (After Notice)); 12.941(d) (Emergency Verified Motion for Child Pick-
Up Order); 12.941(e) (Order to Pick-Up Minor Child(ren)); 12.942(a) (Motion for 
Appointment of Guardian Ad Litem); 12.942(b) (Order Appointing Guardian Ad 
Litem); 12.943 (Motion to Deviate from Child Support Guidelines); 12.947(a) 
(Motion for Temporary Support with Dependent Minor Child(ren)); 12.947 (b) 
(Temporary Order of Support with Dependent or Minor Child(ren)); 12.960 
(Motion for Civil Contempt/Enforcement); 12.980(a) (Petition for Injunction for 
Protection Against Domestic Violence); 12.980(c)(1) (Temporary Injunction for 
Protection Against Domestic Violence with Minor Child(ren)); 12.980(d)(1) (Final 
Judgment of Injunction for Protection Against Domestic Violence with Minor 
Child(ren) (After Notice)); 12.981(a)(1) (Stepparent Adoption: Consent and 
Waiver by Parent); 12.981(b)(1) (Joint Petition for Adoption by Stepparent); 
12.981(b)(2) (Final Judgment of Stepparent Adoption); 12.983(a) (Petition to 
Determine Paternity and for Related Relief); 12.983(b) (Answer to Petition to 
Determine Paternity and for Related Relief); 12.983(c) (Answer to Petition and 
Counterpetition to Determine Paternity and for Related Relief); 12.983(g) (Final 
Judgment of Paternity); 12.990(b)(1) (Final Judgment of Dissolution of Marriage 
with Minor Child(ren) (Uncontested)); 12.990(c)(1) (Final Judgment of 
Dissolution of Marriage with Dependent or Minor Child(ren)); 12.993(a) 
(Supplemental Final Judgment Modifying Parental Responsibility/Visitation); 
12.993(b) (Supplemental Final Judgment Modifying Child Support); 12.994(a) 
(Final Judgment for Support Unconnected with Dissolution of Marriage with 
Dependent or Minor Child(ren)). 
3 
 
 
 
 
 
 
 
 
publication notice will appear in The Florida Bar News. The forms will be posted 
on this Court’s website at www.floridasupremecourt.org/decisions/rules.shtml.  
Interested persons shall have sixty days from the date of this opinion to file 
comments with the Court. By adoption of these forms, we express no opinion as to 
their correctness or applicability, or on the substance of the new legislation.  The 
forms discussed herein may also be accessed and downloaded from this Court’s 
website at www.flcourts.org/gen_public/family/forms_rules/index.shtml. 
It is so ordered. 
QUINCE, C.J., and PARIENTE, LEWIS, CANADY, POLSTON, and 
LABARGA, JJ., concur. 
PERRY, J., did not participate. 
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND 
IF FILED, DETERMINED. 
Original Proceeding – The Florida Family Law Rules of Procedure  
4 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
  
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
  
   
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
APPENDIX 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.901(b)(1),
PETITION FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR 
MINOR CHILD(REN) (03/09) 
When should this form be used? 
This form should be used when a husband or wife is filing for a dissolution of marriage and you and your 
spouse have a dependent or minor child(ren) together or the wife is pregnant. You and/or your spouse 
must have lived in Florida for at least 6 months before filing for a dissolution in Florida. You must file 
this form if the following is true: 
• 
You and your spouse have a dependent or minor child(ren) together or the wife is pregnant. 
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. 
What should I do next? 
For your case to proceed, you must properly notify your spouse 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, you 
may use constructive service. You may also be able to use constructive service if your spouse resides in 
another state or country. However, if constructive service is used, other than granting a divorce, the 
court may only grant limited relief. For more information on constructive service, see Notice of Action 
for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit 
of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If your spouse 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 service is very complex and you may wish to consult an attorney regarding these issues. 
If personal service is used, the respondent has 20 days to answer after being served with your petition. 
Your case will then generally proceed in one of the following three ways: 
DEFAULT. If after 20 days, your spouse has not filed an answer, you may file a Motion for Default, 
Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. Then, if you have 
filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set 
a final hearing. You must notify your spouse 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. 
UNCONTESTED. If your spouse files an answer that agrees with everything in your petition or an answer 
and waiver, and you have complied with mandatory disclosure and filed all of the required papers, you 
may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You must notify your 
spouse 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 your spouse files an answer or an answer and counterpetition, which disagrees with or 
denies anything in your petition, and you are unable to settle the disputed issues, you should file a 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with 
mandatory disclosure and filed all of the required papers. 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). If your spouse files an 
answer and counterpetition, you should answer the counterpetition within 20 days using an Answer to 
Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d). 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the 
beginning of these forms. The words that are in “bold underline” in these instructions are defined 
there. For further information, see chapter 61, Florida Statutes. 
Special notes... 
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of 
Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to 
have filing fees deferred. 
If this is a domestic violence case and you want to keep your address confidential for safety reasons, do 
not enter the address, telephone, and fax information at the bottom of this form. 
Instead, file 
Petitioner’s Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law 
Form 12.980(h). 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if 
you are asking that child support be ordered in the final judgment. (If you do not know your 
spouse’s income, you may file this worksheet after his or her financial affidavit has been served 
on you.) 
• 	
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) 
OR photocopy of current Florida driver’s license, Florida identification card, or voter’s 
registration card (issue date of copied document must be at least six months before date case is 
actually filed with the clerk of the circuit court). 
• 	
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you and your spouse have 
reached an agreement on any or all of the issues. 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed with the petition if the petitioner seeks to establish child support. 
Otherwise, it must be filed within 45 days of service of the petition on the respondent.) 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if 
not filed at the time of the petition, unless you and your spouse have agreed not to exchange 
these documents.) 
• 	
Parenting 
Plan, 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form 
12.995(a)or 
Supervised/Safety Focused Parenting Plan, Form 12.995(b) If the parents have reached an 
agreement, a signed and notarized Parenting Plan should be attached. 
If the parents have not 
reached an agreement, a proposed Parenting Plan may be filed. 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
6 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
     
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
Parenting Plan and Time‐Sharing. If you and your spouse are unable to agree on parenting 
arrangements and a time‐sharing schedule, a judge will decide for you as part of establishing a Parenting 
Plan. The judge will decide the parenting arrangements and time‐sharing based on the child(ren)’s best 
interests. Regardless of whether there is an agreement, the court reserves jurisdiction to modify issues 
relating to the minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning parenting 
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) 
being served. For more information, you may consult section 61.13, Florida Statutes. 
A parenting course must be completed prior to entry of the final judgment. You should contact the 
clerk, family law intake staff, or judicial assistant about requirements for parenting courses where you 
live. 
Listed below are some terms with which you should become familiar before completing your petition. If 
you do not fully understand any of the terms below or their implications, you should speak with an 
attorney before going any further. 
• 
Shared Parental Responsibility 
• 
Sole Parental Responsibility 
• 
Supervised Time‐Sharing 
• 
No contact 
• 
Parenting Plan 
• 
Parenting Plan Recommendation 
• 
Time‐Sharing Schedule 
Child Support. 
The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure 
Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, 
you should be able to calculate the amount of child support that should be paid using the Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
Because the child 
support guidelines take several factors into consideration, change over time, and vary from state to 
state, your child support obligation may be more or less than that of other people in seemingly similar 
situations. 
Alimony. Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the 
other spouse has the ability to pay it. If you want alimony, you must request it in writing in the original 
petition or counterpetition. If you do not request alimony in writing before the final hearing, it is 
waived (you may not request it later). You may request either permanent alimony, lump sum alimony, 
or rehabilitative alimony. 
Marital/Nonmarital Assets and Liabilities. Florida law requires an equitable distribution of marital 
assets and marital liabilities. “Equitable” does not necessarily mean “equal.” Many factors, including 
child support, time‐sharing, and alimony awards, may lead the court to make an unequal (but still 
equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those 
assets and liabilities which the parties agree or the court determines belong to, or are the responsibility 
of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, 
the judge will not consider it when distributing marital assets and liabilities. 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
7 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Temporary Relief. 
If you need temporary relief regarding temporary use of assets, temporary 
responsibility for liabilities, parental responsibility and time‐sharing with child(ren), temporary child 
support, or temporary alimony, you may file a Motion for Temporary Support and Time‐Sharing with 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For 
more information, see the instructions for that form. 
Marital Settlement Agreement. If you and your spouse are able to reach an agreement on any or all of 
the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent 
or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both of you must 
sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to 
agree will be considered contested and settled by the judge at the final hearing. 
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved 
or established by the court. If you and your spouse have reached an agreement, you should file a 
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), or a Supervised/Safety 
Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(b) which addresses 
the time‐sharing schedule for the child(ren). 
If you have not reached an agreement, a proposed 
Parenting Plan may be filed. If the parties are unable to agree, a Parenting Plan will be established by 
the court. 
Final Judgment Form. 
These family law forms contain a Final Judgment of Dissolution of Marriage 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), 
which the judge may use if your case is contested. If you and your spouse reach an agreement on all of 
the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor 
Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should 
check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final 
judgment with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
8 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
        
        
 
 
  
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                   
   
 
 
 
 
 
 
 
 
                           
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
PETITION FOR DISSOLUTION OF MARRIAGE 
WITH DEPENDENT OR MINOR CHILD(REN) 
I, {full legal name} 
, the 
[one only] ( 
) Husband ( 
) Wife, being sworn, certify that the following statements are true: 
1. 	
JURISDICTION/RESIDENCE 
( 
) Husband ( 
) Wife ( 
) Both has (have) lived in Florida for at least 6 months before the filing 
of this Petition for Dissolution of Marriage. 
2. 	
The husband [one only] ( 
) is ( 
) is not a member of the military service. 
The wife [one only] 
( 
) is ( 
) is not a member of the military service. 
3. 	
MARRIAGE HISTORY 
Date of marriage: {month, day, year} 
Place of marriage: {city, state, country} 
Date of separation: {month, day, year} 
( √ if approximate) 
4. 
DEPENDENT OR MINOR CHILD(REN) 
[ all that apply] 
a. 	
___ The wife is pregnant. Baby is due on: {date} 
b. 	
___ The minor (under 18) child(ren) common to both parties are: 
Name 	
Place of Birth 
Birth date 
Sex 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
9 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
    
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
c. 	
___The minor child(ren) born or conceived during the marriage who are not common to 
both parties are: 
Name 	
Place of Birth 
Birth date 
Sex 
The birth father(s) of the above minor child(ren) is (are) {name and address} 
d. 	 ___The child(ren) common to both parties who are 18 or older but who are dependent 
upon the parties due to a mental or physical disability are: 
Name 	
Place of Birth 
Birth date 
Sex 
5. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
(You must 
complete and attach this form in a dissolution of marriage with minor child(ren)). 
6. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this petition. 
7. 
This petition for dissolution of marriage should be granted because: 
[ one only] 
a. 
___ The marriage is irretrievably broken. 
b. 	
___ One of the parties has been adjudged mentally incapacitated for a period of 3 years 
prior to the filing of this petition. A copy of the Judgment of Incapacity is attached. 
SECTION I. MARITAL ASSETS AND LIABILITIES 
[ one only] 
1. 	
___ There are no marital assets or liabilities. 
2. 	
___ There are marital assets or liabilities. 
All marital and nonmarital assets and 
liabilities are (or will be) listed in the financial affidavits, Florida Family Law Rules of 
Procedure Form 12.902(b) or (c), to be filed in this case. 
[ √ all that apply] 
a. 	
___ All marital assets and liabilities have been divided by a written agreement between 
the parties, which is attached, to be incorporated into the final judgment of dissolution 
of marriage. (The parties may use Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved Family 
Law Form 12.902(f)(1). 
b. 	
___ The Court should determine how the assets and liabilities of this marriage are to be 
distributed, under section 61.075, Florida Statutes. 
c. 	
___ Petitioner should be awarded an interest in Respondent’s property because: 
SECTION II. SPOUSAL SUPPORT (ALIMONY) 
[ one only] 
1. 
___ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
10 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
             
        
        
 
        
 
 
         
 
 
 
 
 
                                                                             
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
           
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
  
 
 
 
 
  
 
        
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
         
         
 
 
 
 
 
 
 
  
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
     
       
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
  
 
 
 
 
 
 
2. 	
___ Petitioner requests that the Court order Respondent to pay the following spousal support 
(alimony) and claims that he or she has a need for the support that he or she is requesting and 
Respondent has the ability to pay that support. Spousal support (alimony) is requested in the 
amount of $ 
every ( 
) week ( 
) other week ( 
) month, beginning {date} 
and 
continuing until {date or event} 
. 
Explain why the Court should order Respondent to pay and any specific request(s) for type of 
alimony (temporary, permanent, rehabilitative, and/or lump sum): 
[  √if applies] ( 
) Petitioner requests life insurance on Respondent’s life, provided by 
Respondent, to secure such support. 
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY, AND TIME‐SHARING 
1. 
The minor child(ren) currently reside(s) with ( 
) Mother ( 
) Father ( 
) Other: {explain} 
2. 
Parental Responsibility. 
It is in the child(ren)’s best interests that parental 
responsibility be: 
[ √ one only] 
a. 	
___ shared by both Father and Mother. 
b. 	
___ awarded solely to ( 
) Father ( 
) Mother. Shared parental responsibility would be 
detrimental to the child(ren) because: 
3. 	
Parenting Plan and Time‐Sharing. It is in the best interests of the child(ren) that the 
family be ordered to comply with a Parenting Plan that ( 
) includes ( 
) does not include 
parental time‐sharing with the child(ren). The Petitioner states that it is in the best interests of 
the child (ren) that: 
(Choose only one) 
a. 	
___ The attached proposed Parenting Plan should be adopted by the court. The parties 
( ) have ( ) have not agreed to the Parenting Plan. 
b. 
___ The court should establish a Parenting Plan with the following provisions: 
� 	
No time‐sharing for the ___ Husband ___ Wife. 
� 	
Limited time‐sharing with the ___ Husband ___ Wife. 
� 	
Supervised Time‐Sharing for the ___ Husband ___ Wife. 
� 	
Supervised or third‐party exchange of the child(ren). 
� 	
Time‐Sharing Schedule as follows: 
4. 
Explain why this request is in the best interests of the child(ren): 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
11 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
    
 
 
 
   
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
           
           
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                                                                       
SECTION IV. CHILD SUPPORT 
[ all that apply] 
1. 	
___ Petitioner requests that the Court award child support as determined by Florida’s child 
support 
guidelines, section 61.30, Florida Statutes. 
A completed Child Support Guidelines 
Worksheet, 
Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such support should 
be ordered retroactive to: 
a. 	
___ the date of separation {date} 
. 
b. 	
___ the date of the filing of this petition. 
c. 	
___ other {date} 
{explain} 
2. 	
___ Petitioner requests that the Court award child support to be paid beyond the age of 18 
years because: 
a. 	
___ the following child(ren) {name(s)} 
is (are) dependent because of a mental or physical incapacity which began before the 
age of 18. {explain} 
b. 	
___ the following child(ren) {name(s)} 
is 
(are) 
dependent in fact and is (are) in high school while he/she (they) are between the ages of 
18 and 19; said child(ren) is (are) performing in good faith with reasonable expectation 
of graduation before the age of 19. 
3. 	
___Petitioner requests that the Court award a child support amount that is more than or less 
than Florida’s child support guidelines. Petitioner understands that Motion to Deviate from 
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be 
filed before the court will consider this request. 
4. 	
___Petitioner requests that medical/dental insurance coverage for the minor child(ren) be 
provided by: 
[one only] 
a. 	
___ Father. 
b. 	
___ Mother. 
5. 	
___Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: 
[ one only] 
a. 	
___by Father. 
b. 	
___by Mother. 
c. 	
___by Father and Mother [each pay one‐half]. 
d. 	
___according to the percentages in the Child Support Guidelines Worksheet, Florida Family 
Law Rules of Procedure Form 12.902(e). 
e. 	
___Other {explain}: __________________________________________________________ 
6. 	
Petitioner requests that life insurance to secure child support be provided by: 
a. 	
___Father. 
b. 	
___Mother. 
c. 	
___Both. 
SECTION V. OTHER 
1. 	
[If Petitioner is also the Wife, please indicate by either ( 
) yes ( 
) or no whether 
Petitioner/Wife wants to be known by her former name, which was {full legal name} 
. 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
12 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
2. 
Other relief {specify}: 
SECTION VI. PETITIONER’S REQUEST (This section summarizes what you are asking the Court to include 
in the final judgment of dissolution of marriage.) 
Petitioner requests that the Court enter an order dissolving the marriage and: 
[all that apply] 
1. 	
___distributing marital assets and liabilities as requested in Section I of this petition; 
2. 	
___awarding spousal support (alimony) as requested in Section II of this petition; 
3. 	
___ adopt or establish a Parenting Plan containing provisions for parental responsibility and 
time‐sharing for the dependent or minor child(ren) common to both parties, as requested in 
Section III of this petition; 
4. 	
___establishing child support for the dependent or minor child(ren) common to both parties, as 
requested in Section IV of this petition; 
5. 	
___restoring Wife’s former name as requested in Section V of this petition; 
6. 	
___awarding other relief as requested in Section V of this petition; and any other terms 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: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
13 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
                                         
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
   
 
 
 
                                                
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
  
 
   
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
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] 
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. 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with
Dependent or Minor Child(ren) (03/09)
14 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.902(d), UNIFORM CHILD CUSTODY JURISDICTION AND
ENFORCEMENT ACT (UCCJEA) AFFIDAVIT (03/09) 
When should this form be used? 
This form should be used in any case involving custody of, visitation with, or time‐sharing with any minor 
child(ren). This affidavit is required even if the custody of, visitation, or time‐sharing with the minor 
child(ren) are 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 the original with the clerk of the circuit 
court in the county where the petition was filed and keep a copy for your records. 
What should I do next? 
A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served 
on him or her with your initial papers. 
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... 
If you are the petitioner in an injunction for protection against domestic violence case and you have filed 
Petitioner=s Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law 
Form 12.980(i), 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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction 
and Enforcement Act (UCCJEA) Affidavit (03/09) 
15 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
              
 
 
 
 
                                                                         
            
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
             
 
 
 
 
  
 
 
 
                                                                                        
   
 
 
    
 
     
 
 
  
 
 
  
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 (03/09) 
16 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
             
 
 
 
 
  
 
 
 
                                                                                        
   
 
 
    
                
  
 
 
    
 
  
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
             
 
 
 
 
  
 
 
 
                                                                                        
   
 
 
    
                
  
 
 
    
 
  
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
____/____ 
* If you are the petitioner in an injunction for protection against domestic violence case and you have 
filed Petitioner=s Request for Confidential Filing of Address, Florida Supreme Court Approved Family 
Law Form 12.980(i), you should write Aconfidential@ 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 (03/09) 
17 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____/____ 
____/____ 
____/____ 
____/____ 
____/____ 
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement 
Act (UCCJEA) Affidavit (03/09) 
18 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
   
 
 
   
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
    
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
      
 
 
        
 
 
        
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
2. 
Participation in custody or time‐sharing proceeding(s): 
[ √ one only] 
___ 
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, concerning custody of or time‐sharing 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, concerning custody of or time‐sharing 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): 
[ √  one only] 
___ 
I HAVE NO INFORMATION of any custody or time‐sharing proceeding pending in a court of this 
or any other state concerning a child subject to this proceeding. 
___ 
I HAVE THE FOLLOWING INFORMATION concerning a custody or time‐sharing 
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: 
b. 
Type of proceeding: 
c. 
Court and state: 
d. 
Date of court order or judgment (if any): 
4. 
Persons not a party to this proceeding: 
[ √ one only] 
___ 
I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or 
claims to have custody, visitation or time‐sharing 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 custody, visitation, or time‐sharing with respect to any child 
subject to this proceeding: 
a. 
Name and address of person: 
( 
) has physical custody ( 
) claims custody rights ( 
) claims visitation or time‐sharing 
Name of each child: 
b. 
Name and address of person: 
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement 
Act (UCCJEA) Affidavit (03/09) 
19 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
        
 
 
        
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
      
 
 
        
 
 
        
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
        
        
 
 
        
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
                                                 
 
 
 
 
 
 
  
 
( 
) has physical custody ( 
) claims custody rights ( 
) claims visitation. or time‐sharing 
Name of each child: 
c. 
Name and address of person: 
( 
) has physical custody ( 
) claims custody rights ( 
) claims visitation or time‐sharing 
Name of each child: 
5. 
Knowledge of prior child support proceedings: 
[ √ one only] 
___ 
The child(ren) described in this affidavit are NOT subject to existing child support order(s) in this 
or any state or territory. 
___ 
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): 
e. 
Amount of child support paid and by whom: 
6. 	
I acknowledge that I have a continuing duty to advise this Court of any custody, visitation or 
time‐sharing, 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. 
I certify that a copy of this document was [ √ one only] ( 
) 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: 
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: 
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement 
Act (UCCJEA) Affidavit (03/09) 
20 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
    
                              
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
      
 
 
      
 
 
 
 
STATE OF FLORIDA 
COUNTY OF _________________________ 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} 
, 
{state} 
, {phone} 
, helped {name} 
, 
who 
is 
the 
[
 √ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.902(d), Uniform Child Custody Jurisdiction and Enforcement 
Act (UCCJEA) Affidavit (03/09) 
21 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.902(f)(1), MARITAL SETTLEMENT AGREEMENT FOR
DISSOLUTION OF MARRIAGE 
WITH DEPENDENT OR MINOR CHILD(REN) (03/09) 
When should this form be used? 
This form should be used when a Petition for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.901(b)(1), has been filed and the 
parties have reached an agreement on some or all of the issues at hand. 
This form should be typed or printed in black ink. Both parties must sign the agreement and have their 
signatures witnessed by a notary public or deputy clerk. After completing this form, you should file the 
original with the clerk of the circuit court in the county where the petition was filed and keep a copy for 
your records. 
You should then refer to the instructions for your petition, answer, or answer and 
counterpetition concerning the procedures for setting a hearing or trial (final hearing). 
Where can I look for more information? 
Before proceeding, you should read General Information for Self‐Represented Litigants found at the 
beginning of these forms. The words that are in bold underline in these instructions are defined there. 
For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or 
answer that were filed in this case. 
Special notes... 
With this form you must also file a Child Support Guidelines Worksheet, Florida Family Law Rules of 
Procedure Form 12.902(e), if not already filed. 
This form does not act to transfer title to the property. 
Such transfer must be done by deed or 
supplemental final judgment. 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
22 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
                                                                        
       
 
 
 
 
                                                                         
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
_______________________ 
Division: 
_______________________ 
, 
Petitioner, 
and 
, 
Respondent. 
MARITAL SETTLEMENT AGREEMENT FOR DISSOLUTION OF MARRIAGE 
WITH DEPENDENT OR MINOR CHILD(REN) 
We, {Husband=s full legal name} 
, 
and {Wife=s full legal name} 
, 
being sworn, certify that the following statements are true: 
1. 	
We were married to each other on {date} 
. 
2. 	
Because of irreconcilable differences in our marriage (no chance of staying together), we have 
made this agreement to settle once and for all what we owe to each other and what we can 
expect to receive from each other. Each of us states that nothing has been held back, that we 
have honestly included everything we could think of in listing our assets (everything we own and 
that is owed to us) and our debts (everything we owe), and that we believe the other has been 
open and honest in writing this agreement. 
3. 	
We have both filed a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c). Because we have voluntarily made full and fair disclosure to each other of all 
our assets and debts, we waive any further disclosure under rule 12.285, Florida Family Law 
Rules of Procedure. 
4. 	
Each of us agrees to execute and exchange any papers that might be needed to complete this 
agreement, including deeds, title certificates, etc. 
SECTION I. MARITAL ASSETS AND LIABILITIES 
A. 	 Division of Assets. We divide our assets (everything we own and that is owed to us) as follows: Any 
personal item(s) not listed below is the property of the party currently in possession of the item(s). 
1. 	
Wife shall receive as her own and Husband shall have no further rights or responsibilities 
regarding these assets: 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
23 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE 
(To avoid confusion at a later date, describe each item as clearly as possible. You do 
not need to list account numbers. Where applicable, include whether the name on 
any title/deed/account described below is wife=s, husband=s, or both.) 
Current Fair 
Market Value 
9 Cash (on hand) 
$ 
9 Cash (in banks/credit unions) 
9 
9 Stocks/Bonds 
9 
9 Notes (money owed to you in writing) 
9 
9 
9 Money owed to you (not evidenced by a note) 
9 
9 
9 Real estate: (Home) 
9 (Other) 
9 
9 Business interests 
9 
9 Automobiles 
9 
9 
9 Boats 
9 Other vehicles 
9 
9 Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
9 
9 
9 Furniture & furnishings in home 
9 
9 Furniture & furnishings elsewhere 
9 
9 Collectibles 
9 
9 Jewelry 
9 
9 Life insurance (cash surrender value) 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
24 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ASSETS: DESCRIPTION OF ITEM(S) WIFE SHALL RECEIVE 
(To avoid confusion at a later date, describe each item as clearly as possible. You do 
not need to list account numbers. Where applicable, include whether the name on 
any title/deed/account described below is wife=s, husband=s, or both.) 
Current Fair 
Market Value 
9 
9 Sporting and entertainment (T.V., stereo, etc.) equipment 
9 
9 
9 
9 Other assets 
9 
9 
9 
9 
9 
9 
Total Assets to Wife 
$ 
2. 
Husband shall receive as his own and Wife shall have no further rights or responsibilities 
regarding these assets: 
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE 
(To avoid confusion at a later date, describe each item as clearly as possible. You do 
not need to list account numbers. Where applicable, include whether the name on 
any title/deed/account described below is wife=s, husband=s or both.) 
Current Fair 
Market Value 
9 Cash (on hand) 
$ 
9 Cash (in banks/credit unions) 
9 
9 Stocks/Bonds 
9 
9 Notes (money owed to you in writing) 
9 
9 
9 Money owed to you (not evidenced by a note) 
9 
9 
9 Real estate: (Home) 
9 (Other) 
9 
9 Business interests 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
25 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
ASSETS: DESCRIPTION OF ITEM(S) HUSBAND SHALL RECEIVE 
(To avoid confusion at a later date, describe each item as clearly as possible. You do 
not need to list account numbers. Where applicable, include whether the name on 
any title/deed/account described below is wife=s, husband=s or both.) 
Current Fair 
Market Value 
9 
9 Automobiles 
9 
9 
9 Boats 
9 Other vehicles 
9 
9 Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
9 
9 
9 Furniture & furnishings in home 
9 
9 Furniture & furnishings elsewhere 
9 
9 Collectibles 
9 
9 Jewelry 
9 
9 Life insurance (cash surrender value) 
9 
9 Sporting and entertainment (T.V., stereo, etc.) equipment 
9 
9 
9 
9 Other assets 
9 
9 
9 
9 
9 
Total Assets to Husband 
$ 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
26 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B. 	
Division of Liabilities/Debts. We divide our liabilities (everything we owe) as follows: 
1. 	
Wife shall pay as her own the following and will not at any time ask Husband to pay these 
debts/bills: 
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY WIFE 
(To avoid confusion at a later date, describe each item as clearly as 
possible. You do not need to list account numbers. Where applicable, 
include whether the name on any mortgage, note, or account described 
below is wife=s, husband=s, or both.) 
Monthly 
Payment 
Current 
Amount 
Owed 
9 Mortgages on real estate: (Home) 
$ 
$ 
9 (Other) 
9 
9 Charge/credit card accounts 
9 
9 
9 
9 
9 
9 Auto loan 
9 Auto loan 
9 Bank/credit union loans 
9 
9 
9 
9 Money you owe (not evidenced by a note) 
9 
9 Judgments 
9 
9 Other 
9 
9 
9 
Total Debts to Be Paid by Wife 
$ 
$ 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
27 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
2. 
Husband shall pay as his own the following and will not at any time ask Wife to pay these 
debts/bills: 
LIABILITIES: DESCRIPTION OF DEBT(S) TO BE PAID BY HUSBAND 
(To avoid confusion at a later date, describe each item as clearly as 
possible. You do not need to list account numbers. Where applicable, 
include whether the name on any mortgage, note or account described 
below is wife=s, husband=s, or both.) 
Monthly 
Payment 
Current 
Amount 
Owed 
9 Mortgages on real estate: (Home) 
$ 
$ 
9 (Other) 
9 
9 Charge/credit card accounts 
9 
9 
9 
9 
9 
9 Auto loan 
9 Auto loan 
9 Bank/credit union loans 
9 
9 
9 
9 Money you owe (not evidenced by a note) 
9 
9 Judgments 
9 
9 Other 
9 
9 
9 
9 
Total Debts to Be Paid by Husband 
$ 
$ 
C. 
Contingent Assets and Liabilities (listed in Section III of our Family Law Financial Affidavits) will be 
divided as follows: 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
28 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
   
 
 
    
 
        
        
 
        
 
 
  
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
        
        
 
        
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION II. SPOUSAL SUPPORT (ALIMONY) (If you have not agreed on this matter, write n/a on the 
lines provided.) 
[ one only] 
1. 	
___Each of us forever gives up any right to spousal support (alimony) that we may have. 
2. 
___ ( 
) HUSBAND ( 
) WIFE agrees to pay spousal support (alimony) in the amount of $ 
every ( 
) week ( 
) other week ( 
) month, beginning {date} 
and continuing 
until {date or event} 
. 
Explain type of alimony (temporary, permanent, rehabilitative, and/or lump sum) and any other 
specifics: 
[if applies] ( 
) Life insurance in the amount of $ 
to secure the above support, will be 
provided by the obligor. 
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME‐SHARING 
1. 
The parties’ minor child(ren) are: 
Name 
Birth date 
2. 	
The parties shall have time‐sharing and parental responsibility in accordance with the Parenting 
Plan attached as Exhibit _____. 
SECTION IV. CHILD SUPPORT 
1. 	
( 
) Mother ( 
) Father will pay child support, under Florida=s child support guidelines, section 
61.30, Florida Statutes, to the primary residential or sole parent named above. Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is completed and 
attached. 
This parent shall be obligated to pay child support in the amount of $ 
, every ( 
) week ( 
) 
other week ( 
) month, beginning {date} 
and continuing until modified by court 
order, the youngest child turns 18, becomes emancipated, marries, dies, otherwise becomes self‐
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
29 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                  
 
 
 
 
 
 
 
 
 
 
  
 
     
 
 
 
    
 
 
 
 
 
                       
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
  
    
 
 
      
        
 
        
 
 
                 
 
 
 
 
 
 
 
 
 
 
          
        
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
         
        
 
 
        
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
_________________________________________________________________________ 
supporting or, if after the age of 18, until {date} 
. 
If the child support amount above 
deviates 
from 
the 
guidelines 
by 
5% 
or 
more, 
explain 
the 
reason(s) 
here:____________________________________________________________________ 
2. 
Child Support Arrearage. There currently is a child support arrearage of $ 
__________ 
for retroactive child support and/or $ 
for previously ordered unpaid child support. 
The total of $ 
in child support arrearage shall be repaid at the rate of $ 
every 
( 
) week ( 
) other week ( 
) month, beginning {date} 
, until paid in full including statutory 
interest. 
3. 	
Health Insurance. 
( 
) Mother ( 
) Father will maintain health insurance coverage for the 
parties’ minor child(ren). The party providing coverage will provide insurance cards to the other 
party showing coverage. OR ( 
) Health insurance is not reasonably available at this time. Any 
uninsured/ unreimbursed medical costs for the minor child(ren) shall be assessed as follows: 
a. 	
___Shared equally by both parents. 
b. 	
___Prorated according to the child support guideline percentages. 
c. 
___Other {explain}: ______________________________________________________ 
As to these uninsured/unreimbursed medical expenses, the party who incurs the expense shall submit a 
request for reimbursement to the other party within 30 days, and the other party, within 30 days of 
receipt, shall submit the applicable reimbursement for that expense, according to the schedule of 
reimbursement set out in this paragraph. 
4. 	
Dental Insurance. ( 
) Mother ( 
) Father will maintain ( 
) dental insurance coverage for the 
parties’ minor child(ren). The party providing coverage will provide insurance cards to the other 
party showing coverage. OR ( 
) dental insurance is not reasonably available at this time. Any 
uninsured/ unreimbursed dental costs for the minor child(ren) shall be assessed as follows: 
a. 	
___Shared equally by both parents. 
b. 	
___Prorated according to the child support guideline percentages. 
c. 
___Other {explain}: ______________________________________________________ 
As to these uninsured/unreimbursed dental expenses, the party who incurs the expense shall submit a 
request for reimbursement to the other party within 30 days, and the other party, within 30 days of 
receipt, shall submit the applicable reimbursement for that expense, according to the schedule of 
reimbursement set out in this paragraph. 
5. 	
Life Insurance. ( 
) Mother ( 
) Father shall be required to maintain life insurance coverage for 
the benefit of the parties’ minor child(ren) in the amount of $ 
until the youngest child 
turns 18, becomes emancipated, marries, dies, or otherwise becomes self‐supporting. 
6. 	
IRS Income Tax Deduction(s). The assignment of any tax deductions for the child(ren) shall be 
as follows: {explain} __________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
30 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The other parent will convey any applicable IRS form regarding the income tax deduction. 
7. 	
Other provisions relating to child support (e.g., uninsured medical/dental expenses, insurance 
coverage, life insurance to secure child support, orthodontic payments, college fund, etc.): 
SECTION V. OTHER 
SECTION VI. We have not agreed on the following issues: 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
31 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
 
 
 
 
 
                                                                                       
 
  
 
                                                                                       
  
 
                                                                                       
 
 
  
 
                                                                                       
 
  
 
                                                                                       
 
  
 
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied 
with this agreement and intend to be bound by it. 
Dated: 
Signature of Husband 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
32 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
__________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
__________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
  
                                          
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
   
 
   
 
 
  
 
 
 
 
  
 
   
     
 
       
 
       
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
 
 
 
 
 
                                                                                       
 
  
 
                                                                                       
  
 
                                                                                       
 
 
  
 
                                                                                       
 
  
 
                                                                                       
 
  
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} , _______________________, 
{state} 
, {phone} 
, helped {name} 
, 
who is the [ / one only] 
petitioner or 
respondent, fill out this form. 
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied 
with this agreement and intend to be bound by it. 
Dated: 
Signature of Wife 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
33 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                       
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
____________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
  
                                              
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
                                                              
   
 
 
  
 
 
 
   
  
 
 
 
 
 
 
 
 
      
 
 
      
 
 
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} 
, 
{state} 
, {phone} 
, helped { name} 
, 
who 
is 
the 
[ 
/ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.902(f)(1), Marital Settlement Agreement for Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
34 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.903(a), ANSWER, WAIVER, AND REQUEST FOR COPY OF
FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE (03/09) 
When should this form be used? 
This form should be used when you have been served with a petition for dissolution of marriage 
and you do not wish to contest it or appear at a hearing. If you file this form, you are admitting all 
of the allegations in the petition, saying that you do not need to be notified of or appear at the final 
hearing, and that you would like a copy of the final judgment mailed to you. 
This form should be typed or printed in black ink, and your signature should be witnessed by a 
notary public or deputy clerk. After completing this form, you should sign the form before a notary 
public. 
You should file the original with the clerk of the circuit court in the county where the 
petition was filed and keep a copy for your records. 
What should I do next? 
You have 20 days to answer after being served with the other party=s petition. A copy of this form, 
along with all of the other forms required with this answer and waiver, must be mailed or hand 
delivered to the other party in your case. 
Where can I look for more information? 
Before proceeding, you should read AGeneral 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. 
Special notes... 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), if the case involves a dependent or 
minor child(ren). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e), if the case involves a dependent or minor child(ren). (If you do not know the 
other party’s income, you may file this worksheet after his or her financial affidavit has been 
served on you). 
• 	
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), or Marital 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for 
Copy of Final Judgment of Dissolution of Marriage (03‐09)
35 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Settlement Agreement for Dissolution of Marriage with No Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you have 
reached an agreement on any or all of the issues. 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed within 45 days of service of the petition on you, if not filed at the time 
you file this answer.) 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, 
if not filed at the time you file this answer, unless you and the other party have agreed not 
to exchange these documents.) 
Parenting and Time‐Sharing… By filing this answer and waiver, you are agreeing to any parenting and 
time‐sharing requests in the petition. The judge may request a parenting plan recommendation or 
appoint a guardian ad litem in your case. This means that a neutral person will review your situation 
and report to the judge concerning parenting issues. The purpose of such intervention is to be sure that 
the best interests of the child(ren) is (are) being served. For more information, you may consult section 
61.13, Florida Statutes. 
A parenting course must be completed prior to entry of a final judgment. You should contact the clerk, 
family law intake staff, or judicial assistant about requirements for parenting courses where you live. 
Listed below are some terms with which you should become familiar before completing your answer to 
the petition. If you do not fully understand any of the terms below or their implications, you should 
speak with an attorney before going any further. 
• 	
Shared Parental Responsibility 
• 	
Sole Parental Responsibility 
• 	
Supervised Time‐Sharing 
• 	
No contact 
• 	
Parenting Plan 
• 	
Parenting Plan Recommendation 
• 	
Time‐Sharing Schedule 
Child Support... By filing this answer and waiver, you are agreeing to any child support requests in the 
petition. The court may order one parent to pay child support to assist the other parent in meeting the 
child(ren)’s material needs. Both parents are required to provide financial support, but one parent 
may be ordered to pay a portion of his or her support for the child(ren) to the other parent. Florida has 
adopted guidelines for determining the amount of child support to be paid. These guidelines are based 
on the combined income of both parents and take into account the financial contributions of both 
parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you 
should be able to calculate the amount of child support that should be paid using the Child Support 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for 
Copy of Final Judgment of Dissolution of Marriage (03‐09)
36 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
     
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
      
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
      
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
Because the child 
support guidelines take several factors into consideration, change over time, and vary from state to 
state, your child support obligation may be more or less than that of other people in seemingly similar 
situations. 
Alimony... By filing this answer and waiver, you are agreeing to any alimony requests in the petition. 
Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the other spouse 
has the ability to pay it. If you want alimony, you must request it in writing in a counterpetition and 
should not use this form. If you do not request alimony in writing before the final hearing, it is waived 
(you may not request it later). You may request either permanent alimony, lump sum alimony, or 
rehabilitative alimony. 
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital 
assets and marital liabilities. “Equitable” does not necessarily mean “equal.” Many factors, including 
child support, 
time‐sharing and alimony awards, may lead the court to make an unequal (but still 
equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those 
assets and liabilities which the parties agree or the court determines belong to, or are the responsibility 
of, only one of the parties. By filing this answer and waiver, you are agreeing to any requests in the 
petition regarding division of assets and liabilities. 
Final Judgment... You should receive a copy of the Final Judgment in the mail. If, for some reason you 
do not, you should call the clerk=s office to request a copy. It is important for you to review a copy of the 
Final Judgment in your case to see what happened and to know what you must do and what you are 
entitled to receive. 
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 a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last 
page 
of 
every 
form 
he 
or 
she 
helps 
you 
complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for Copy of Final 
Judgment of Dissolution of Marriage (03/09) 
37 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
        
        
 
 
        
 
 
 
 
 
 
 
 
  
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ANSWER, WAIVER, AND REQUEST FOR COPY OF FINAL JUDGMENT OF 
DISSOLUTION OF MARRIAGE 
I, {full legal name} 
, Respondent, being sworn, certify that 
the following information is true: 
1. 	
Respondent answers the Petition for Dissolution of Marriage filed in this action and admits all 
the allegations. By admitting all of the allegations in the petition, respondent agrees to all relief 
requested in the petition including any requests regarding parenting and time‐sharing, child 
support, alimony, distribution of marital assets and liabilities, and temporary relief. 
2. 	
Respondent waives notice of hearing as well as all future notices in connection with the Petition 
for Dissolution of Marriage, as filed. Respondent also waives appearance at the final hearing. 
3. 	
Respondent requests that a copy of the Final Judgment of Dissolution of Marriage entered in 
this case be forwarded to Respondent at the address below. 
4. 	
If this case involves minor child(ren), a completed Uniform Child Custody Jurisdiction and 
Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 
12.902(d), is filed with this answer. 
5. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this answer. 
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 
is filed with this answer. 
I certify that a copy of this document was [ / one only] ( 
) mailed ( 
) faxed and mailed ( 
) 
hand delivered to the person(s) listed below on {date} 
. 
Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for Copy of Final Judgment of 
Dissolution of Marriage (03/09) 
38 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
                 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
          
                                      
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
Other party or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this 
answer and waiver and that the punishment for knowingly making a false statement includes fines 
and/or imprisonment. 
Dated: 
Signature of Respondent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF ________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced 
_____________________________________________ 
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 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.903(a), Answer, Waiver, and Request for Copy of Final Judgment of 
Dissolution of Marriage (03/09) 
39 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.903(b),
ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE (03/09) 
When should this form be used? 
This form should be used when you are responding to a petition for dissolution of marriage and you 
wish to admit or deny all of the allegations in the petition but you do not plan to file a 
counterpetition seeking relief. 
You can use this form to answer any petition for dissolution of 
marriage, whether or not there are minor child(ren). 
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 was filed and keep a copy for your records. This must be 
done within 20 days of receiving the petition. 
What should I do next? 
A copy of this form, along with all of the other forms required with this answer, must be mailed or 
hand delivered to the other party in your case. You have 20 days to answer after being served with 
the other party’s petition. After you file your answer, the case will generally proceed in one of the 
following two ways: 
UNCONTESTED... If you file an answer that agrees with everything in the other party’s petition and 
you have complied with mandatory disclosure and filed all of the required papers, either party may 
call the clerk, family law intake staff, or judicial assistant to set a final hearing. If you request the 
final hearing, you must notify the other party 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 you file an answer which disagrees with or denies anything in the petition, and you 
are unable to settle the disputed issues, either party may file a Notice for Trial, Florida Supreme 
Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure and 
filed all of the required papers. 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). 
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 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for 
Dissolution of Marriage (03/09) 
40 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
defined there. See chapter 61, Florida Statutes, for more information. 
Special notes... 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), if the case involves a dependent or 
minor child(ren). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if 
the case involves a dependent or minor child(ren). (If you do not know the other party’s income, 
you may file this worksheet after his or her financial affidavit has been served on you). 
• 	
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), or Marital 
Settlement Agreement for Dissolution of Marriage with Property but No Dependent or 
Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), if you 
have reached an agreement on any or all of the issues. 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed within 45 days of service of the petition on you, if not filed at the time 
you file this answer.) 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932. (This must be filed within 45 days of service of the petition on you, 
if not filed at the time you file this answer, unless you and the other party have agreed not 
to exchange these documents.) 
Parenting and Time‐sharing... 
If you and your spouse are unable to agree on parenting 
arrangements and a time‐sharing schedule, a judge will decide for you as part of establishing a 
Parenting Plan. The judge will decide the parenting arrangements and time‐sharing schedule based 
on the child(ren)’s best interests. Regardless of whether there is an agreement, the court reserves 
jurisdiction to modify issues relating to the minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your 
case. This means that a neutral person will review your situation and report to the judge concerning 
parenting issues. 
The purpose of such intervention is to be sure that the best interests of the 
child(ren) is (are) being served. 
For more information, you may consult section 61.13, Florida 
Statutes. 
A parenting course must be completed prior to the entry of a final judgment. You should contact 
the clerk, family law intake staff, or judicial assistant about requirements for parenting courses 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for 
Dissolution of Marriage (03/09) 
41 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
where you live. 
Listed below are some terms with which you should become familiar before completing your answer 
to the petition. If you do not fully understand any of the terms below or their implications, you 
should speak with an attorney before going any further. 
• 
Shared Parental Responsibility 
• 
Sole Parental Responsibility 
• 
Supervised Time‐Sharing 
• 
No contact 
• 
Parenting Plan 
• 
Parenting Plan Recommendation 
• 
Time‐Sharing Schedule 
Child Support... The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)=s material needs. Both parents are required to provide financial support, 
but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other 
parent. Florida has adopted guidelines for determining the amount of child support to be paid. 
These guidelines are based on the combined income of both parents and take into account the 
financial contributions of both parents and the number of overnights the child(ren) spend with each 
parent. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, you 
should be able to calculate the amount of child support that should be paid using the Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because the child 
support guidelines take several factors into consideration, change over time, and vary from state to 
state, your child support obligation may be more or less than that of other people in seemingly 
similar situations. 
Alimony... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that 
the other spouse has the ability to pay it. If you want alimony, you must request it in writing in a 
counterpetition. Florida Supreme Court Approved Family Law Form 12.903(c)(1) (with dependent or 
minor child(ren)), or Florida Supreme Court Approved Family Law Form 12.903(c)(2) (no dependent 
or minor child(ren)). If you do not request alimony in writing before the final hearing, it is waived 
(you may not request it later). 
Marital/Nonmarital Assets and Liabilities... 
Florida law requires an equitable distribution of 
marital assets and marital liabilities. “Equitable” does not necessarily mean “equal.” Many factors, 
including child support, any parenting plan and time‐sharing schedule, and alimony awards, may 
lead the court to make an unequal (but still equitable) distribution of assets and liabilities. 
Nonmarital assets and nonmarital liabilities are those assets and liabilities which the parties agree 
or the court determines belong to, or are the responsibility of, only one of the parties. If the parties 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for 
Dissolution of Marriage (03/09) 
42 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
agree or the court finds an asset or liability to be nonmarital, the judge will not consider it when 
distributing marital assets and liabilities. 
Temporary Relief... If you need temporary relief regarding temporary use of assets, temporary 
responsibility for liabilities, parental responsibility and time‐sharing with child(ren), temporary child 
support, or temporary alimony, you may file a Motion for Temporary Support and Time‐Sharing 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a), 
or, if there are no dependent or minor child(ren), Motion for Temporary Support with No 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(c). For 
more information, see the instructions for these forms. 
Marital Settlement Agreement... If you and your spouse are able to reach an agreement on any or 
all of the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), or 
Marital Settlement Agreement for Dissolution of Marriage with No Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). Both parties must sign 
this agreement before a notary public or deputy clerk. Any issues on which you are unable to agree 
will be considered contested and settled by the judge at the final hearing. 
Final Judgment Form... These family law forms contain a Final Judgment of Dissolution of Marriage 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 
12.990(c)(1), and Final Judgment of Dissolution of Marriage with Property but No Dependent or 
Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(2), which the judge 
may use if your case is contested. If you and your spouse reach an agreement on all of the issues, 
the judge may use Final Judgment of Dissolution of Marriage with Dependent or Minor Child(ren) 
(Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1), Final Judgment of 
Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (Uncontested), 
Florida Supreme Court Approved Family Law Form 12.990(b)(2), or Final Judgment of Dissolution of 
Marriage with No Property and No Dependent or Minor Child(ren), Florida Supreme Court 
Approved Family Law Form 12.990(b)(3). You should check with the clerk, family law intake staff, or 
judicial assistant to see if you need to bring a final judgment with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, 
Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number on 
the bottom of the last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for 
Dissolution of Marriage (03/09) 
43 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
        
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
          
 
 
 
 
         
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ANSWER TO PETITION FOR DISSOLUTION OF MARRIAGE 
I, {full legal name} 
, Respondent, being 
sworn, certify that the following information is true: 
1. 	
I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the 
Petition and, therefore, admit those allegations: {indicate section and paragraph number} 
2. 	
I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in 
the Petition and, therefore, deny those allegations: {indicate section and paragraph number} 
3. 	
I currently am unable to admit or deny the allegations raised in the following paragraphs due to 
lack of information: {indicate section and paragraph number} _________________________ 
4. 	
If this case involves a dependent or minor child(ren), a completed Uniform Child Custody 
Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family 
Law Form 12.902(d), is filed with this answer. 
5. 	
If this case involves a dependent or minor child(ren), a completed Child Support Guidelines 
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is [ / one only] ( 
) filed 
with this answer or ( 
) will be filed after the other party serves his or her financial affidavit. 
6. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this answer. 
7. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), [ / one only] ( 
) is filed with this answer or ( 
) will be timely filed. 
Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for Dissolution of Marriage 
(03/09) 
44 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
        
        
 
 
        
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
                
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
   
                                       
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
                                                                     
                                              
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
I certify that a copy of this document was [ / one only] ( 
hand delivered to the person(s) listed below on {date} 
) mailed ( 
) faxed and mailed ( 
. 
) 
Petitioner or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this answer and that the punishment for knowingly making a false statement includes fines 
and/or imprisonment. 
Dated: 
Signature of Respondent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF __________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced 
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 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.903(b), Answer to Petition for Dissolution of Marriage 
(03/09) 
45 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
   
   
 
 
 
 
 
 
 
 
   
 
 
 
 
    
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
   
 
 
 
 
 
 
 
 
   
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.903(c)(1), ANSWER TO PETITION AND COUNTERPETITION FOR
DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR 
CHILD(REN)(03/09) 
When should this form be used? 
This form should be used when you are responding to a petition for dissolution of marriage with 
dependent or minor child(ren) and you are asking the court for something not contained in the petition. 
The answer portion of this form is used to admit or deny the allegations contained in the petition, and 
the counterpetition portion of this form is used to ask for whatever you want the court to do for you. 
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 was filed and keep a copy for your records. 
What should I do next? 
You have 20 days to answer after being served with the other party=s petition. A copy of this form must 
be mailed or hand delivered to the other party. After you file an answer and counterpetition your case 
will then generally proceed as follows: 
The other party is required to answer your counterpetition within 20 days using an Answer to 
Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d). 
UNCONTESTED... Your dissolution is uncontested if you and your spouse agree on all issues raised in the 
petition and the counterpetition. If this is the case, and you and the other party have complied with 
mandatory disclosure and filed all of the required papers, either party may call the clerk, family law 
intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the 
other party 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... Your dissolution is contested if you and your spouse disagree on any issues raised in the 
petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice 
for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with 
mandatory disclosure and filed all of the required papers. 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). 
Where can I look for more information? 
Before proceeding, you should read General Information for Self‐Represented Litigants found at the 
beginning of these forms. The words that are in bold underline in these instructions are defined there. 
For further information, see chapter 61, Florida Statutes. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
46 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
Special notes... 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d) 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party=s income, you may file this worksheet after his or her financial 
affidavit has been served on you.) 
• 	
Affidavit of Corroborating Witness, Florida Supreme Court Approved Family Law Form 12.902(i) 
OR photocopy of current Florida driver=s license, Florida identification card, or voter=s 
registration card (issue date of copied document must be at least six months before date case is 
actually filed with the clerk of the circuit court). 
• 	
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), if you have reached 
an agreement on any or all of the issues. 
• 	
Parenting 
Plan, 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form 
12.995(a) 
or 
Supervised/Safety Focused Parenting Plan, Form 12.995(b). If the parents have reached an 
agreement, a signed and notarized Parenting Plan should be attached. If the parents have not 
reached an agreement, a proposed Parenting Plan may be filed. 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed within 45 days of service of the petition on you, if not filed at the time you 
file this answer.) 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed at 
the time you file this answer, unless you and the other party have agreed not to exchange these 
documents.) 
Parenting Plan and Time‐Sharing. . . If you and your spouse are unable to agree on parenting 
arrangements and a time‐sharing schedule, a judge will decide for you as part of establishing a Parenting 
Plan. The judge will decide the parenting arrangements and time‐sharing schedule based on the 
child(ren)=s best interests. Regardless of whether there is an agreement, the court reserves jurisdiction 
to modify issues relating to the minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning parenting 
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is (are) 
being served. For more information, you may consult section 61.13, Florida Statutes. 
A parenting course must be completed prior to entry of the final judgment. You should contact the 
clerk, family law intake staff, or judicial assistant about requirements for parenting courses or mediation 
where you live. 
Listed below are some terms with which you should become familiar before completing your petition. If 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
47 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
you do not fully understand any of the terms below or their implications, you should speak with an 
attorney before going any further. 
• 
Shared Parental Responsibility 
• 
Sole Parental Responsibility 
• 
Supervised Time‐Sharing 
• 
No contact 
• 
Parenting Plan 
• 
Parenting Plan Recommendation 
• 
Time‐Sharing Schedule 
Child Support... The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)=s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents.. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure 
Form 12.902(b) or (c), and your spouse will be required to do the same. From your financial affidavits, 
you should be able to calculate the amount of child support that should be paid using the Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
Because the child 
support guidelines take several factors into consideration, change over time, and vary from state to 
state, your child support obligation may be more or less than that of other people in seemingly similar 
situations. 
Alimony... Alimony may be awarded to a spouse if the judge finds that he or she needs it and that the 
other spouse has the ability to pay it. If you want alimony, you must request it in writing in your 
counterpetition. If you do not request alimony in writing before the final hearing, it is waived (you 
may not request it later). 
You may request either permanent alimony, lump sum alimony, or 
rehabilitative alimony. 
Marital/Nonmarital Assets and Liabilities... Florida law requires an equitable distribution of marital 
assets and marital liabilities. AEquitable@ does not necessarily mean Aequal.@ Many factors, including 
child support, time‐sharing and alimony awards, may lead the court to make an unequal (but still 
equitable) distribution of assets and liabilities. Nonmarital assets and nonmarital liabilities are those 
assets and liabilities which the parties agree or the court determines belong to, or are the responsibility 
of, only one of the parties. If the parties agree or the court finds an asset or liability to be nonmarital, 
the judge will not consider it when distributing marital assets and liabilities. 
Parenting Plan. . . In all cases involving minor or dependent child(ren), a Parenting Plan shall be 
approved or established by the court. If you and your spouse have reached an agreement, you should 
file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a), or a 
Supervised/Safety Focused Parenting Plan, Florida Supreme Court Approved Family Law Form 
12.995(b) which addresses the time‐sharing schedule for the child(ren). If you have not reached an 
agreement, a proposed Parenting Plan may be filed. A Parenting Plan will be established by the court. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
48 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Temporary Relief... 
If you need temporary relief regarding temporary use of assets, temporary 
responsibility for liabilities, parental responsibility and time‐sharing with child(ren), temporary child 
support, or temporary alimony, you may file a Motion for Temporary Support and Time‐Sharing with 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more 
information, see the instructions for that form. 
Marital Settlement Agreement... If you and your spouse are able to reach an agreement on any or all of 
the issues, you should file a Marital Settlement Agreement for Dissolution of Marriage with Dependent 
or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both parties must 
sign this agreement before a notary public or deputy clerk. Any issues on which you are unable to 
agree will be considered contested and settled by the judge at the final hearing. 
Final Judgment Form... These family law forms contain a Final Judgment of Dissolution of Marriage 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.990(c)(1), 
which the judge may use if your case is contested. If you and your spouse reach an agreement on all of 
the issues, the judge may use a Final Judgment of Dissolution of Marriage with Dependent or Minor 
Child(ren) (Uncontested), Florida Supreme Court Approved Family Law Form 12.990(b)(1). You should 
check with the clerk, family law intake staff, or judicial assistant to see if you need to bring a final 
judgment with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
49 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                         
 
 
 
 
 
                                                                           
          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_______________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                   
   
 
 
 
 
 
 
 
                   
   
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner/Counter respondent, 
and 
, 
Respondent/Counter petitioner. 
ANSWER TO PETITION AND COUNTERPETITION 
FOR DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) 
I, {full legal name} 
, Respondent, being 
sworn, certify that the following information is true: 
ANSWER TO PETITION 
1. 	
I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the 
Petition and, therefore, admit those allegations: {indicate section and paragraph number} 
. 
2. 	
I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in 
the Petition and, therefore, deny those allegations: {indicate section and paragraph number} 
. 
3. 
I currently am unable to admit or deny the following paragraphs due to lack of information: 
{indicate section and paragraph number} _________________________________________ 
. 
COUNTERPETITION FOR DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) 
1. 	
JURISDICTION/RESIDENCE 
( 
) Husband ( 
) Wife ( 
) Both has (have) lived in Florida for at least 6 months before the filing 
of this Petition for Dissolution of Marriage. 
2. 	
Petitioner [√one only] ( 
) is ( 
) is not a member of the military service. 
Respondent [ √ one only] ( 
) is ( 
) is not a member of the military service. 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
50 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
  
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
      
 
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
       
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
   
 
 
 
       
 
         
                              
 
 
          
 
 
 
   
 
         
                              
 
 
          
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
3. 	
MARRIAGE HISTORY 
Date of marriage: {month, day, year} 
Place of marriage: {city, state, country} 
Date of separation: {month, day, year} 
(indicate if approximate) 
4. 
DEPENDENT OR MINOR CHILD(REN) 
[ √ all that apply] 
a. 	
___The wife is pregnant. Baby is due on: {date} 
b. 	
___The minor (under 18) child(ren) common to both parties are: 
Name 
Place of Birth 	
Birth date 
Sex 
c. 	
___The minor child(ren) born or conceived during the marriage who are not common to 
both parties are: 
Name 
Place of Birth 	
Birth date 
Sex 
The birth father(s) of the above minor child(ren) is (are) {name and address} 
d. ___ The child(ren) common to both parties who are 18 or older but who are dependent upon 
the parties due to a mental or physical disability are: 
Name 
Place of Birth 	
Birth date 
Sex 
5. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) AffidavitFlorida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition. You 
must complete and attach this form in a dissolution of marriage with minor child(ren). 
6. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this counterpetition. 
7. 
This counterpetition for dissolution of marriage should be granted because: 
[ one only] 
a. 	
___The marriage is irretrievably broken. 
b. 	
___One of the parties has been adjudged mentally incapacitated for a period of 3 years prior 
to the filing of this counterpetition. A copy of the Judgment of Incapacity is attached. 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
51 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
             
        
        
 
        
 
 
  
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION I. MARITAL ASSETS AND LIABILITIES 
[ one only] 
1. 	
___There are no marital assets or liabilities. 
2. 	
___There are marital assets or liabilities. All marital and nonmarital assets and liabilities are (or 
will be) listed in the financial affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c), to be filed in this case. 
[ all that apply] 
a. 	
___All marital assets and liabilities have been divided by a written agreement between the 
parties, which is attached to be incorporated into the final judgment of dissolution of 
marriage. (The parties may use Marital Settlement Agreement for Dissolution of Marriage 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 
12.902(f)(1). 
b. 	
___The Court should determine how the assets and liabilities of this marriage are to be 
distributed, under section 61.075, Florida Statutes. 
c. 
___Respondent should be awarded an interest in Petitioner=s property because: 
SECTION II. SPOUSAL SUPPORT (ALIMONY) 
[one only] 
1. 	
___Respondent forever gives up his/her right to spousal support (alimony) from 
Petitioner. 
2. 	
___Respondent requests that the Court order Petitioner to pay the following spousal 
support (alimony) and claims that he or she has a need for the support that he or she is 
requesting and Petitioner has the ability to pay that support. 
Spousal support 
(alimony) is requested in the amount of $ 
every ( 
) week ( 
) other week ( 
) 
month, beginning {date} 
and 
continuing 
until 
{date 
or 
event} 
__________________. 
Explain why the Court should order Petitioner to pay and any specific request(s) for type of 
alimony (temporary, permanent, rehabilitative, and/or lump sum): 
[ if applies] ( 
) Respondent requests life insurance on Petitioner=s life, provided by Petitioner, 
to secure such support. 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
52 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
   
 
 
 
 
 
 
 
 
 
 
               
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
       
       
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
     
        
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
 
 
 
     
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME‐SHARING 
1. 	
The minor child(ren) currently reside(s) with ( 
) Mother ( 
) Father ( 
) Other: {explain} 
2. 
Parental Responsibility. It is in the child(ren)=s best interests that parental responsibility be: 
[one only] 
a. 	
___shared by both Father and Mother. 
b. 	
___awarded solely to ( 
) Father ( 
) Mother. 
Shared parental responsibility would be 
detrimental to the child(ren) because: ____________________________________________ 
3. 	
Parenting Plan and Time‐Sharing. It is in the best interests of the child(ren) that the family be 
ordered to comply with a Parenting Plan that ( 
) includes ( 
) does not include parental time­
sharing with the child(ren). 
The Respondent states that it is in the best interests of the 
child(ren) that: 
(Choose only one) 
a. 	
___The attached proposed Parenting Plan should be adopted by the court. The parties 
( ) have ( ) have not agreed to the Parenting Plan. 
b. 	
___The court should establish a Parenting Plan with the following provisions: 
� 	
No time‐sharing for the ___ Husband ___ Wife. 
� 	
Limited time‐sharing with the ___ Husband ___ Wife. 
� 	
Supervised time‐sharing for the ___ Husband ___ Wife. 
� 	
Supervised or third‐party exchange of the child(ren). 
� 	
Time‐sharing as follows: ___________________________________________________ 
Explain why this request is in the best interests of the child(ren): 
SECTION IV. CHILD SUPPORT [ √ all that apply] 
1. 	
Respondent requests that the Court award child support as determined by Florida=s child 
support guidelines, section 61.30, Florida Statutes. 
A completed Child Support Guidelines 
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. Such 
support should be ordered retroactive to: 
a. 
___ the date of separation {date} 
. 
b. 
___the date of the filing of this petition. 
c. 
___other {date} 
{explain} _________________________________________ 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
53 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
________________________________________________________________________ 
 
                                                     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
  
 
 
 
   
 
 
 
 
         
        
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
2. 	
___Respondent requests that the Court award child support to be paid beyond the age of 18 
years because: 
a. 	
___the following child(ren) {name(s)} ____________________________________________ 
is (are) dependent because of a mental or physical incapacity which began before the age of 
18. {explain} ________________________________________________________________ 
b. 	
the following child(ren) {name(s)} 
is (are) dependent in 
fact and is (are) in high school while he/she (they) are between the ages of 18 and 19; said 
child(ren) is (are) performing in good faith with reasonable expectation of graduation before 
the age of 19. 
3. 	
___Respondent requests that the Court award a child support amount that is more than or less 
than Florida=s child support guidelines. Respondent understands that Motion to Deviate from 
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be 
filed before the court will consider this request. 
4. 	
Respondent requests that medical/dental insurance coverage for the minor child(ren) be 
provided by: 
[ √ one only] 
a. 	
___Father. 
b. 	
___Mother. 
5. 	
___Respondent requests that uninsured medical/dental expenses for the child(ren) be paid: 
[ √ one only] 
a. 	
___by Father. 
b. 	
___ by Mother. 
c. 	
___ by Father and Mother each paying one‐half. 
d. 	
___ according to the percentages in the Child Support Guidelines Worksheet, Florida Family 
Law Rules of Procedure Form 12.902(e). 
e. 	
___ Other {explain}: __________________________________________________________ 
6. 	
___ Respondent requests that life insurance to secure child support be provided by: 
a. 	
___Father. 
b. 	
___ Mother. 
c. 	
___ Both. 
SECTION V. OTHER 
1. 	
[If Respondent is also the Wife, √ one only] ( 
) yes ( 
) no 
Respondent/Wife wants to be 
known by her former name, which was {full legal name} . 
2. 	
Other relief {specify}: ____________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
54 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
   
 
 
 
 
  
 
 
 
 
 
   
   
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
   
   
 
 
 
 
  
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
        
        
 
 
        
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
SECTION VI. RESPONDENT=S/COUNTERPETITIONER=S REQUEST (This section summarizes what you are 
asking the Court to include in the final judgment of dissolution of marriage.) 
Respondent requests that the Court enter an order dissolving the marriage and: 
[ √ all that apply] 
1. 	
___ distributing marital assets and liabilities as requested in Section I of this petition; 
2. 	
___ awarding spousal support (alimony) as requested in Section II of this petition; 
3. 	
___ adopt or establish a Parenting Plan containing provisions for parental responsibility 
and time‐sharing for the dependent or minor child(ren) common to both parties, as 
requested in Section III of this petition; 
4. 	
___ establishing child support for the dependent or minor child(ren) common to both 
parties, as requested in Section IV of this petition; 
5. 	
___ restoring Wife=s former name as requested in Section V of this petition; 
6. 	
___ awarding other relief as requested in Section V of this petition; and any other terms 
the Court deems necessary. 
I certify that a copy of this document was [ √ one only] ( 
) mailed ( 
) faxed and mailed ( 
) 
hand delivered to the person(s) listed below on {date} 
. 
Petitioner or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this answer and counterpetition and that the punishment for knowingly making a false 
statement includes fines and/or imprisonment. 
Dated: 	
_____________________________________________ 
Signature of Respondent/Counterpetitioner 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
55 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
        
 
 
 
 
 
  
                                     
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} 
, 
{state} 
, {phone} 
, helped {name} 
, 
who 
is 
the 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.903(c)(1), Answer to Petition and Counterpetition for 
Dissolution of Marriage with Dependent or Minor Child(ren)(03/09)
56 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
   
  
 
 
 
 
   
 
   
 
 
 
 
 
 
    
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.903(e),
ANSWER TO SUPPLEMENTAL PETITION (03/09) 
When should this form be used? 
This form should be used when you are responding to a supplemental petition for modification of 
Parenting Plan, time‐sharing schedule, child support, or alimony. This form is used to admit or deny 
all of the allegations in the supplemental petition if you do not plan to file a counterpetition. There 
is no form for a counterpetition to a supplemental petition in these Family Law Forms. If you want 
to file a counterpetition to a supplemental petition you will need to either seek legal assistance or 
create a form yourself. 
You may construct an answer and counterpetition using the pertinent 
sections contained in the Answer to Petition and Counterpetition for Dissolution of Marriage with 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.903(c)(1), or 
Answer to Petition and Counterpetition for Dissolution of Marriage with Property but No 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.903(c)(2). 
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 case was filed and keep a copy for your records. This must be done 
within 20 days of receiving the supplemental petition. 
What should I do next? 
A copy of this form, along with all of the other forms required with this answer, must be mailed or 
hand delivered to the other party in your case. Regardless of whether you file a counterpetition, 
you have 20 days to answer after being served with the other party’s supplemental petition. After 
you file your answer, the case will generally proceed in one of the following two ways: 
UNCONTESTED... If you file an answer that agrees with everything in the other party’s supplemental 
petition and you have complied with mandatory disclosure and filed all of the required papers, 
either party may call the clerk, family law intake staff, or judicial assistant to set a final hearing. If 
you request the hearing, you must notify the other party 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 you file an answer which disagrees with or denies anything in the supplemental 
petition, and you are unable to settle the disputed issues, either party may file a Notice for Trial, 
Florida Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory 
disclosure and filed all of the required papers. 
Some circuits may require the completion of 
mediation before a final hearing may be set. If you request the hearing, you should contact the 
clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition 
(03/09) 
57 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
  
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
   
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
(final hearing). 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at 
the beginning of these forms. The words that are in “bold underline” in these instructions are 
defined there. See chapter 61, Florida Statutes, for more information. 
Special notes... 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), if the case involves child(ren). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e), if child support is an issue. (If you do not know the other party=s income, you 
may file this worksheet after his or her financial affidavit has been served on you.) 
• 	
Settlement Agreement, if you have reached an agreement on any or all of the issues. 
Although there is no form for this in these Florida Family Law Forms, you may construct a 
settlement agreement using the pertinent sections contained in Marital Settlement 
Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida 
Supreme Court Approved Family Law Form 12.902(f)(1), or Marital Settlement Agreement 
for Dissolution of Marriage with [Property but] No Dependent or Minor Child(ren), Florida 
Supreme Court Approved Family Law Form 12.902(f)(2). 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), if not previously filed. 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed within 45 days of service of the supplemental petition on you, if not filed 
at the time you file your answer.) 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932. (This must be filed within 45 days of service of the supplemental 
petition on you, if not filed at the time of you file your answer, unless you and the other 
party have agreed not to exchange these documents.) 
Parenting and Time‐Sharing... If you and your spouse are unable to agree about a Parenting Plan a 
judge will decide for you as part of establishing a parenting plan. 
The judge will decide the 
parenting and time‐sharing arrangements based on the child(ren)’s best interests. Regardless of 
whether there is an agreement, the court reserves jurisdiction to modify issues relating to the minor 
child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning 
parenting issues. 
The purpose of such intervention is to be sure that the best interests of the 
child(ren) is (are) being served. For more information, you may consult section 61.13, Florida Statutes. 
A parenting course must be completed prior to entry of a final judgment. You should contact the 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition 
(03/09) 
58 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
clerk, family law intake staff, or judicial assistant about requirements for parenting courses or 
mediation where you live. 
Listed below are some terms with which you should become familiar before completing your 
supplemental petition. If you do not fully understand any of the terms below or their implications, 
you should speak with an attorney before going any further. 
Shared Parental Responsibility 
Sole Parental Responsibility 
Supervised Time‐Sharing 
No contact 
Parenting Plan 
Parenting Plan Recommendation 
Time‐Sharing Schedule 
Child Support... If this case involves child support issues, the court may order one parent to pay 
child support to assist the other parent in meeting the child(ren)’s material needs. Both parents are 
required to provide financial support, but one parent may be ordered to pay a portion of his or her 
support for the child(ren) to the other parent. Florida has adopted guidelines for determining the 
amount of child support to be paid. These guidelines are based on the combined income of both 
parents and take into account the financial contributions of both parents. You must file a Family 
Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and the other 
parent will be required to do the same. 
From your financial affidavits, you should be able to 
calculate the amount of child support that should be paid using the Child Support Guidelines 
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
Because the child support 
guidelines take several factors into consideration, change over time, and vary from state to state, 
your child support obligation may be more or less than that of other people in seemingly similar 
situations. 
Temporary Relief... If you need temporary relief regarding parental responsibility and time‐sharing 
with child(ren), child support or alimony, you may file a Motion for Temporary Support with 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a) or, if 
you need temporary relief regarding alimony and there are no dependent or minor child(ren), you 
may file a Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme 
Court Approved Family Law Form 12.947(c). For more information, see the instructions for these 
forms. 
Settlement Agreement... If you and the other party are able to reach an agreement on any or all of 
the issues, you should file a Settlement Agreement. Although there is no form for this in these 
Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections 
contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1), or Marital Settlement 
Agreement for Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition 
(03/09) 
59 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Court Approved Family Law Form 12.902(f)(2). 
Both parties must sign this agreement before a 
notary public or deputy clerk. Any issues on which you are unable to agree will be considered 
contested and settled by the judge at the final hearing. 
Final Judgment Form... These family law forms contain a Supplemental Final Judgment Modifying 
Parental Responsibility, Visitation, or Parenting Plan/Time‐Sharing, Florida Supreme Court 
Approved Family Law Form 12.993(a), a Supplemental Final Judgment Modifying Child Support, 
Florida Supreme Court Approved Family Law Form 12.993(b), and a Supplemental Final Judgment 
Modifying Alimony, Florida Supreme Court Approved Family Law Form 12.993(c), which the judge 
may use, as appropriate. You should check with the clerk, family law intake staff, or judicial assistant 
to see if you need to bring a final judgment with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, 
Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number on 
the bottom of the last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition 
(03/09) 
60 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
   
 
 
 
     
 
        
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
        
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ANSWER TO SUPPLEMENTAL PETITION 
I, {full legal name} 
, 
being 
sworn, 
certify that the following information is true: 
1. 	
I agree with Petitioner as to the allegations raised in the following numbered paragraphs in 
the Supplemental Petition and, therefore, admit those allegations: {indicate section and 
paragraph number} 
2. 	
I disagree with Petitioner as to the allegations raised in the following numbered paragraphs 
in the Supplemental Petition and, therefore, deny those allegations: {indicate section and 
paragraph number} 
3. 	
I currently am unable to admit or deny the following paragraphs due to lack of information: 
{indicate section and paragraph number} 
4. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
5. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this answer, if one has not been previously filed in this case. 
[ / if applies] 
6. 	
This case involves minor child(ren), and a completed Uniform Child Custody Jurisdiction 
and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 
12.902(d), is filed with this answer. 
7. 	
This case involves child support, and a completed Child Support Guidelines Worksheet, 
Florida Family Law Rules of Procedure Form 12.902(e), is filed or will be filed with the court. 
Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition (03/09)
61 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
        
        
 
 
 
      
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
                                            
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
( 
I certify that a copy of this document was [ / one only] ( 
) hand delivered to the person(s) listed below on {date} 
) mailed ( 
) faxed and mailed 
. 
Petitioner or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this answer and that the punishment for knowingly making a false statement includes 
fines and/or imprisonment. 
Dated: 
Signature of Respondent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF ________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary 
or clerk.] 
Personally known 
Produced identification 
Type of identification produced ____________________________________________ 
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 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.903(e), Answer to Supplemental Petition (03/09)
62 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.904(a),
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION OF 
MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) (03/09) 
When should this form be used? 
This form may be used to ask the court to enter a support order if you and your spouse are 
separated, and your spouse has the ability to contribute to you and your minor child(ren), but 
has failed to do so. You can only use this form if a dissolution of marriage has not been filed 
and based upon the time‐sharing schedule, you are entitled to support. If a petition for 
dissolution of marriage has been filed, you should file a Motion for Temporary Support and 
Time‐Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law 
Form 12.947(a), instead of using this petition. 
Also, if you are requesting that an order be 
entered for you to pay support to your spouse, you should not file this form. 
This petition cannot address the issues of property, debts, or parental responsibility and time­
sharing with child(ren). It only deals with alimony and child support. 
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. 
What should I do next? 
For your case to proceed, you must properly notify the other party in your case 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, you may use constructive service. You may also be able to use 
constructive service if the other party resides in another state or country. 
However, if 
constructive service is used, other than granting a divorce, the court may only grant limited 
relief. For more information on constructive service, see Notice of Action for Dissolution of 
Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent 
Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). If you need to use 
constructive service, use the Notice of Action for Dissolution of Marriage, Florida Supreme 
Court Approved Family Law Form 12.913(a), after striking through “for Dissolution of Marriage” 
and inserting “for Support Unconnected with Dissolution of Marriage with Dependent or Minor 
Child(ren).” 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 service is very complex and you 
may wish to consult an attorney regarding these issues. 
If personal service is used, the other party has 20 days to answer after being served with your 
petition. Your case will then generally proceed in one of the following three 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. Then, if you have 
filed all of the required papers, you may call the clerk, family law intake staff, or judicial 
assistant to set a final hearing. You must notify the other party 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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected 
with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
63 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UNCONTESTED. 
If the respondent files an answer that agrees with everything in your petition 
or an answer and waiver, and you have complied with mandatory disclosure and filed all of the 
required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final 
hearing. You must notify the other party 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 the respondent files an answer or an answer and counterpetition, which 
disagrees with or denies anything in your petition, and you are unable to settle the disputed 
issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 
12.924, after you have complied with mandatory disclosure and filed all of the required papers. 
Some circuits may require the completion of mediation before a final hearing may be set. Then 
you should contact the clerk, family law intake staff, or judicial assistant for instructions on how 
to set your case for trial (final hearing). If the respondent files an answer and counterpetition, 
you should answer the counterpetition within 20 days using an Answer to Counterpetition, 
Florida Supreme Court Approved Family Law Form 12.903(d). 
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 section 61.09, 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 from the clerk, fill it out, and the clerk will determine 
whether you are eligible to have filing fees deferred. 
With this form you must also file the following: 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d), if the case involves minor or dependent child(ren). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of service of the petition on the respondent, if 
not filed at the time of the petition, unless you and the other party have agreed not to exchange 
these documents.) 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if 
you are asking that child support be ordered in the final judgment. (If you do not know the 
other party’s income, you may file this worksheet after his or her financial affidavit has been 
served on you.) 
Child Support. The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. 
Both parents are required to provide financial 
support, but one parent may be ordered to pay a portion of his or her support for the child(ren) 
to the other parent. Florida has adopted guidelines for determining the amount of child support 
to be paid. These guidelines are based on the combined income of both parents and take into 
account the financial contributions of both parents and the number of overnights the child(ren) 
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected 
with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
64 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
spend with each parent. You must file a Family Law Financial Affidavit, Florida Family Law Rules 
of Procedure Form 12.902(b) or (c), and your spouse will be required to do the same. From your 
financial affidavits, you should be able to calculate the amount of child support that should be 
paid using the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e). Because the child support guidelines take several factors into consideration, change 
over time, and vary from state to state, your child support obligation may be more or less than 
that of other people in seemingly similar situations. 
Temporary Relief. If you need temporary relief regarding child support or temporary alimony, 
you may file a Motion for Temporary Support and Time‐Sharing with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.947(a). For more information, 
see the instructions for that form. 
Final Judgment Form. 
These family law forms contain a Final Judgment of Support 
Unconnected with Dissolution of Marriage with Dependent or Minor Child(ren), Florida 
Supreme Court Approved Family Law Form 12.994(a), which the judge may use if your case is 
contested. You should check with the clerk, family law intake staff, or judicial assistant to see if 
you need to bring a final judgment with you to the hearing. 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. 
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 a Disclosure from 
Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. 
A nonlawyer helping you fill out these forms also must put his or her name, address, and 
telephone number on the bottom of the last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected 
with Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
65 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
   
 
 
 
 
 
 
 
                   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
  
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
___________________________ 
_______________ 
___________ 
___________ 
___________________________ 
_______________ 
___________ 
___________ 
___________________________ 
_______________ 
___________ 
____________ 
___________________________ 
_______________ 
___________ 
_____________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
   
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
PETITION FOR SUPPORT UNCONNECTED WITH DISSOLUTION 
OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) 
I, {full legal name} 
, the 
[one only] ( 
) Husband ( 
) Wife, being sworn, certify that the following statements are true: 
1. 	
JURISDICTION 
( 
) Husband ( 
) Wife ( 
) Both live in Florida at the filing of this Petition for Support 
Unconnected with Dissolution of Marriage, which is filed pursuant to section 61.09, Florida 
Statutes. 
2. 	
Petitioner [one only] 
( 
) is ( 
) is not a member of the military service. 
Respondent [one only] ( 
) is ( 
) is not a member of the military service. 
3. 	
MARRIAGE HISTORY 
a. 
Date of marriage: {month, day, year} 
b. 
Place of marriage: {city, state, country} 
c. 
Date of separation: {month, day, year} ___________________ (___√ if approximate) 
4. 	
MINOR CHILD(REN) 
[ all that apply] 
a. 	
___The wife is pregnant. The baby is due on: {date} 
. 
b. 	
___The minor (under 18) child(ren) common to both parties are: 
Name 	
Place of Birth 
Birth date 
Sex 
c. 
The minor child(ren) born or conceived during the marriage who are not common to 
both parties 
are: 
Name 	
Place of Birth 
Birth date 
Sex 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
66 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                               
                                    
                                                     
 
 
 
 
       
 
                                                               
                                    
                                                     
 
 
 
 
       
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
_____________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
____________________ 
 
____________   
_________ 
_______ 
 
____________________ 
 
____________   
_________ 
_______ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
  
 
 
   
   
 
 
 
  
        
  
      
 
        
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
The birth father(s) of the above minor child(ren) is (are) {name and address} 
d. 
____The child(ren) common to both parties who are 18 or older but who are dependent 
upon the parties due to a mental or physical incapacity are: 
Name 	
Place of Birth 
Birth date 
Sex 
5. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this petition. 
6. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
7. 	
A completed Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e), is, or will be, filed. 
8. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
SECTION I. SPOUSAL SUPPORT (ALIMONY) 
[one only] 
1. 	
___Petitioner does not request spousal support (alimony) from Respondent at this time. 
2. 	
___ Respondent has the ability to contribute to the maintenance of Petitioner and has failed to 
do so. Petitioner requests that the Court order Respondent to pay the following spousal support 
(alimony) and claims that he or she has a need for the support that he or she is requesting. 
Spousal support (alimony) is requested in the amount of $______________ every ( 
) week 
( 
) other week ( 
) month, beginning {date} ________________________, and continuing until 
{date or event} _________________________________________________________________ 
Explain why the Court should order Respondent to pay and any specific request(s) for type of 
alimony (temporary, permanent, rehabilitative, and/or lump sum): 
[  √ if applies] ( 
) 
Petitioner requests life insurance on Respondent’s life, provided by 
Respondent, to secure such support. 
SECTION II. CHILD SUPPORT 
Respondent has the ability to contribute to the maintenance of his or her minor child(ren) and 
has failed to do so. Based upon the time‐schedule, the Petition is entitled to child support. 
[ all that apply] 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
67 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
________________________            __________________________________________ 
_______________________________________________            ___________________ 
 
 
 
 
 
  
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
   
 
 
 
 
 
  
  
 
 
 
 
 
 
 
        
 
 
 
_______________________________________________________________________   
__________________________________________________________________ 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
1. 	
___Petitioner requests that the Court award child support as determined by Florida’s child 
support guidelines, section 61.30, Florida Statutes. 
2. 	
___Petitioner requests that the Court award child support to be paid beyond the age of 18 years 
because: 
a. 	
____the following child(ren), {name(s)} 
, 
is (are) dependent because of a mental or physical incapacity which began prior to the 
age of 18 {explain}: 
b. 	
____the following child(ren), {name(s)} 
, 
is (are) dependent in fact and is (are) in high school while he/she (they) are between the 
ages of 18 and 19; said child(ren) is (are) performing in good faith with reasonable 
expectation of graduation before the age of 19. 
3. 	
___Petitioner requests that medical/dental insurance coverage for the minor child(ren) be 
provided by: [ √one only] 
a. 	
___ Father. 
b. 	
___ Mother. 
4. 	
___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: 
[ one only] 
a. 	
___ by father. 
b. 	
___ by mother. 
c. 	
___ by Father and Mother each paying one‐half. 
d. 	
_according to the percentages in the Child Support Guidelines Worksheet, Florida 
Family Law Rules of Procedure Form 12.902(e). 
e. 
Other {explain}: ___________________________________________________ 
5. 
Petitioner requests that life insurance to secure child support be provided by: 
a. 	
___Father. 
b. 	
___Mother. 
c. 	
___Both. 
SECTION III. OTHER RELIEF 
SECTION IV. PETITIONER’S REQUEST (This section summarizes what you are asking the Court to 
include in the order for support.) 
Petitioner requests that the Court enter an order establishing support and: 
[all that apply] 
a. 	
___awarding spousal support (alimony) as requested in Section I of this petition; 
b. 	
___establishing child support for the minor child(ren) common to both parties, as 
requested in Section II of this petition; 
c. 	
___ awarding other relief as requested in Section III of this petition; and any other terms 
the Court deems necessary. 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
68 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
                                                          
 
 
 
 
 
  
 
 
                                         
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
  
                                                 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
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: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF 
Sworn to or affirmed and signed before me on 
by 
. 
_____________________________________________ 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
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] 
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. 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (03/09) 
69 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
     
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.905(a),
SUPPLEMENTAL PETITION TO MODIFY PARENTING PLAN/ TIME–
SHARING SCHEDULE AND OTHER RELIEF (03/09) 
When should this form be used? 
This form should be used when you are asking the court to change the current Parenting Plan/time­
sharing schedule. The court can change the Parenting Plan/time‐sharing schedule if the judge finds 
that there has been a substantial change in the circumstances of the parties and the change is in 
the child(ren)’s best interests. 
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 this form in the county where the 
original order was entered. If the order was entered in another state, or if the child(ren) live(s) in 
another state, you should speak with an attorney about where to file this form. You should file the 
original with the clerk of the circuit court and keep a copy for your records. 
What should I do next? 
For your case to proceed, you must properly notify the other party in your case of the supplemental 
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, you may use constructive service. You may also be able to use 
constructive service if the other party resides in another state or country. However, if constructive 
service is used, other than granting a dissolution of marriage, the court may only grant limited 
relief. 
For more information on constructive service, see Notice of Action for Dissolution of 
Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and Affidavit of Diligent 
Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). 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 service is very complex and you may wish to consult an attorney regarding these issues. 
If personal service is used, the other party has 20 days to answer after being served with your 
supplemental petition. Your case will then generally proceed in one of the following three 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. Then, if you have filed 
all of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set 
a final hearing. 
You must notify the other party of the hearing by using a Notice of Hearing 
(General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify 
Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
70 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
  
hearing form. 
UNCONTESTED... 
If the respondent files an answer that agrees with everything in your 
supplemental petition or an answer and waiver, and you have complied with mandatory disclosure 
and filed all of the required papers, you may call the clerk, family law intake staff, or judicial 
assistant to set a final hearing. You must notify the other party 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 the respondent files an answer or an answer and counterpetition, which disagrees 
with or denies anything in your supplemental petition, and you are unable to settle the disputed 
issues, you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, 
after you have complied with mandatory disclosure and filed all of the required papers. Some 
circuits may require the completion of mediation before a final hearing may be set. Then you should 
contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case 
for trial (final hearing). If the respondent files an answer and counterpetition, you should answer 
the counterpetition within 20 days using an Answer to Counterpetition, Florida Supreme Court 
Approved Family Law Form 12.903(d). 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at 
the beginning of these forms. The words that are in “bold underline” in these instructions are 
defined there. For further information, see chapter 61, Florida Statutes. 
Special notes... 
If you do not have the money to pay the filing fee, you may obtain an Application for Determination 
of Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible 
to have filing fees deferred. 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e). (If you do not know the other party’s income, you may file this worksheet after 
his or her financial affidavit has been served on you.) 
• 	
Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a). If the parties 
have reached an agreement, the Parenting Plan should be signed by both parties. If you 
have not reached an agreement, a proposed Parenting Plan may be filed. If this case 
involves a request for relocation of a minor child, pursuant to section 61.13001, Florida 
Statutes, a proposed Parenting Plan must be attached. 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify 
Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
71 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), if not previously filed. 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932. (This must be filed within 45 days of service of the supplemental 
petition on the respondent, if not filed at the time of the supplemental petition, unless you 
and the other party have agreed not to exchange these documents.) 
Parenting and Time‐Sharing. 
If you and the respondent are unable to agree a judge will decide for 
you as part of establishing a Parenting Plan. The judge will decide the parenting and time‐sharing 
arrangements based on the child(ren)’s best interests. 
Regardless of whether there is an 
agreement, the court reserves jurisdiction to modify issues relating to the minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your 
case. This means that a neutral person will review your situation and report to the judge concerning 
parenting issues. 
The purpose of such intervention is to be sure that the best interests of the 
child(ren) is (are) being served. 
For more information, you may consult section 61.13, Florida 
Statutes. 
A parenting course must be completed prior to entry of a final judgment. You should contact the 
clerk, family law intake staff, or judicial assistant about requirements for parenting courses or 
mediation where you live. 
Listed below are some terms with which you should become familiar before completing your 
supplemental petition. If you do not fully understand any of the terms below or their implications, 
you should speak with an attorney before going any further. 
• 	
Shared Parental Responsibility 
• 	
Sole Parental Responsibility 
• 	
Supervised Time‐Sharing 
• 
No contact 
C 
Parenting Plan 
C 
Parenting Plan Recommendation 
C 
Time‐Sharing Schedule 
Child Support. 
The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, 
but one parent may be ordered to pay a portion of his or her support for the child(ren) to the other 
parent. Florida has adopted guidelines for determining the amount of child support to be paid. 
These guidelines are based on the combined income of both parents and take into account the 
financial contributions of both parents and the number of overnights the child(ren) spend with each 
parent. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), and the other parent will be required to do the same. 
From your financial 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify 
Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
72 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
affidavits, you should be able to calculate the amount of child support that should be paid using the 
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
Because the child support guidelines take several factors into consideration, change over time, and 
vary from state to state, your child support obligation may be more or less than that of other people 
in seemingly similar situations. 
Temporary Relief. 
If you need temporary relief regarding parental responsibility and time‐sharing 
with child(ren), or temporary child support, you may file a Motion for Temporary Support and 
Time‐Sharing with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law 
Form 12.947(a). For more information, see the instructions for that form. 
Settlement Agreement. 
If you and the respondent are able to reach an agreement on any or all of 
the issues, you should file a Settlement Agreement. Although there is no form for this in these 
Florida Family Law Forms, you may construct a settlement agreement using the pertinent sections 
contained in Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(1). 
Both parties must sign 
this agreement before a notary public. Any issues on which you are unable to agree will be 
considered contested and settled by the judge at the final hearing. 
Final Judgment Form. 
These family law forms contain a Supplemental Final Judgment Modifying, 
Parenting Plan/Time‐Sharing schedule, Florida Supreme Court Approved Family Law Form 
12.993(a), which the judge may use. You should check with the clerk, family law intake staff, or 
judicial assistant to see if you need to bring it with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, 
Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number on 
the bottom of the last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify 
Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
73 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
   
 
 
 
 
                                                                         
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
        
 
 
        
 
 
    
  
   
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
                          
 
            
 
            
 
            
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
        
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
SUPPLEMENTAL PETITION TO MODIFY 
PARENTING PLAN/TIME­SHARING SCHEDULE AND OTHER RELIEF 
I, {full legal name} 
, being sworn, certify 
that the following information is true: 
1. 	
The parties to this action were granted a final judgment of ( 
) dissolution of marriage ( 
) paternity 
on {date} 
A copy of the final judgment and any modification(s) is attached. 
2. 	
Paragraph(s) 
of the ( 
) final judgment or ( 
) most recent modification 
thereof describes the present Parenting Plan/Time‐Sharing schedule. 
3. 	
Since the final judgment or last modification thereof, there has been a substantial change in 
circumstances, requiring a modification of the Parenting Plan/Time‐Sharing schedule. Those 
substantial changes are as follows: {explain} 
4. 
I ask the Court to modify the ( 
) Parenting Plan ( 
) Time‐Sharing schedule as follows: {explain} 
Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify Parenting 
Plan/Time‐Sharing Schedule and Other Relief (03/09) 
74 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
     
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
_________________________________________________________________________________ 
 
_________________________________________________________________________________ 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
  
 
 
                                         
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
___________________________________________ 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
5. 
This modification is in the best interests of the child(ren) because: {explain} 
6. 	
If the requested modification is granted, Petitioner requests that child support be modified, 
consistent with the modification of the Parenting Plan/Time‐Sharing schedule. A Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be filed. 
7. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c), is, or will be, filed. 
8. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
9. 	
If not previously filed in this case, a completed Notice of Social Security Number, Florida Supreme 
Court Approved Family Law Form 12.902(j), is filed with this petition. 
10. Other: _____________________________________________________________________ 
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: ______________________________________ 
Telephone Number: __________________________________ 
Fax Number: ________________________________________ 
STATE OF FLORIDA 
COUNTY OF 
Sworn to or affirmed and signed before me on 
by 
NOTARY PUBLIC or DEPUTY CLERK 
Print, type, or stamp commissioned name of notary 
or deputy clerk.] 
Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify Parenting 
Plan/Time‐Sharing Schedule and Other Relief (03/09) 
75 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
___ 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] 
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. 
Florida Supreme Court Approved Family Law Form 12.905(a), Supplemental Petition to Modify Parenting 
Plan/Time‐Sharing Schedule and Other Relief (03/09) 
76 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.905(b), SUPPLEMENTAL PETITION FOR MODIFICATION OF
CHILD SUPPORT (03/09) 
When should this form be used? 
This form should be used when you are asking the court to change a current court‐ordered child support 
obligation. 
The court can change a child support order if the judge finds that there has been a 
substantial change in the circumstances of the parties and the change is in the child(ren)’s best 
interests. 
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 this form in the county where the original order 
was entered. If the order was entered in another state, or if the child(ren) live(s) in another state, you 
should speak with an attorney about where to file this form. You should file the original with the clerk 
of the circuit court and keep a copy for your records. 
What should I do next? 
For your case to proceed, you must properly notify the other party in your case of the supplemental 
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, you may use constructive service. You may also be able to use constructive 
service if the other party resides in another state or country. However, if constructive service is used, 
other than granting a divorce, the court may only grant limited relief. 
For more information on 
constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved 
Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of 
Procedure Form 12.913(b). 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 service is very complex and you may wish to consult 
an attorney regarding these issues. 
If personal service is used, the other party has 20 days to answer after being served with your 
supplemental petition. Your case will then generally proceed in one of the following three 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. Then, if you have filed all 
of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final 
hearing. You must notify the other party 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. 
UNCONTESTED... If the respondent files an answer that agrees with everything in your supplemental 
petition or an answer and waiver, and you have complied with mandatory disclosure and filed all of the 
required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. 
You must notify the other party 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 the respondent files an answer or an answer and counterpetition, which disagrees 
with or denies anything in your supplemental petition, and you are unable to settle the disputed issues, 
you should file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you 
have complied with mandatory disclosure and filed all of the required papers. Some circuits may require 
the completion of mediation before a final hearing may be set. Then you should contact the clerk, family 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for 
Modification of Child Support (03/09) 
77 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
    
law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). If 
the respondent files an answer and counterpetition, you should answer the counterpetition within 20 
days using an Answer to Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d). 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the 
beginning of these forms. The words that are in “bold underline” in these instructions are defined 
there. For further information, see chapter 61, Florida Statutes. 
Special notes... 
If you do not have the money to pay the filing fee, you may obtain an Application for Determination of 
Civil Indigent Status from the clerk, fill it out, and the clerk will determine whether you are eligible to 
have filing fees deferred. 
With this form, you must also file the following: 
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party’s income, you may file this worksheet after his or her financial 
affidavit has been served on you.) 
Settlement Agreement, if you have reached an agreement on any or all of the issues. Although 
there is no form for this in these Florida Family Law Forms, you may construct a settlement 
agreement using the pertinent sections contained in Marital Settlement Agreement for 
Dissolution of Marriage with Dependent or Minor Child(ren), Florida Supreme Court Approved 
Family Law Form 12.902(f)(1). 
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), 
if not previously filed. 
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of service of the supplemental petition on the 
respondent, if not filed at the time of the supplemental petition, unless you and the other party 
have agreed not to exchange these documents.) 
Child Support... The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents. You must file a Family Law Financial Affidavit, Florida Family Law Rules of Procedure 
Form 12.902(b) or (c), and the other parent will be required to do the same. 
From your financial 
affidavits, you should be able to calculate the amount of child support that should be paid using the 
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). Because 
the child support guidelines take several factors into consideration, change over time, and vary from 
state to state, your child support obligation may be more or less than that of other people in seemingly 
similar situations. 
Temporary Relief... If you need temporary relief regarding child support, you may file a Motion for 
Temporary Support and Time‐Sharing with Dependent or Minor Child(ren), Florida Supreme Court 
Approved Family Law Form 12.947(a). For more information, see the instructions for that form. 
Settlement Agreement... If you and the respondent are able to reach an agreement on any or all of the 
issues, you should file a Settlement Agreement. Although there is no form for this in these Florida 
Family Law Forms, you may construct a settlement agreement using the pertinent sections contained in 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for 
Modification of Child Support (03/09) 
78 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Marital Settlement Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), 
Florida Supreme Court Approved Family Law Form 12.902(f)(1). Both parties must sign this agreement 
before a notary public or deputy clerk. Any issues on which you are unable to agree will be considered 
contested and settled by the judge at the final hearing. 
Final Judgment Form... 
These family law forms contain a Supplemental Final Judgment Modifying 
Child Support, Florida Supreme Court Approved Family Law Form 12.993(b), which the judge may use. 
You should check with the clerk, family law intake staff, or judicial assistant to see if you need to bring it 
with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for 
Modification of Child Support (03/09) 
79 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
        
 
 
 
 
      
 
        
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
 
 
    
 
 
 
      
 
      
 
        
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
   
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
SUPPLEMENTAL PETITION FOR MODIFICATION OF CHILD SUPPORT 
I, {full legal name} 
, being sworn, certify 
that the following information is true: 
1. 	
The parties to this action were granted a final judgment ( 
) of dissolution of marriage 
( 
) of paternity ( 
) for support unconnected with a dissolution of marriage on {date} 
. 
A copy of the final judgment and any modification(s) is attached. 
2. 	
Paragraph(s) 
of the ( 
) final judgment or ( 
) most recent modification 
thereof establishes the present child support at $ 
every 
( 
) 
week 
( 
) 
other 
week ( 
) month, beginning on {date} 
. 
3. 	
Since the final judgment or most recent modification thereof, there has been a substantial 
change in circumstances, requiring a modification in child support. This change in circumstance 
is as follows: {explain} ____________________________________________________________ 
4. 
I ask the Court to modify child support as follows: {explain} ______________________________ 
5. 
This change is in the best interests of the child(ren) because: {explain} _____________________ 
Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for Modification of Child 
Support (03/09) 
80 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
6. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
7. 	
If not previously filed in this case, a completed Notice of Social Security Number, Florida 
Supreme Court Approved Family Law Form 12.902(j), is filed. 
8. 	
A Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, 
or will be, filed. 
9. 
Other: _________________________________________________________________________ 
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: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for Modification of Child 
Support (03/09) 
81 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                              
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
   
 
 
 
                                                
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
  
 
   
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
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] 
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. 
Florida Supreme Court Approved Family Law Form 12.905(b), Supplemental Petition for Modification of Child 
Support (03/09) 
82 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.905(d), SUPPLEMENTAL PETITION FOR
TEMPORARY MODIFICATION OF PARENTING ISSUES FOR 
CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR
TEMPORARILY ASSIGNED TO MILITARY SERVICE (03/09) 
When should this form be used? 
This form should be used when a parent seeks a temporary modification of an order establishing 
custody, visitation, a parenting plan or time‐sharing schedule because the parent is activated, 
deployed, or temporarily assigned to military service and the parent’s ability to comply with the 
prior order (s) and time‐sharing schedule and is materially affected. 
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. 
What should I do next? 
For your case to proceed, you must properly notify the other party in your case of the 
supplemental 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, you may use constructive service. You may 
also be able to use constructive service if the other party resides in another state or country. 
However, if constructive service is used, other than granting dissolution of marriage, the court 
may only grant limited relief. For more information on constructive service, see Notice of Action 
for Dissolution of Marriage, Florida Supreme Court Approved Family Law Form 12.913(a), and 
Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b). 
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 service is very complex and you may wish to 
consult an attorney regarding these issues. 
If personal service is used, the other party has 20 days to answer after being served with your 
supplemental petition. Your case will then generally proceed in one of the following three 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. Then, if you have 
filed all of the required papers, you may call the clerk, family law intake staff, or judicial 
assistant to set a final hearing. You must notify the other party 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. 
UNCONTESTED... 
If the respondent files an answer that agrees with everything in your 
supplemental petition or an answer and waiver, and you have complied with mandatory 
disclosure and filed all of the required papers, you may call the clerk, family law intake staff, or 
judicial assistant to set a final hearing. You must notify the other party of the hearing by using a 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition 
for Temporary Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or 
Temporarily Assigned to Military Service (03/09) 
83 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
    
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other 
appropriate notice of hearing form. 
CONTESTED... 
If the respondent files an answer or an answer and counterpetition, which 
disagrees with or denies anything in your supplemental petition, and you are unable to settle 
the disputed issues, you should file a Notice for Trial, Florida Supreme Court Approved Family 
Law Form 12.924, after you have complied with mandatory disclosure and filed all of the 
required papers. Some circuits may require the completion of mediation before a final hearing 
may be set. Then you should contact the clerk, family law intake staff, or judicial assistant for 
instructions on how to set your case for trial (final hearing). If the respondent files an answer 
and counterpetition, you should answer the counterpetition within 20 days using an Answer to 
Counterpetition, Florida Supreme Court Approved Family Law Form 12.903(d). 
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 section 61.13002, 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 from the clerk, fill it out, and the clerk will determine 
whether you are eligible to have filing fees deferred. 
With this form, you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 
12.902(e). (If you do not know the other party’s income, you may file this worksheet 
after his or her financial affidavit has been served on you.) 
• 	
Settlement Agreement, if you have reached an agreement on any or all of the issues. 
Although there is no form for this in these Florida Family Law Forms, you may construct 
a settlement agreement using the pertinent sections contained in Marital Settlement 
Agreement for Dissolution of Marriage with Dependent or Minor Child(ren), Florida 
Supreme Court Approved Family Law Form 12.902(f)(1). 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), if not previously filed. 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c). 
• 	
Parenting Plan, Florida Supreme Court Approved Family Law Form, 12.995(a) or (b). If 
the parties have reached an agreement, a signed and notarized Parenting Plan should 
be attached. If you have not reached an agreement, a proposed Parenting Plan may be 
filed. If this involves relocation of minor child(ren) pursuant to section 61.13001, Florida 
Statutes, a Parenting Plan must be attached. 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition 
for Temporary Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or 
Temporarily Assigned to Military Service (03/09) 
84 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932. (This must be filed within 45 days of service of the 
supplemental petition on the respondent, if not filed at the time of the supplemental 
petition, unless you and the other party have agreed not to exchange these documents.) 
Temporary Judgment Form... 
These family law forms contain a Supplemental Temporary 
Judgment Modifying Parenting Issues for Children of a Parent Activated, Deployed or 
Temporarily Assigned to Military Service Florida Supreme Court Approved Family Law Form 
12.993(d)), which the judge may use. You should check with the clerk, family law intake staff, or 
judicial assistant to see if you need to bring it with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, 
Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number 
on 
the 
bottom 
of 
the 
last 
page 
of 
every 
form 
he 
or 
she 
helps 
you 
complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition 
for Temporary Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or 
Temporarily Assigned to Military Service (03/09) 
85 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
                                                                
   
 
 
 
 
   
                                                             
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
        
 
 
        
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
   
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
    
 
 
        
        
  
 
      
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                
 
 
 
        
        
        
 
 
 
 
 
 
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
__________________________________________________________________________________
IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT, 
IN AND FOR ____________________ COUNTY, FLORIDA 
Case No.: ________________________ 
Division: ________________________ 
__________________________________, 
Petitioner, 
and 
____________________________________, 
Respondent. 
SUPPLEMENTAL PETITION FOR TEMPORARY MODIFICATION OF PARENTING 
G
ISSUES FOR CHILD(REN) OF PARENT ACTIVATED, DEPLOYED, OR 
TEMPORARILY ASSIGNED TO MILITARY SERVICE 
I, {full legal name} ________________________________________, being sworn, certify that 
the following information is true: 
1. 	
The parties to the action, {names} ____________________________________, were granted a final 
judgment of [ one only] ( 
) dissolution of marriage ( 
) paternity on {date} __________________. A 
copy/copies of the final judgment or any modification(s) is/are attached. 
2. 	
Paragraph(s) _____ of the [ √ one only] ( 
) final judgment or ( 
) most recent modification of it 
grants custody or time‐sharing of the minor child(ren), {name(s)} ____________________________, 
with{name of parent} ____________________________________________________. 
3. 
The parent, {name} ____________________, is [all that apply] ( 
) activated ( 
) deployed 
( 
) temporarily assigned to military service. 
4. 	
The parent, {name} _____________________________, is temporarily unable to continue the 
current parenting plan and time‐sharing schedule with the minor child(ren) during the period of 
time that the parent is [ √ all that apply] ( 
) activated ( 
) deployed ( 
) temporarily assigned to 
military service. 
5. 	
I ask the court to temporarily modify/amend 
the parental responsibility 
and time‐sharing 
schedule 
of 
the 
minor 
child(ren) 
during 
the 
period 
of 
time 
that 
the 
parent, 
{name} 
___________________, is 
[ √ all that apply] ( 
) activated ( 
) deployed ( 
) temporarily 
assigned 
to 
military 
service 
as 
follows:{explain}____________________________________________________________________ 
6. 	
This temporary modification/amendment is in the best interest of the child(ren) because {explain} 
Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition for Temporary 
Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to 
Military Service (03/09) 
86 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ 
 
 
 
 
 
 
 
       
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
     
 
 
        
        
  
   
 
 
 
 
 
 
 
 
 
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. 
I ask that the court adopt ( ) the attached temporary Parenting Plan ( ) time‐sharing schedule 
set forth below during the time that the parent is [ all that apply] ( 
) activated ( 
) deployed 
( 
) 
temporarily 
assigned 
to 
military 
service: 
8. 	
If the requested modification/amendment is granted, Petitioner requests that child support be 
temporarily modified/amended, consistent with the temporary modification/amendment of the 
Parenting Plan and time‐sharing schedule. A Child Support Guidelines Worksheet, Florida Family Law 
Rules of Procedure Form 12.902(e) is, or will be, filed. 
9. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c) is filed with this Petition. 
10. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
11. Other: _________________________________________________________________________ 
a. 
____________________________________________________________________________ 
b. 
____________________________________________________________________________ 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this petition and that 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: _______________________________ 
Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition for Temporary 
Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to 
Military Service (03/09) 
87 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
   
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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] 
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. 
Florida Supreme Court Approved Family Law Form 12.905(d), Supplemental Petition for Temporary 
Modification of Parenting Issues for Child(ren) of Parent Activated, Deployed, or Temporarily Assigned to 
Military Service (03/09) 
88 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.940(d),
MOTION TO MODIFY OR DISSOLVE TEMPORARY INJUNCTION (03/09) 
When should this form be used? 
If a temporary injunction, either ex parte or after a hearing, has been entered against you, you may 
use this form to ask the court to modify or dissolve that injunction. 
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 the injunction was entered and keep 
a copy for your records. You should ask the clerk to process your motion through their emergency 
procedures. A hearing will be held within 5 working days. You should ask for the date and time of 
your hearing and should file Notice of Hearing (General), Florida Supreme Court Approved Family 
Law Form 12.923 or other appropriate notice of hearing form, and send a copy to the other party. 
What should I do next? 
A copy of this form must be mailed or hand delivered to the other party, along with a notice of 
hearing. 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at 
the beginning of these forms. For further information, see chapter 61, Florida Statutes, and rule 
1.610, Florida Rules of Civil Procedure. 
Special notes... 
With this form you must also file the following, if you have not already done so: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), if the parental responsibility or time­
sharing of a minor child(ren) is at issue. 
Order... These family law forms contain an Order Dissolving Temporary Injunction, Florida Supreme 
Court Approved Family Law Form 12.940(e), which the judge may use. You should check with the 
clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with 
you to the hearing. 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 
Instructions for Florida Supreme Court Approved Family Law Form 12.940(d), Motion to Modify or Dissolve 
Temporary Injunction (03/09) 
89 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out 
these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.940(d), Motion to Modify or Dissolve 
Temporary Injunction (03/09) 
90 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
        
        
 
 
        
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
and 
, 
Petitioner, 
, 
Respondent. 
MOTION TO MODIFY OR DISSOLVE TEMPORARY INJUNCTION 
( 
) Petitioner ( 
) Respondent requests the Court to enter an order ( 
) dissolving the 
temporary injunction issued in the above styled case ( 
) modifying the temporary injunction issued in 
the above styled case in the following manner: 
. 
I am the party against whom this temporary injunction has been granted and under rule 1.610, Florida 
Rules of Civil Procedure, I request that a hearing be held within 5 days after the filing of this motion. 
I certify that a copy of this document was [ / one only] ( 
) 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: 
Dated: 
Signature of Party 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
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} 
, 
Florida Supreme Court Approved Family Law Form 12.940(d), Motion to Modify or Dissolve Temporary Injunction 
(03/09) 
91 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
  
 
   
     
 
       
 
       
 
 
 
 
 
{state} 
, {phone} 
, helped {name} 
, 
who is the [ / one only] 
petitioner or 
respondent, fill out this form. 
Florida Supreme Court Approved Family Law Form 12.940(d), Motion to Modify or Dissolve Temporary Injunction 
(03/09) 
92 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
                                                                         
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
   
 
 
   
 
 
 
 
 
                                              
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ORDER DISSOLVING TEMPORARY INJUNCTION 
Upon ( 
) Petitioner=s ( 
) Respondent=s motion and after hearing, the Court, being fully 
advised in the premises, 
ORDERS that the temporary injunction entered on {date} 
in the 
above‐styled case is hereby dissolved. 
ORDERED on {date} 
, at {time} 
. 
CIRCUIT JUDGE 
COPIES TO: 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
U.S. Department of State 
Office of Children’s Issues 
2201 “C” Street NW 
CA/OCS/CI 
Washington, D.C. 20520 
Fax (202) 736‐9133 
preventabduction@state.gov 
Florida Supreme Court Approved Family Law Form 12.940(e), Order Dissolving Temporary Injunction 
(03/09) 
93 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED 
FAMILY LAW FORM 12.941(a),
VERIFIED MOTION FOR TEMPORARY INJUNCTION TO 
PREVENT REMOVAL OF MINOR CHILD(REN) AND/OR DENIAL
OF PASSPORT SERVICES (03/09) 
When should this form be used? 
You should use this form if you want the court to enter an order that your minor child(ren) is (are) 
not to be removed from the State of Florida while a case involving parenting or time‐sharing is 
pending, that passport services for the minor child(ren) be prohibited, and/or that existing passports 
be turned over to you. 
This form should be typed or printed in black ink. If you want the court to enter an ex parte order, 
without giving the other side advance notice of the hearing, you should explain your reasons in 
paragraph 5 of this form. After completing this form, you should sign the form before a notary 
public. You should file the original with the clerk of the circuit court in the county where your case 
is pending and keep a copy for your records. You should also ask the clerk to process your motion 
though their emergency procedures. 
What should I do next? 
If the court enters an order without advance notice to the other party, you should take a certified 
copy of the order to the sheriff’s office for further assistance. You must have this form and the 
court’s order, served by personal service on the other party. You should read the court’s order 
carefully. Look for directions in the order that apply to you and note the time and place of the 
hearing scheduled in the order. You should go to the hearing with whatever evidence you have 
regarding your motion. 
If the court will not enter an order without advance notice to the other side, you should check with 
the clerk of court, family law intake staff, or judicial assistant for information on the local 
procedure for scheduling a hearing on your motion, unless the court sets a hearing in its order 
denying your request for an ex parte hearing. When you know the date and time of your hearing, 
you should file Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 
12.923 or other appropriate notice of hearing form, and use personal service to notify the other 
party of your motion, the court’s order, if any, and the hearing. 
Instructions for Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary 
Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
94 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 chapter 61, Florida Statutes, and rule 
1.610, Florida Rules of Civil Procedure. 
Special notes... 
If you have an attorney, your attorney must certify in writing the efforts that have been made to 
give the other party notice, if no notice is given. The court may require you to post a bond as a 
condition of the injunction. 
With this form you must also file the following, if you have not already done so, and provide a copy 
to the other party: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d). 
Temporary Injunctions... These family law forms contain a Temporary Injunction to Prevent 
Removal of Minor Child(ren) and/or Denial of Passport Services (Ex Parte), Florida Supreme Court 
Approved Family Law Form 12.941(b), which the judge may use if he or she enters an order without 
a hearing, and a Temporary Injunction to Prevent Removal of Minor Child(ren) and/or Denial of 
Passport Services (After Notice), Florida Supreme Court Approved Family Law Form 12.941(c), 
which the judge may use if he or she enters an order after a hearing. You should check with the 
clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with 
you to the hearing. 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. 
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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary 
Injunction to Prevent Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
95 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
  
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
VERIFIED MOTION FOR TEMPORARY INJUNCTION TO PREVENT REMOVAL OF 
MINOR CHILD(REN) AND/OR DENIAL OF PASSPORT SERVICES 
( 
) Petitioner ( 
) Respondent requests the Court to enter a temporary injunction to prevent 
removal of the following listed minor child(ren) from the jurisdiction of this Court and deny passport 
services for the child(ren) and says: 
1. 	
The minor child(ren) subject to this request is (are): 
Name 	
Birth date 
2. 	
The child(ren) has (have) been a resident(s) of 
County, Florida since {date} 
. 
3. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this motion. 
4. 
It is in the best interests of the minor child(ren) that the Court order the following: 
[ / all that apply] 
a. 	
___The child(ren) not be removed from the jurisdiction of this Court while litigation is pending 
because:______________________________________________________________________ 
b. 	
___Passport services for the minor child(ren) be prohibited because:_____________________ 
Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary Injunction to Prevent 
Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
96 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
        
  
 
      
 
 
 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
 
        
        
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
        
        
 
 
        
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
_____________________________________________________________________________________ 
_____________________________________________________________________________________ 
_____________________________________________________________________________________  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
                 
 
 
 
  
 
 
 
 
 
 
c. 	
___Existing passports for the minor child(ren) be immediately turned over to ( 
) Petitioner 
( 
) Respondent because: _____________________________________________________ 
5. 	
This motion should be granted ( 
) with ( 
) without notice to the other party. {If without notice, 
explain why there would be immediate and irreparable harm if the other party is given notice.} 
WHEREFORE, ( 
) Petitioner ( 
) Respondent requests the following from the Court: 
[ / all that apply] 
a. 	
___enter a temporary injunction to prevent removal of the child(ren) named above from the 
jurisdiction of this Court while this action is pending; 
b. 	
___enter an order denying passport services for the minor child(ren); 
c. 	
___ enter an order requiring that any existing passports for the minor child(ren) be immediately 
delivered to ( 
) Petitioner ( 
) Respondent; 
d. 	
___enter a temporary injunction without notice to the other party. 
I certify that a copy of this document was [ one only] ( 
) mailed ( 
) faxed and mailed ( 
) hand 
delivered to the person(s) listed below on {date__________________________________________ 
or ( 
) was not delivered to the person(s) listed below because _________________________________ 
Other party or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary Injunction to Prevent 
Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
97 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
   
                                       
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
   
                                             
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this verified motion 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: 
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 the party filing this motion is represented by an attorney, the attorney must complete the 
following: 
I, the undersigned attorney for the movant, hereby certify in that the following efforts have 
been made to give notice. {if no efforts have been made, why} 
Signature 
Florida Bar Number 
Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary Injunction to Prevent 
Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
98 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
      
 
 
      
 
 
 
 
Printed Name 
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 
[ 
/ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.941(a), Verified Motion for Temporary Injunction to Prevent 
Removal of Minor Child(ren) and/or Denial of Passport Services (03/09)
99 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
     
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) 
AND/OR DENIAL OF PASSPORT SERVICES (EX PARTE) 
Upon verified motion of ( 
) Petitioner ( 
) Respondent, the Court has jurisdiction of the parties 
and the subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that: 
NOTICE OF HEARING 
This Temporary Injunction to Prevent Removal of Child(ren) has been issued without prior notice 
to Respondent. Pursuant to Rule 1.610, Florida Rules of Civil Procedure, the other party may file a 
motion to dissolve or modify this temporary injunction and a hearing will be scheduled within 5 days of 
that motion. 
[ / if applies] 
____ 
If no motion to dissolve is filed, Petitioner and Respondent are instructed that they are 
scheduled to appear and testify at a hearing regarding this matter on {date}___________, at _______ 
a.m./p.m., when the Court will consider whether the Court should continue, modify, or dissolve this 
Temporary Injunction to Prevent Removal of Child(ren) and/or Denial of Passport Services, which 
would remain in effect until modified or dissolved by the Court, and whether other things should be 
ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable 
{name}___________________________________________, at {room name/number, location, address, 
city}_________________________________________________________, Florida. If Petitioner and/or 
Respondent do (does) not appear, this temporary injunction may be continued in force, extended, or 
dismissed, and/or additional orders may be issued, including the imposition of court costs. 
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 
{name}__________________________,{address}____________________________________________, 
{telephone}______________________ , within 2 working days of your receipt of this temporary 
Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/09)
100 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
   
 
 
 
 
 
 
 
 
 
      
        
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
______________________________________________________________________ 
______________________________________________________________________ 
______________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________ 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
        
        
 
 
   
 
 
  
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
injunction. If you are hearing or voice impaired, call TDD 1‐800‐955‐8771. 
FINDINGS 
1. 	
It appears from specific facts shown by verified motion that immediate and irreparable injury, loss, 
or damage will result to the minor child(ren) if a temporary injunction is not issued without notice to 
the other party. 
2. 	
( 
) Petitioner=s ( 
) Respondent=s attorney has certified in writing any efforts made to give notice. 
3. 	
The reasons why notice should not be given are: _______________________________________ 
TEMPORARY INJUNCTION 
[ / all that apply] 
1. 	
____The following child(ren) shall not be removed from the jurisdiction of this Court during the 
pendency of this proceeding, or until further order of this Court: 
Name 	
Birth date 
2. 	
____ ( 
) Petitioner ( 
) Respondent shall not apply for any passports or passport services on behalf 
of the child(ren). 
3. 	
____ ( 
) Petitioner ( 
) Respondent shall immediately deliver any existing passports for the 
child(ren) to {name} _____________________________________________________________. 
4. 	
The Court may enforce compliance with the terms of this injunction through civil and/or indirect 
criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a 
fine. 
5. 	
Violation of this injunction may constitute criminal contempt of court. 
6. 	
Bond. 
a. 	
___ Bond is waived because this injunction is issued solely to prevent physical injury or abuse of 
a natural person. 
b. 	
___ This order is conditioned upon ( 
) Petitioner ( 
) Respondent posting bond in the sum of 
$ _______ with the clerk of this Court. 
7. 	
Expiration. This injunction shall remain in effect until the minor child(ren) reach(es) the age of 18, 
until the hearing scheduled herein, if any, or {date} ___________, whichever occurs first, unless 
modified by further order of this Court. 
ORDERED on {date} _________________ , at{time} _________________. 
Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/09)
101 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
__________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ was [only 
one] ( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
U.S. Department of State 
Office of Children’s Issues 
2201 “C” Street NW 
CA/OCS/CI 
Washington, D.C. 20520 
Fax (202) 736‐9133 
preventabduction@state.gov 
Florida Supreme Court Approved Family Law Form 12.941(b), Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (Ex Parte) (03/09)
102 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
TEMPORARY INJUNCTION TO PREVENT REMOVAL OF MINOR CHILD(REN) 
AND/OR DENIAL OF PASSPORT SERVICES (AFTER NOTICE) 
Upon verified motion of ( 
) Petitioner ( 
) Respondent, the Court has jurisdiction of the parties 
and the subject matter and the Court being fully advised, it is ORDERED and ADJUDGED that: 
[all that apply] 
1. 	
The following minor child(ren) shall not be removed from the jurisdiction of this Court during the 
pendency of this proceeding, or until further order of this Court: 
Name 	
Birth date 
2. 	
( 
) Petitioner ( 
) Respondent shall not apply for any passports or passport services on behalf of 
the child(ren). 
3. 	
( 
) Petitioner ( 
) Respondent shall immediately deliver any existing passports for the child(ren) to 
{name} _____________________________________________________________. 
4. 	
The Court may enforce compliance with the terms of this injunction through civil and/or indirect 
criminal contempt proceedings, which may include arrest, incarceration, and/or the imposition of a 
fine. 
5. 	
Violation of this injunction may constitute criminal contempt of court. 
Florida Supreme Court Approved Family Law Form 12.941(c), Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (After Notice) (03/09)
103 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
        
        
 
 
   
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
6. 	
Bond. 
a. 	
Bond is waived because this injunction is issued solely to prevent physical injury or abuse of a 
natural person. 
b. 	
This order is conditioned upon ( 
) Petitioner ( 
) Respondent posting bond in the sum of 
$ 
With the clerk of this Court. 
7. 	
Expiration. This temporary injunction shall remain in effect until the minor child(ren) reaches the 
age of 18, or until {date} ____________________, not to exceed one year from the date of this 
order, whichever occurs first, unless modified by further order of this Court. 
ORDERED on {date}___________________________, at {time} ________________. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}_____________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
U.S. Department of State 
Office of Children’s Issues 
2201 “C” Street NW 
CA/OCS/CI 
Washington, D.C. 20520 
Fax (202) 736‐9133 
preventabduction@state.gov 
Florida Supreme Court Approved Family Law Form 12.941(c), Temporary Injunction to Prevent Removal of Minor 
Child(ren) and/or Denial of Passport Services (After Notice) (03/09)
104 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
   
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.941(d), EMERGENCY VERIFIED MOTION FOR CHILD PICK­UP 
ORDER (03/09) 
When should this form be used? 
You may use this form to request that the court enter an order directing the sheriff or other law 
enforcement officer to take a minor child(ren) from the person who currently has physical possession of 
the child(ren) and deliver the child(ren) to your physical custody or possession. This form should only be 
used in an emergency by a person who has a pre‐existing legal right to physical possession of a minor 
child. This means that you already have a court order awarding you legal custody of or time‐sharing 
with the child(ren) OR you are the birth mother of one or more children born out of wedlock and no 
court order has addressed any other person=s parental rights. Before proceeding, you should read 
AGeneral Information for Self‐Represented Litigants@ found at the beginning of these forms. 
This form should be typed or printed in black ink. This form presumes that you want the court to enter 
an ex parte order without giving the other side advance notice of the hearing. You should explain your 
reasons for why such an ex parte order should be entered in paragraph 7 of this form. After completing 
this form, you should sign the form before a notary public or deputy clerk. You should file the original, 
along with all of the other forms required, with the clerk of the circuit court in the county where the 
child(ren) is (are) physically located and keep a copy for your records. You should also ask the clerk to 
process your motion though their emergency procedures. 
What should I do next? 
If the court enters an order without advance notice to the other party, you should take a certified copy 
of the order to the sheriff=s office for further assistance. You must have this form and the court=s order 
served by personal service on the other party. You should read the court=s order carefully. The order 
may require the sheriff to place the child(ren) somewhere other than in your physical possession. Look 
for directions in the order that apply to you and note the time and place of the hearing scheduled in the 
order. You should go to the hearing with whatever evidence you have regarding your motion. 
If the court will not enter an order without advance notice to the other side, you should check with the 
clerk of court, judicial assistant, or family law intake staff for information on the local procedure for 
scheduling a hearing on your motion, unless the court sets a hearing in its order denying your request 
for an ex parte hearing. When you know the date and time of your hearing, you should file Notice of 
Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, and use personal service 
to notify the other party of your motion, the court=s order, if any, and the hearing. 
Special notes... 
With this form you must also file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
• 	
A certified copy of the court order showing that you have legal custody of or time‐sharing with 
the child(ren), if any. 
OR 
A certified copy of the child(ren)=s birth certificate, if you are the birth mother of a child born 
out of wedlock and no court order addressing paternity exists. 
Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child 
Pick‐Up Order (03/09) 
105 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
OR 
A certified copy of any judgment establishing paternity, time‐sharing with or custody of the 
minor child(ren). 
Order... These family law forms contain an Order to Pick‐Up Minor Child(ren), Florida Supreme Court 
Approved Family Law Form 12.941(e), which the judge may use. You should check with the clerk, family 
law intake staff, or judicial assistant to see if you need to bring a blank order form with you to the 
hearing. 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. 
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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child 
Pick‐Up Order (03/09) 
106 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
        
        
 
 
 
 
 
 
   
   
 
 
 
 
 
    
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                      
 
  
                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                       
___________________________________________________________________________  
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
EMERGENCY VERIFIED MOTION FOR CHILD PICK‐UP ORDER 
I, {full legal name} 
, being sworn, 
certify that the following information is true: 
1. 	
This is a motion to enforce existing custody or time sharing rights (as an operation of law or 
court‐ordered) regarding the following minor child(ren): 
Name 
Sex 
Birth Date 
Race 
Physical Description 
2. 	
Currently, the child(ren) subject to this motion is (are) in the physical possession of {full legal 
name}___________________________________________________________________ 
____________________________________ whose address or present physical location is: 
This individual=s relationship to the minor child(ren) is: 
3. 	
I ( 
) am ( 
) am not married to the person named in paragraph 2. 
4. 	
Status of minor child(ren). I have a superior right to custody of or time‐sharing with the minor 
child(ren) over the person named in paragraph 2 because: 
[ / all that apply]: 
a. 	
___ Custody or Time‐Sharing has been established by a court. A final judgment or order 
awarding custody or time‐sharing of the minor child(ren) was made on {date} ______ in 
{name of court} 
{case number} 
. 
This 
order 
awarded custody of or specific time‐sharing with the minor child(ren) to me. This final 
judgment or order applies to the following minor child(ren): {list name(s) of the child(ren) or 
write Aall@} _____________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick‐Up Order 
(03/09) 
107 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
   
       
        
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
_____________________________________________________________________ 
_____________________________________________________________________ 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
   
 
 
  
                                                                                
                                                      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
      
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
_____________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
      
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
A certified copy of said final judgment or order is attached, has not been modified, and is 
still in effect. [ / if applies] ( 
) This order is an out‐of‐state court order which is entitled to 
full faith and credit enforcement under the Uniform Child Custody Jurisdiction and 
Enforcement Act and/or the federal Parental Kidnaping Prevention Act. 
b. 	
___ Custody or time‐sharing is established as an operation of law. I am the birth mother of 
the minor child(ren) who was (were) born out of wedlock and there is no final judgment or 
order awarding custody of or time‐sharing with the following minor child(ren): {list name(s) 
of the child(ren) or write Aall@} _____________________________________________ 
___ 	
Paternity has not been established. A certified copy of the minor child(ren)=s birth 
certificate is attached and has not been amended. 
___ 	
Paternity has been established. A certified copy of the final judgment of paternity, 
which shows no award of custody or time‐sharing was made, is attached. This order 
has not been changed and is still in effect. 
c. 	
___ Other: 
______ 
5. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this motion. 
6. 
Facts relating to the minor child(ren)=s current situation. 
[ / all that apply] 
a. 	
___ The person named in paragraph 2 wrongfully removed or wrongfully detained the minor 
child(ren) on {date} 
as follows: ____________________________________ 
9 Check here if you are attaching additional pages to continue these facts. 
b. 	
___ I believe that the minor child(ren) is (are) in immediate danger of harm or removal from 
this court=s jurisdiction while with the person named in paragraph 2 based on the following: 
c. 
___ The current location of the minor child(ren) is: 
( 
) 
unknown 
( 
) 
believed to be at the following address(es) with the following people {list both the address 
and the people you believe will be there}: 
Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick‐Up Order 
(03/09) 
108 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
 
 
 
  
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. 
Advance notice of this motion to the individual named in paragraph 2 should not be required 
because: _______________________________________________________________________ 
8. 	
If needed, I can be contacted for notice of an emergency or expedited hearing at the following 
addresses/locations: ____________________________________________________________ 
Name of Contact Person: _________________________________________________________ 
Address: ______________________________________________________________________ 
Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} 
Name of Contact Person: 
Address: 
Telephone number(s) where I (or my designee) can be reached: {give name of individual to call} 
9. 
Attorneys= = Fees, Costs, and Suit Monies. 
[ / if applies] 
___ 
I have filed this motion because of wrongful acts of the person listed in paragraph two above. I 
request that this Court award reasonable attorney=s fees, costs, and suit monies as applicable or 
authorized under Florida law, the UCCJEA, and other legal authorities. 
WHEREFORE, I request an Emergency Order to Pick‐Up Minor Child(ren), without advance 
notice, directing all sheriffs of the State of Florida or other authorized law enforcement officers in this 
state or any other state to pick up the previously named minor child(ren) and deliver them to my 
physical custody. 
Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick‐Up Order 
(03/09) 
109 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
                                           
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
            
 
            
 
 
 
 
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 Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF _________________________________ 
Sworn to or affirmed and signed before me on 
by 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
___ 
Personally known 
___ 
Produced identification 
Type of identification produced _______________________ 
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 
[ 
/ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.941(d), Emergency Verified Motion for Child Pick‐Up Order 
(03/09) 
110 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ORDER TO PICK‐UP MINOR CHILD(REN) 
An Emergency Verified Motion for Child Pick‐Up Order has been filed by ( 
) Petitioner ( 
) 
Respondent, alleging facts which under existing law are determined to be sufficient to authorize taking 
into custody the minor child(ren) named below. Based on this motion, this Court makes the following 
findings, notices, and conclusions: 
JURISDICTION 
This Court has jurisdiction over issues surrounding the minor child(ren) listed below based on 
the following: 
[ all that apply] 
a. 	
___ This Court exercised and continues to exercise original jurisdiction over the minor children 
listed below under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA), 
specifically, section 61.514, Florida Statutes. 
b. 	
___ A certified out‐of‐state custody decree has been presented to this Court with a request for 
full faith and credit recognition and enforcement under the Parental Kidnapping Prevention Act, 
28 U.S.C. Section 1738A. This Court has jurisdiction to enforce this decree under the UCCJEA, 
specifically sections 61.501‐61.542, Florida Statutes. 
c. 	
___ By operation of Florida law governing the custody of or time‐sharing with child(ren) born 
out of wedlock, this Court has jurisdiction over the child(ren) listed below because this (these) 
child(ren) was (were) born in the State of Florida and no prior court action involving the minor 
child(ren) has addressed a putative father’s rights to time‐sharing or other parental rights. See 
sections 742.031 and 744.301, Florida Statutes. 
d. 	
___ Pursuant to the UCCJEA, specifically section 61.516, Florida Statutes, this Court has 
jurisdiction to modify a custody decree of another state and has consulted with the Court which 
took initial jurisdiction over the minor child(ren) to determine this authority. 
e. 	
___ Other: 
Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick‐Up Minor Child(ren) (03/09) 
111 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
  
       
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
                         
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
                             
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTICE OF HEARING 
Because this Order to Pick‐Up Minor Child(ren) has been issued without prior notice to the non‐
movant {name} 
, all 
parties involved in this matter are informed that they are scheduled to appear and testify at a hearing 
regarding this matter on {date} 
, at {time} 
,at which time the Court will 
consider whether the Court should issue a further order in this case, and whether other things should be 
ordered, including who should pay the filing fees and costs. The hearing will be before The Honorable 
{name} ______________________________________________________________________________ 
at {room name/number, location, address, city}_______________________________________, Florida. 
If a party does not appear, this order may be continued in force, extended, or dismissed, and/or 
additional orders may be issued, including the imposition of court costs. 
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 
{name} _________________________________________________, {address}____________________ 
___________________________________________________________________________________, 
{telephone} _____________________, within 2 working days of your receipt of this order. If you are 
hearing or voice impaired, call TDD 1‐800‐955‐8771. 
ORDER 
This Court ORDERS AND DIRECTS any and all sheriffs of the State of Florida (or any other 
authorized law enforcement officer in this state or in any other state) to immediately take into custody 
the minor child(ren) identified below from anyone who has possession and: 
1. 
___ 
Place 
the 
minor 
child(ren) 
in 
the 
physical 
custody 
of 
{name} 
________________ who ( 
) may ( 
) may not remove the minor child(ren) 
from the jurisdiction of this Court. 
OR 
___ Accompany the minor child(ren) to the undersigned judge, if the minor child(ren) is (are) 
picked up during court hours, for immediate hearing on the issue of custody or time‐sharing. 
It is the intention of this Court that the nonmoving party, minor child(ren), and movant appear 
immediately upon service of this order before the undersigned judge, if available, or duty judge 
to conduct a hearing as to which party is entitled to lawful custody of the minor child(ren) at 
issue. It is not the intention of the court to turn over the child(ren) to the movant on an ex parte 
basis. Neither party should be permitted to remove the child(ren) from the jurisdiction of this 
Court pending a hearing. If unable to accomplish the above, the sheriff/officer shall take the 
child(ren) into custody and place them with the Department of Children and Family Services of 
the State of Florida pending an expedited hearing herein. 
OR 
___ Place the minor child(ren) in the physical custody of {agency} ________________________ 
who shall contact the undersigned judge for an expedited hearing. The sheriff/officer shall not 
delay the execution of this court order for any reason or permit the situation to arise where the 
nonmoving party is allowed to remove the child(ren) from the jurisdiction of this court. 
2. 	
NEITHER PARTY OR ANYONE AT THEIR DIRECTION, EXCEPT PURSUANT TO THIS ORDER, 
MAY REMOVE THE CHILD(REN) FROM THE JURISDICTION OF THIS COURT PENDING 
Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick‐Up Minor Child(ren) (03/09) 
112 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FURTHER HEARING. 
SHOULD THE NONMOVING PARTY IN ANY WAY VIOLATE THE 
MANDATES OF THIS ORDER IN THE PRESENCE OF THE LAW ENFORCEMENT OFFICER, 
THIS OFFICER IS TO IMMEDIATELY ARREST AND INCARCERATE THE OFFENDING PARTY 
UNTIL SUCH TIME AS THE OFFENDING PARTY MAY BE BROUGHT BEFORE THIS COURT 
FOR FURTHER PROCEEDINGS. 
All sheriffs of the State for Florida are authorized and ORDERED to serve (and/or execute) and 
enforce this order in the daytime or in the nighttime and any day of the week, except as limited by this 
order above. 
Except as limited by the above, if necessary, the sheriff/officer is authorized to take all 
reasonable, necessary, and appropriate measures to effectuate this order. The sheriff/officer shall not 
delay the execution of this order for any reason or permit the situation to arise where the child(ren) is 
(are) removed from the jurisdiction of this Court before execution of this order. 
The minor child(ren) is (are) identified as follows: 
Name 
Sex 
Birth date 
Race 
Physical Description 
Current location/address of minor child(ren) or of party believed to have possession of the minor 
child(ren): 
ORDERED on {date} 
, at {time} 
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [√ only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent 
(or 
his 
or 
her 
attorney) 
Florida Supreme Court Approved Family Law Form 12.941(e), Order to Pick‐Up Minor Child(ren) (03/09) 
113 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.942(a), MOTION FOR APPOINTMENT OF
GUARDIAN AD LITEM (03/09) 
When should this form be used? 
This form may be used by either party in a family law case involving parenting, time–sharing, or 
paternity of a minor child(ren) to request that the judge appoint a guardian ad litem to represent 
the best interests of the minor child(ren). You should use this form if you feel that your child(ren) 
needs someone other than you to ensure that both the judicial system and the other party(ies) 
act(s) in the best interests of the child(ren). A guardian ad litem may be a volunteer who has been 
trained and certified by the State of Florida Guardian ad Litem Program or an attorney who is a 
member in good standing with The Florida Bar. 
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. 
What should I do next? 
A copy of this form must be mailed or hand delivered to the other party in your case. 
It is possible that there will be a hearing on your motion. The judge may want to hear the reasons 
you feel an appointment of a guardian ad litem is necessary, or, the other party may object to your 
motion. If a hearing is required, check with the clerk of court, family law court staff, or judicial 
assistant for information on the local procedure for scheduling a hearing. When you know the date 
and time of your hearing, you should file Notice of Hearing (General), Florida Supreme Court 
Approved Family Law Form 12.923, or other appropriate notice of hearing form, and provide a copy 
to the other party. 
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 may also want to contact the Guardian ad Litem Program office 
in your area or see sections 61.401B405, Florida Statutes. 
Special notes... 
Order... These family law forms contain an Order Appointing a Guardian ad Litem, Florida Supreme 
Court Approved Family Law Form 12.942(b), which the judge may use. You should check with the 
clerk, family law intake staff, or judicial assistant to see if you need to bring a blank order form with 
you to the hearing. 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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.942(a), Motion for Appointment of 
Guardian ad Litem (03/09) 
114 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.942(a), Motion for Appointment of 
Guardian ad Litem (03/09) 
115 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
               
       
 
       
      
                  
 
 
 
 
 
    
 
    
    
    
 
 
 
 
 
    
 
    
    
    
 
 
 
 
 
    
 
    
    
    
 
 
 
 
 
    
 
    
    
    
 
 
 
 
 
    
 
    
    
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
  
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
MOTION FOR APPOINTMENT OF GUARDIAN AD LITEM 
( 
) Petitioner ( 
) Respondent requests that the Court enter an order appointing a guardian 
ad litem with all powers, privileges, and responsibilities authorized in section 61.403, Florida 
Statutes, and states: 
1. 	
The following minor child(ren) is (are) subject to this proceeding: 
Name 	
Birth date 
Age 
Sex 
Location/Address 
2. 	
Verified allegations of child abuse or neglect as defined in sections 39.01(2) or (45), Florida 
Statutes, ( 
) HAVE ( 
) HAVE NOT been made in this case. 
3. 	
The matters before the Court regarding the minor child(ren) are: 
a. 	
sole/shared parental responsibility 
b. 	
Parenting Plan and time‐sharing schedule 
c. 	
other: 
4. 
It is in the best interests of the minor child(ren) that a guardian ad litem be appointed to 
advance the best interests of the minor child(ren) because: 
Florida Supreme Court Approved Family Law Form 12.942(a), Motion for Appointment of Guardian ad Litem 
(03/09) 
116 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
        
        
 
 
 
      
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
                 
   
 
  
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
        
 
        
 
 
 
 
I certify that a copy of this document was [ / one only] ( 
) 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: 
Dated: 
Signature of Party 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
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 
[ 
/ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.942(a), Motion for Appointment of Guardian ad Litem 
(03/09) 
117 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
             
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
             
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ORDER APPOINTING GUARDIAN AD LITEM 
Upon ( 
) Petitioner’s ( 
) Respondent’s ( 
) Court’s own motion to appoint guardian ad litem 
for the minor child(ren) herein and the Court finding that: 
a. 
___ verified allegations of child abuse or neglect as defined in sections 39.01(2) or (45), 
Florida Statutes, have been made and are determined to be well‐founded, 
OR 
b. 
___ it is otherwise in the best interests of the child(ren) that a guardian ad litem be 
appointed to advance the best interests of the minor child(ren) because: 
, it is thereupon 
ORDERED as follows: 
1. 	
A guardian ad litem shall be appointed for the minor child(ren), {name(s)} 
, 
now residing at {street address} 
. 
2. 	
The State of Florida Guardian ad Litem Program for the 
Judicial Circuit shall assign a 
certified guardian ad litem for the minor child(ren). Upon filing of the Notice of Acceptance, the 
guardian 
ad 
litem 
can 
be 
served 
c/o 
Guardian 
ad 
Litem 
Program, 
{address} 
_____________________________________________________________ Pursuant to the State 
of Florida Guardian ad Litem Standards of Operation adopted by the Supreme Court of Florida, if 
the Guardian ad Litem Program is appointed in the absence of a well founded allegation of 
abuse or neglect, an automatic discharge by the Court will occur upon filing of a Motion to 
Discharge by the Program if the Program does not have sufficient volunteer and/or supervisory 
resources available to accommodate this appointment. 
OR 
Florida Supreme Court Approved Family Law Form 12.942(b), Order Appointing Guardian ad Litem (03/09) 
118 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
      
        
        
 
 
        
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{name} 
, an attorney in good standing with The Florida 
Bar, is appointed to serve as a private guardian ad litem for the above minor child(ren). The fees 
of the private guardian shall be paid by: 
( 
) Petitioner ( 
) Respondent ( 
) each party equally ( 
) other, {specify} 
_________ 
. 
3. 	
The guardian ad litem is a party to any judicial proceeding from the date of this order until the 
date of discharge and shall have all of the powers, privileges, and responsibilities authorized in 
section 61.403, Florida Statutes, to the extent necessary to advance the best interests of the minor 
child(ren). 
4. 	
The guardian ad litem must be provided with copies of all pleadings, notices, stipulations, and 
other documents filed in this action and is entitled to reasonable notice before any action 
affecting the child(ren) is taken by either of the parties, their counsel, or the Court. 
The 
guardian ad litem is entitled, through counsel, to be present at any depositions, hearings, or 
other proceedings concerning the minor child(ren). 
5. 	
The guardian ad litem may investigate the allegations of the pleadings affecting the minor 
child(ren), and after proper notice may interview witnesses or any other person having 
information concerning the welfare of the minor child(ren). 
6. 	
The guardian ad litem shall maintain any information received from any source described in 
section 61.403(2), Florida Statutes, as confidential and shall not disclose such information 
except in reports to the Court served upon both parties to this cause and their counsel, or as 
directed by the Court. 
7. 	
The parties, or any other person entrusted by the parties with the care of the minor child(ren) 
shall allow the guardian ad litem access to the minor child(ren) at reasonable times and 
locations and no person shall obstruct the guardian ad litem from the minor child(ren). 
8. 	
The guardian ad litem shall submit his or her recommendations to the Court regarding any 
stipulation or agreement, whether incidental, temporary, or permanent, which affects the 
interest or welfare of the minor child(ren), within 10 days after the date the stipulation or 
agreement is served upon the guardian ad litem. 
9. 	
The guardian ad litem shall file a written report with the Court, which may include 
recommendations and a statement of the wishes of the minor child(ren). The report must be 
filed and served on all parties at least 20 days prior to the hearing at which it will be presented 
unless the Court waives such time period. The guardian ad litem’s report shall address the 
following areas, subject to any conditions ordered by this Court: 
a. 	
___ parental responsibility of child(ren); 
b. 	
___ residence of child(ren); 
c. 
___ time‐sharing including times and locations; 
d. 
___ appearance of child(ren) at depositions/hearings; 
Florida Supreme Court Approved Family Law Form 12.942(b), Order Appointing Guardian ad Litem (03/09) 
119 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
 
 
 
 
         
  
 
 
 
 
e. 
___ relocation; 
f. 
___ best interests of child(ren) regarding scientific tests; and/or 
g. 
___ other _________________________________________________________ 
This appointment is subject to the following conditions: 
10. The guardian ad litem is automatically discharged without further order 30 days after the entry 
of a final order or judgment in this proceeding, unless otherwise ordered by the Court. 
ORDERED on 
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [ only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Guardian ad Litem Program 
Other: 
Florida Supreme Court Approved Family Law Form 12.942(b), Order Appointing Guardian ad Litem (03/09) 
120 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.943,
MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES (03/09) 
When should this form be used? 
Child support in Florida is determined by the child support guidelines found in section 61.30, Florida 
Statutes. The court, at its discretion, may raise or lower the child support guidelines amount by up to 
5%. In addition, the court may raise or lower the guidelines support amount by more than 5%, if written 
reasons are given for the adjustment. 
The court may make these additional adjustments based on 
certain considerations, which are reflected in this form. You should review this form to determine if any 
of the reasons for adjusting the child support guidelines amount apply to your situation and you should 
complete this form only if you want the court to order more child support or less child support than the 
amount required by the child support guidelines. 
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. 
What should I do next? 
A copy of this form must be 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 section 61.30, Florida Statutes. 
Special notes... 
More information on the child support guidelines as well as a chart for converting income and expenses 
to monthly amounts if paid or incurred on other than a monthly basis is contained in the instructions to 
Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), and 
the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
With this form you must also file the following, if not already filed: 
• 	
Florida Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party’s income, you should file this worksheet as soon as you receive 
a copy of his or her financial affidavit.) 
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 
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support 
Guidelines (03/09) 
121 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support 
Guidelines (03/09) 
122 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
  
 
 
                                                         
 
 
 
 
  
 
   
 
                                                                         
 
 
 
 
                                                                          
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES 
( 
) Petitioner ( 
) Respondent requests that the Court enter an order granting the following: 
SECTION I 
[one only] 
a. 	
___MORE child support than the amount required by the child support guidelines. The 
Court should order MORE child support than the amount required by the child support 
guidelines because of: 
[√ all that apply to your situation] 
1. 	
___Extraordinary medical, psychological, educational, or dental expenses; 
2. 	
___Seasonal variations in one or both parent's income or expenses ; 
3. 	
___Age(s) of the child(ren), taking into consideration the greater needs of older child(ren); 
4. 	
___Special needs, such as costs that may be associated with the disability of a child or 
child(ren), that have traditionally 
been met within the family budget even though the 
fulfilling of those needs will cause support to exceed the presumptive amount established 
by the guidelines; 
5. 	
___Total available assets of obligee, obligor, and the child(ren); 
6. 	
___Impact of IRS dependency exemption and waiver of that exemption; 
7. 	
___The Parenting Plan, such as where the child or children spend a significant amount of 
time, but less than 40 percent of the overnights, with one parent, thereby reducing the 
financial expenditures incurred by the other parent, or the refusal of a parent to become 
involved in the activities of the child(ren); 
8. 	
___Any other adjustment that is needed to achieve an equitable result, which may include 
reasonable and necessary expenses or debts jointly incurred during the marriage. 
Explain any items marked above: ____________________________________________ 
. 
b. 	
___LESS child support than the amount required by the child support guidelines. The 
Court should order LESS child support than the amount required by the child support 
guidelines because of: 
[√ all that apply to your situation] 
1. 	
___ Extraordinary medical, psychological, educational, or dental expenses; 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(03/09) 
123 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
               
 
 
 
               
 
 
               
 
 
               
 
 
               
 
 
 
 
 
             
 
                
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
 
                   
                    
                 
2. 	
___Independent income of child(ren), excluding the child(ren)’s SSI (supplemental security 
income) 
3. 	
___Payment of both child support and spousal support to a parent that regularly has been 
paid and for which there is a demonstrated need; 
4. 	
___Seasonal variations in one or both parent's income or expenses; 
5. 	
___Age of the child(ren), taking into consideration the greater needs of older child(ren); 
6. 	
___ Total available assets of obligee, obligor, and child(ren); 
7. 	
___ Impact of IRS dependency exemption and waiver of that exemption; 
8. 	
___ Application of the child support guidelines which requires the obligor to pay more than 
55% of gross income for a single support order; 
9. 	
___ Residency of subsequently born or adopted child(ren) with the obligor, include 
consideration of the subsequent spouse's income; 
10. ___ The Parenting Plan, where the child(ren) spend a significant amount of time, but less 
than 40 percent of the overnights, with one parent, thereby reducing the financial 
expenditures incurred by the other parent; or the refusal of a parent to become involved in 
the activities of the child(ren); 
11. ___Any other adjustment that is needed to achieve an equitable result, which may include 
reasonable and necessary expenses or debts jointly incurred during the marriage. 
Explain any items marked above:___________________________ 
_________________ 
. 
SECTION II. INCOME AND ASSETS OF CHILD(REN) COMMON TO BOTH PARTIES 
List the total of any independent income or assets of the child(ren) common to both parties 
(income from Social Security, gifts, stocks/bonds, employment, trust fund(s), investment(s), etc.). 
Attach an explanation. 
TOTAL VALUE OF ASSETS OF CHILD(REN)
$
TOTAL MONTHLY INCOME OF CHILD(REN)
$
SECTION III. EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES 
All amounts must be MONTHLY. See the instructions with this form to figure out money amounts 
for anything that is NOT paid monthly. Attach more paper, if needed. Items included under Aother@ 
should be listed separately with separate dollar amounts. 
1. 	
Monthly nursery, babysitting, or other child care 
1. 
$ 
2. 	
Monthly after‐school care 
2. 
$ 
3. 	
Monthly school tuition 
3. 
$ 
4. 	
Monthly school supplies, books, and fees 
4. 
$ 
5. 	
Monthly after‐school activities 
5. 
$ 
6. 	
Monthly lunch money 
6. 
$ 
7. 	
Monthly private lessons/tutoring 
7. 
$ 
8. 	
Monthly allowance 
8. 
$ 
9. 	
Monthly clothing 
9. 
$ 
10. Monthly uniforms 	
10. $ 
11. Monthly entertainment (movies, birthday parties, etc.) 	
11. $ 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(03/09) 
124 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
             
 
 
 
              
 
 
 
  
              
 
 
                
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
    
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
                 
                    
                    
                    
                    
                    
                    
 
                    
                    
 
                    
                    
 
 
 
                    
                    
                 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
        
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
                
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
  
 
   
 
 
 
   
 
 
   
 
 
  
 
 
12. Monthly health and dental insurance premiums 	
12. $ 
13. Monthly medical, dental, prescription charges (unreimbursed) 
13. $ 
14. Monthly psychiatric/psychological/counselor (unreimbursed) 
14. $ 
15. Monthly orthodontic (unreimbursed) 	
15. $ 
16. Monthly grooming 	
16. $ 
17. Monthly non‐prescription medications/cosmetics/toiletries/sundries 
17. $ 
18. Monthly gifts from children to others (other children, relatives, 	
18. $ 
teachers, etc.) 
19. Monthly camp or other summer activities 	
19. $ 
20. Monthly clubs (Boy/Girl Scouts, etc.) or recreational fees 
20. $ 
21. Monthly visitation expenses (for nonresidential parent) 
Explain: ______________________________________________ 
21. $ 
22. Monthly insurance (life, etc.) {explain}: ______________________ 
22. $ 
Other {explain}: 
23. ____________________________________________________ 
23. $ 
24. _____________________________________________________ 
24. $ 
25. _____________________________________________________ 
25. $ 
26. TOTAL EXPENSES FOR CHILD(REN) COMMON TO BOTH PARTIES
(add lines 1 through 25)
26. $
_______
I have filed, will file, or am filing with this form the following additional documents: 
1. 	
Florida Family Law Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c). 
2. 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
I certify that a copy of this document was [one only] ( 
) 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: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this 
motion and that the punishment for knowingly making a false statement includes fines and/or 
imprisonment. 
Dated: 
Signature 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(03/09) 
125 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
        
 
 
 
 
 
    
                                         
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
                                                             
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
      
 
 
      
 
 
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} 
, 
{state} 
, {phone} 
, helped {name} 
, 
who 
is 
the 
[ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(03/09) 
126 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.947(a),
MOTION FOR TEMPORARY SUPPORT AND TIME­SHARING WITH 
DEPENDENT OR MINOR CHILD(REN) (03/09) 
When should this form be used? 
This form may be used by: 
(1) The respondent or the petitioner in a pending dissolution of marriage action. For you to use 
this form, a petition for dissolution of marriage must have already been filed. You should use 
this form to ask the court to award any of the following: temporary use of assets; temporary 
exclusive use of the marital home; temporary responsibility for liabilities/debts; temporary 
spousal support (alimony); temporary time‐sharing schedule with minor child(ren); temporary 
child support; and other relief. 
OR 
(2) The petitioner in a pending action for support unconnected with dissolution. For you to use this 
form, a petition for support unconnected with dissolution of marriage must have already been 
filed. You should use this form to ask the court to award temporary spousal support (alimony) 
and/or temporary child support. 
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 the petition for dissolution of marriage was filed 
and keep a copy for your records. 
What should I do next? 
A copy of this form, along with all of the other forms required with this motion, must be mailed or hand 
delivered to the other party in your case. When you have filed all of the required forms, you are ready 
to set a hearing on your motion. You should check with the clerk, family law intake staff, or judicial 
assistant for information on the local procedure for scheduling a hearing. When you know the date and 
time of your hearing, you should notify the other party using a Notice of Hearing (General), Florida 
Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. 
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. Words in bold underline in these instructions are defined there. For further 
information, see chapter 61, Florida Statutes, rule 12.285, Florida Family Law Rules of Procedure, and 
rule 1.610, Florida Rules of Civil Procedure. 
Special notes... 
Instructions for Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and 
Time‐Sharing with Dependent or Minor Child(ren) (03/09)
127 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If you use paragraph 1.c. of this form to ask the court to enter a temporary injunction, the court may 
require you to post a bond. 
With this form you must also file the following, if not already filed: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d), if this case involves a minor or dependent 
child(ren). 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), if 
you are asking that temporary child support be ordered. (If you do not know the other party’s 
income, you may file this worksheet as soon as a copy of his or her financial affidavit has been 
served on you.) 
The parties seeking relief shall serve a financial affidavit (Florida Family Law Rules of Procedure Form 
12.902 (b) or (c) ) and certificate of compliance (Florida Family Law Rules of Procedure Form 12.932) 
with the notice of hearing on the motion for temporary support and time‐sharing. 
Parenting Plan. If you have reached an agreement on either a temporary Parenting Plan or time‐sharing 
schedule, the proposed temporary Parenting Plan or time‐sharing schedule, signed by both parties, 
should be filed. (Either Florida Supreme Court Family Law Form 12.995(a) or 12.995(b)). If you have not 
reached an agreement, a proposed Parenting Plan or temporary time‐sharing schedule may be filed for 
consideration by the Court. 
Temporary Order... These family law forms contain a Temporary Order for Support and Time‐Sharing 
with Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(b), 
which the judge may use. You should check with the clerk, family law intake staff, or judicial assistant to 
see if you need to bring it with you to the hearing. 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. 
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 a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and 
Time‐Sharing with Dependent or Minor Child(ren) (03/09)
128 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
  
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
MOTION FOR TEMPORARY SUPPORT AND TIME­SHARING 
G
WITH DEPENDENT OR MINOR CHILD(REN) 
The ( 
) Petitioner ( 
) Respondent requests that the Court enter an order granting the 
following temporary support: 
[complete all that apply] 
1. 
Assets and Liabilities. 
a. 
___ Award temporary exclusive use and possession of the marital home. {address} 
The Court should do this because: 
b. 
___ Award temporary use and possession of marital assets. {Specify} __________________ 
The Court should do this because: 
c. 
___ Enter a temporary injunction prohibiting the parties from disposing of any marital 
assets, other than ordinary and usual expenses. {Explain} ___________________________ 
The Court should do this because: 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time‐Sharing 
with Dependent or Minor Child(ren) (03/09) 
129 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
   
 
 
 
 
 
 
   
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
    
 
 
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
      
 
 
  
 
 
 
     
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
d. 
___ Require temporary payment of specific marital debts. {Explain} __________________ 
The Court should do this because: 
2. 
Child(ren). 
a. 
___ Enter a temporary Parenting Plan with a time‐sharing schedule for the parties’ minor 
child(ren). 
b. 
___ Enter a temporary injunction prohibiting the parties from permanently removing the 
child(ren) from the jurisdiction of the Court. The Court should do this because: __________ 
3. 	
Support. 
a. 	
___ Award temporary child support of $ 
per month. 
b. 
___ Award temporary spousal support/alimony of $ 
per month. 
The Court should do this because: 
4. 	
Attorney’s fees and costs. 
a. 	
___ Award temporary attorney’s fees of $ 
. 
b. 
___ Award temporary costs of $ 
. 
The Court should do this because: 
5. 
Other Relief. {specify}____________________________________________________________ 
6. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this motion or has already 
been filed with the Court. 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time‐Sharing 
with Dependent or Minor Child(ren) (03/09) 
130 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
                
 
 
  
 
 
 
 
 
 
 
 
 
                                                   
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
      
 
 
      
 
 
 
7. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this motion or has already been filed with the Court. 
I request that the Court hold a hearing on this matter and grant the relief specifically requested 
and any other relief this Court may deem just and proper. 
I certify that a copy of this document was [one only] ( 
) 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: 
Dated: _______________________________ 
Signature of Party 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
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 
[ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time‐Sharing 
with Dependent or Minor Child(ren) (03/09) 
131 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
    
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
        
        
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
TEMPORARY ORDER OF SUPPORT AND TIME‐SHARING 
WITH DEPENDENT OR MINOR CHILD(REN) 
This cause came before this Court for a hearing on a Motion for Temporary Support and Time‐
Sharing with Dependent or Minor Child(ren). 
The Court, having reviewed the file and heard the 
testimony, makes these findings of fact and ORDERS as follows: 
The Court has jurisdiction over the subject matter and the parties. 
SECTION I. MARITAL ASSETS AND LIABILITIES 
A. 	 Injunction. 
1. 	
( 
) Petitioner ( 
) Respondent is (are) prohibited and enjoined from disposing of any 
marital assets without the written permission of the other party or a court order. If checked 
here ( 
), the person(s) prohibited and enjoined from disposing of any marital assets may 
continue to pay all ordinary and usual expenses. 
2. 	
The Court may enforce compliance with the terms of this injunction through civil and/or 
indirect criminal contempt proceedings, which may include arrest, incarceration, and/or the 
imposition of a fine. 
3. 	
Violation of this injunction may constitute criminal contempt of court. 
4. 	
Bond. This order is conditioned upon ( 
) Petitioner ( 
) Respondent posting bond in the 
sum of 
$ 
with the clerk of this Court. 
B. 	
Temporary Use of Assets. 
1. 	
The assets listed below are temporarily determined to be marital assets. Each party shall 
temporarily have the use of, as his/her own, the assets awarded in this section, and the 
other party shall temporarily have no further use of said assets. Any personal property not 
listed below shall be for the use of party currently in possession of that item(s), and he or 
she may not dispose of that item(s) without the written permission of the other party or a 
court order. 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
132 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ASSETS: DESCRIPTION OF ITEM(S) 
Wife Shall 
Have 
Temporary 
Use 
Husband 
Shall Have 
Temporary 
Use 
Automobiles 
Furniture & furnishings in home 
Furniture & furnishings elsewhere 
Jewelry 
Business interests 
Other Assets 
C. 	
Temporary Responsibility for Liabilities/Debts. 
1. 	
The liabilities listed below are temporarily determined to be marital. Each party shall pay as 
his or her own the marital liabilities indicated below and shall keep said payments current. 
The other party shall temporarily have no further responsibility for the payment of these 
debts. 
LIABILITIES: DESCRIPTION OF DEBT(S) 
Current 
Amount 
Owed 
Wife 
Shall Pay 
Husband 
Shall Pay 
Mortgages on real estate: (home) 
$ 
$ 
$ 
Charge/credit card accounts 
Auto loan 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
133 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
          
        
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LIABILITIES: DESCRIPTION OF DEBT(S) 
Current 
Amount 
Owed 
Wife 
Shall Pay 
Husband 
Shall Pay 
Auto loan 
Bank/Credit Union loans 
Money owed (not evidenced by a note) 
Other 
SECTION II. TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME 
[√ all that apply] 
1. 	
___ ( 
) Petitioner ( 
) Respondent shall have temporary exclusive use and possession of the 
dwelling located at: {address} 
until {date or event} 
. 
2. 	
___ 
( 
) Petitioner ( 
) Respondent may make a visit to the premises described in the 
paragraph above for the purpose of obtaining his or her clothing and items of personal health 
and hygiene and to obtain any items awarded in this order. This visit shall occur after notice to 
the person granted temporary exclusive use and possession of the dwelling and at the earliest 
convenience of both parties. 
3. 	
___ Other: ________________________________________________________________ 
SECTION III. 
TEMPORARY PARENTAL RESPONSIBILITY AND TIME‐SHARING WITH DEPENDENT OR 
MINOR CHILD(REN) 
1. 	
Jurisdiction. 
The Court has jurisdiction to determine temporary parental responsibility and 
time‐sharing for the parties’ minor child(ren) listed in paragraph 2 below. 
2. 	
The parties= = dependent or minor child(ren) is (are): 
Name 
Birth date 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
134 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
        
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
         
           
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
_____________________________________________________________________ 
 
 
 
 
    
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
  
_____________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________ 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
3. 
Temporary Parental Responsibility for the Minor Child(ren). 
[ one only] 
a. 	
___ The parties shall have temporary shared parental responsibility for the parties’ minor 
child(ren). 
b. 	
___ 
( 
) Mother ( 
) Father shall have temporary sole parental responsibility for the 
parties’ minor child(ren). Temporary shared parental responsibility would be detrimental to 
the child(ren) at this time because 
. 
c. 	
( 
) Mother ( 
) Father shall have ultimate decision making authority regarding the 
following: 
___________________________________________________________________________. 
d. 	
Other provisions: __________________________________________________________ 
4. 
Temporary Time‐sharing Schedule with Minor Child(ren). The parent(s) shall have: 
[one only] 
a. 	
___ reasonable time‐sharing schedule with the parties’ minor child(ren) as agreed to by the 
parties, subject to any limitations in paragraph 5 below. The Court reserves jurisdiction to 
set a specific schedule. 
b. 	
___the following specified time‐sharing schedule with the parties’ minor child(ren), subject 
to any limitations set out in paragraph 5 below: {specify days and times} ______________ 
Mother’s Temporary Time‐Sharing Schedule . 
Father’s Temporary Time‐sharing Schedule. 
c. 	
___ Time‐sharing in accordance with the temporary Parenting Plan attached as Exhibit ___. 
d. 	
___ no contact with the parties’ minor child(ren) until further order of the Court, due to the 
existing conditions that are detrimental to the welfare of the minor child(ren). {explain} 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
135 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
   
 
 
   
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
   
   
 
 
 
 
        
        
 
 
 
          
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
      
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
         
 
       
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
5. 	
Limitations on Time‐sharing. Neither parent shall take the child(ren) from the other parent or 
any child care provider or other person entrusted by the other parent with the care of the 
child(ren) without the agreement of the other party during the other party’s time‐sharing. The 
above time‐sharing shall be: 
[ if applies] 
a. 	
___ supervised by a responsible adult who is mutually agreeable to the parties. If the 
parties cannot agree, the supervising adult shall be: {name} _________________________. 
b. 	
___ at a supervised visitation center located at: {address} 
_________________________ 
, 
subject to the available times and rules of the supervised visitation center. The cost of such 
visits shall be paid by ( 
) Mother ( 
) Father ( 
) Both. 
6. 	
Communication Arrangements for Temporary Secondary Parenting, Visitation, and Parental 
Responsibility and Time‐sharing with Minor Child(ren). 
[if applies] 
The parties’ communications to arrange time‐sharing and discuss issues relating to the child(ren) 
(if temporary shared parenting, or time‐sharing is provided in paragraph 3 above) are restricted 
as follows: ( 
) telephone, ( 
) fax, e‐mail, or letter, ( 
) a responsible person shall coordinate 
the time‐sharing arrangements of the minor child(ren). 
If the parties cannot agree, the 
responsible person shall be: {name} 
( 
) other conditions for arrangements or discussions: {explain} 
7. 	
Exchange of Minor Child(ren). 
The exchange of the minor child(ren) shall be on time as 
scheduled and as agreed to by the parties. The following conditions, if checked below, shall also 
apply. 
[all that apply] 
a. 
___ The parties shall temporarily exchange the child(ren) at the following location(s): 
b. 
___ ( 
) Mother ( 
) Father shall not get out of the vehicle, and the other parent shall not 
approach the vehicle, during the time the child(ren) are exchanged. 
c. 
___ A responsible person shall conduct all exchanges of the child(ren). ( 
) Mother 
( 
)Father shall not be present during the exchange. 
If the parties cannot agree, the 
responsible person shall be: {name} __________________________________________ 
d. 
___ Other conditions for exchange of the child(ren) are as follows: ________________ 
8. 	
___ Injunction Prohibiting Removing the Child(ren). The Court hereby temporarily prohibits 
and enjoins the ( 
) Mother ( 
) Father ( 
) Both from permanently removing the minor 
child(ren) from the State of Florida without a court order or the written consent of the other 
party. 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
136 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
      
 
 
 
 
 
 
 
  
 
      
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
                        
 
 
 
 
 
 
  
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
                        
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
 
 
______________________________________________________________________ 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
                       
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
  
 
 
9. 
___ Other Temporary Provisions Relating to the Minor Child(ren). 
SECTION IV. TEMPORARY ALIMONY 
1. 	
( 
) The Court denies the request(s) for temporary alimony. OR 
( 
) The Court finds that there is a need for, and that ( 
) Petitioner ( 
) Respondent, 
hereinafter Obligor, has/had the present ability to pay temporary alimony as follows: 
[ √ all that apply] 
a. 
___ Temporary Periodic. Obligor shall pay temporary periodic alimony to Obligee in the 
amount of $ 
per month, payable ( 
) in accordance with Obligor’s employer’s 
payroll cycle, and in any event, at least once a month ( 
) other {explain} 
, 
beginning {date} 
. This temporary periodic alimony shall continue until modified by court 
order, the death of either party, or until, {date/event} 
, 
whichever occurs first. 
b. 
___ Lump Sum. Obligor shall pay temporary lump sum alimony to Obligee in the amount of 
$ 
. This amount shall be paid as follows: 
. 
c. 	
___ Rehabilitative. Obligor shall pay temporary rehabilitative alimony to Obligee in the 
amount of $ 
per month, payable ( 
) in accordance with Obligor’s employer’s 
payroll cycle, and in any event, at least once a month ( 
) other {explain} _______________ 
beginning {date} 
. 
This temporary rehabilitative alimony shall continue until 
modified 
by 
court 
order, 
the 
death 
of 
either 
party 
or 
until 
{date/event} 
,_________________whichever 
occurs 
first. 
The 
temporary 
rehabilitative 
plan 
presented demonstrated the following:_______________________________________ 
. 
d. 	
___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ 
for 
the period of {date} 
through {date} 
, which shall be paid pursuant 
to paragraph 3 below. 
2. 	
Reasons 
for 
Awarding/Denying 
Temporary 
Alimony 
Award. 
The 
reasons 
for 
awarding/denying temporary alimony are as follows: 
a. 	
___ length of the marriage of the party receiving temporary alimony: 
years; 
b. 	
___ age of party receiving temporary alimony: 
; 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
137 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
        
 
      
 
 
 
  
 
 
 
___________________________________________________________________________ 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
                        
 
 
  
 
   
 
 
 
 
 
 
 
 
                       
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
  
        
        
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
  
 
 
 
 
                        
 
 
 
 
                           
 
 
 
 
 
                      
 
 
 
 
 
                      
 
 
  
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
          
 
 
 
 
 
   
 
 
 
 
 
c. 	
___ health of party receiving temporary alimony: ( 
) excellent ( 
) good ( 
) poor 
( 
) other __________________________________________________________________; 
d. 	
___ other factors ____________________________________________________________ 
9 Check here if additional pages are attached. 
3. 	
Retroactive Alimony. ( 
) Petitioner ( 
) Respondent shall pay to the other party the temporary 
retroactive alimony of $ 
, as of {date} 
. 
This amount shall be paid in the 
amount of $ 
per month, payable in accordance with Obligor=s employer=s payroll 
cycle, and in any event at least once a month ( 
) other {explain} 
__________________ 
beginning {date} 
, until paid in full including statutory interest. 
4. 
Insurance. 
[ √ all that apply] 
a. 
___ Health Insurance. ( 
) Petitioner ( 
) Respondent shall temporarily be required to pay 
health insurance premiums for the other party not to exceed $ 
per month. 
Further, ( 
) Petitioner ( 
) Respondent shall pay any uninsured medical costs for the other 
party not exceed $ 
per year. As to these uninsured medical expenses, the party 
who is entitled to reimbursement of the uninsured medical expense shall submit request for 
reimbursement to the other party within 30 days, and the other party shall, within 30 days 
after receipt, submit the applicable reimbursement for that expense. 
b. 	
___ 
Life Insurance (to secure payment of support). 
To secure the temporary alimony 
obligations set forth in this order, the Obligor shall temporarily maintain life insurance 
coverage on his/her life naming the Obligee as the sole irrevocable beneficiary, so long as 
reasonably available. 
This temporary insurance shall be in the amount of at least 
$ 
and shall remain in effect until this temporary obligation for alimony 
terminates. 
5. 	
Other provisions relating to temporary alimony: 
______________________________ 
SECTION V. TEMPORARY CHILD SUPPORT 
1. 	
The Court finds that there is a need for temporary child support and that the ( 
) Mother ( 
) 
Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the 
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), 
filed by the ( 
) Mother ( 
) Father are correct OR the Court makes the following findings: The 
Mother’s net monthly income is $ 
.The Father’s net monthly income is $ 
. 
Monthly child care costs are $ 
. Monthly health/dental insurance costs are 
$
. 
2. 	
Amount. Obligor shall be obligated to pay temporary child support in the amount of $ 
______ 
per month payable ( 
) in accordance with Obligor’s payroll cycle, and in any event at least once 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
138 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
    
 
        
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
                      
 
 
  
 
   
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
  
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
        
        
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
        
        
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
                        
        
 
        
 
        
 
 
 
        
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
a month ( 
) {explain} 
beginning {date} 
, and continuing until further court order or until 
{date/event}____________________________________________________________________, 
{explain} 
. 
If the temporary child support ordered deviates from the guidelines by more than 5%, the 
factual findings which support that deviation are: 
. 
3. 
Retroactive Child Support. 
[ if applies] 
( 
) Mother ( 
) Father shall pay to the other party the temporary retroactive child support of 
$ 
, as of {date} 
. 
This amount shall be paid in the amount of 
$ 
per month, payable in accordance with Obligor’s employer’s payroll cycle, and in 
any event at least once a month ( 
) other {explain} 
beginning {date} 	
, until paid in full including statutory interest. 
4. 
Insurance. 
[ √ all that apply] 
a. 	
___ Health/Dental Insurance. ( 
) Mother ( 
) Father shall be required to temporarily 
maintain ( 
) health ( 
) dental insurance coverage for the parties’ minor child(ren), so 
long as reasonably available. The party providing coverage shall be required to convey 
cards showing coverage to the other party. OR ( 
) Health ( 
) dental insurance is not 
reasonably available at this time. 
b. 	
___ Reasonable and necessary uninsured medical/dental/prescription drug costs for 
the minor child(ren) shall temporarily be assessed as follows: 
( 
) Shared equally by both parents. 
( 
) Prorated according to the child support guideline percentages. 
( 
) Other {explain}: 
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the 
expense shall submit request for reimbursement to the other party within 30 days, and the 
other party, within 30 days of receipt, shall submit the applicable reimbursement for that 
expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). 
To secure the temporary child support 
obligations in this order, ( 
) Petitioner ( 
) Respondent ( 
) Each party shall temporarily 
maintain life insurance coverage, in an amount of at least $ 
, on ( 
) his life ( 
) her 
life ( 
) his/her life naming the ( 
) minor child(ren) as the sole irrevocable beneficiary(ies) ( 
) 
primary residential parent as the sole irrevocable beneficiary as Trustee for the minor child(ren), 
so long as reasonably available. The obligation to maintain the life insurance coverage shall 
continue until the Court orders otherwise or until {date/event} _______________________ 
. 
6. 	
IRS Income Tax Deduction(s). The assignment of any tax deduction for the child(ren) shall be as 
follows: __________________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
139 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
 
   
 
 
 
 
   
 
                        
   
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
______________________________________________________________________ 
_____________________________________________________________________
 
_____________________________________________________________________ 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
         
 
        
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. 
Other provisions relating to temporary child support: 
______________________________ 
SECTION VI. METHOD OF PAYMENT 
Obligor shall pay any temporary court‐ordered child support/alimony and arrears, if any, as follows: 
1. 
Central Governmental Depository. 
[ if applies] 
a. 	
___ 
Obligor shall pay temporary court‐ordered support directly to the Central 
Governmental Depository in {name} 
County, 
along 
with 
any 
depository service charge. 
b. 	
___ Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that temporary support payments need not be directed through the Central 
Governmental Depository. However, either party may subsequently apply to the depository 
pursuant to section 61.13(1)(d)3, Florida Statutes, to require payments through the Central 
Governmental Depository. 
2. 
Income Deduction. 
[√ if applies] 
a. 	
___ Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this temporary support obligation until all of said support is deducted from Obligor=s 
income. Until temporary support payments are deducted from Obligor=s paycheck, Obligor is 
responsible for making timely payments directly to the Central Governmental Depository or 
the Obligee, 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 in cases of modification, 
AND 
( 
) there is an agreement by the Obligor to advise the central governmental depository of 
any change in payor and health insurance OR ( 
) there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant to the payment 
method prescribed above. 
4. 	
Other provisions relating to method of payment. _________________________________ 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
140 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
  
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
                       
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
  
           
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
                                              
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
       
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
SECTION VII. TEMPORARY ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___ ( 
) Petitioner’s ( 
) Respondent’s request(s) for temporary attorney fees, costs, and suit 
money is (are) denied because 	 _______________________________________________ 
. 
2. 	
___ The Court finds there is a need for and an ability to pay temporary attorney fees, costs, and 
suit money. ( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party 
$ 
in temporary attorney fees, and $ 
in costs. The Court further finds that 
the temporary attorney fees awarded are based on the reasonable rate of $ 
per hour 
and 
reasonable hours. Other provisions relating to temporary attorney fees, costs, 
and suit money are as follows: ________________________________________________ 
SECTION VIII. OTHER PROVISIONS 
Other Provisions: 
ORDERED on {date} 
, at {time} 	
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} _________________________________ was [only one] 
( ) mailed ( ) faxed and mailed ( ) hand delivered to the parties listed below on 
{ date}____________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time‐Sharing with 
Dependent or Minor Child(ren) (03/09) 
141 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
           
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
   
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
   
 
 
   
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
   
     
 
 
 
 
   
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
  
     
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY 
LAW FORM 12.960,
MOTION FOR CIVIL CONTEMPT/ENFORCEMENT
(03/09) 
When should this form be used? 
You may use this form to ask the court to enforce a prior court order or final judgment. 
What should I do next? 
To initiate a civil contempt/enforcement proceeding against a party who is not complying with a 
prior court order, you must file a motion with the court explaining what the party has failed to do. 
This form should be typed or printed in black ink. After completing this form, you should sign it 
before a notary public or deputy clerk. You should then 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. 
A copy of this form must be personally served by a sheriff or private process server or mailed* or 
hand delivered to any other party(ies) in your case. *Please note that if notice is mailed, the court in 
certain circumstances may not consider mailing to be adequate notice. If you want to be sure, you 
should have the motion personally served. 
This is a technical area of the law; if you have any 
questions about it, you should consult a lawyer. For more information on personal service, see the 
instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure 
Form 12.910(a). 
The court will then set a hearing. You should check with the clerk of court, judicial assistant, or 
family law intake staff for information on the local procedure for scheduling a hearing. Once you 
know the time and date of the hearing, you will need to complete Notice of Hearing on Motion for 
Contempt/Enforcement, Florida Supreme Court Approved Family Law Form 12.961, or, if applicable, 
Notice of Hearing (Child Support Enforcement Hearing Officer), Florida Supreme Court Approved 
Family Law Form 12.921, or [Notice of Hearing Before] General Magistrate, Florida Family Law 
Rules of Procedure Form 12.920[(c)], which will specify a time and place for a hearing on the issue. 
A copy of this form must be mailed or hand delivered to the other party. Again, if notice is mailed, 
the court in certain circumstances may not consider mailing to be adequate notice. If you want to 
be sure, you should have the notice personally served. This is a technical area of the law; if you have 
any questions about it, you should consult a lawyer. For more information on personal service, see 
the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of 
Procedure Form 12.910(a). 
At the hearing, as in any other civil proceeding, you, as the moving party, will have the burden of 
proving the other party has not obeyed a prior court order. Once noncompliance is established, the 
other party will have an opportunity to show an inability to comply with the prior court order. If he 
or she is unable to do so, the judge may find the other party to be in contempt. If so, the judge may 
order appropriate sanctions to compel compliance by the other party, including jail, payment of 
attorneys’ fees, suit money, or costs, and coercive or compensatory fines, and may order any other 
relief permitted by law. 
Instructions 
for 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form 
12.960, 
Motion 
for 
Civil 
Contempt/Enforcement (03/09) 
142 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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. See also section 61.14, Florida Statutes and rule 12.615, Florida 
Family Law Rules of Procedure. 
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. 
Instructions 
for 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form 
12.960, 
Motion 
for 
Civil 
Contempt/Enforcement (03/09) 
143 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                         
 
 
 
 
  
 
   
 
                                                                         
 
 
 
 
                                                                          
 
 
 
 
 
 
 
      
 
      
 
 
 
 
 
 
 
 
 
 
 
        
        
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
MOTION FOR CIVIL CONTEMPT/ENFORCEMENT 
( 
) 
Petitioner 
( 
) 
Respondent 
requests 
that 
the 
Court 
enter 
an 
order 
of 
civil 
contempt/enforcement against ( 
) Petitioner ( 
) Respondent in this case because: 
1. 	
A final judgment or order {title of final judgment or order}__________________________ 
in this case was entered on {date} 
, by {court, city, and state} 
. 
9 Check here if the judgment or order is not from this Court and attach a copy. 
2. 	
This order of the Court required the other party in this case to do or not do the following: 
{Explain what the other party was ordered to do or not do.} __________________________ 
G Check here if additional pages are attached. 
3. 	
The other party in this case has willfully failed to comply with this order of the Court: {Explain 
what the other party has or has not done.} _________________________________ 
G Check here if additional pages are attached. 
4. 	
I respectfully request that the Court issue an order holding the above‐named person in civil 
contempt, if appropriate, and/or providing the following relief: 
a. 	
___enforcing or compelling compliance with the prior order or judgment; 
b. 	
___awarding a monetary judgment; 
Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/09)
144 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
   
 
 
   
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
       
       
 
 
       
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
                                                    
c. 	
___if a monetary judgment was included in the prior order, issuing a writ of execution 
or garnishment or other appropriate process; 
d. 	
___awarding prejudgment interest; 
e. 	
___requiring the other party to pay costs and fees in connection with this motion; 
f. 	
___if the other party is found to be in civil contempt, ordering a compensatory fine; 
g. 	
___if the other party is found to be in civil contempt, ordering a coercive fine; 
h. 	
___if the other party is found to be in civil contempt, ordering incarceration of the other 
party; 
i. 	
___issuing a writ of possession for real property, writ for possession of personal 
property, or other appropriate writ; 
j. 	
___issuing a writ of bodily attachment if the other party fails to appear at the hearing 
set on this motion; 
k. 	
___requiring the other party to make payments through the central governmental 
depository; 
l. 	
___requiring the support payments to be automatically deducted from the other party’s 
income or funds; 
m. 	 ___requiring the other party to seek employment; 
n. 	
___awarding make‐up time‐sharing with minor child(ren) as follows {explain}: 
; and 
o. 	
___ awarding other relief {explain}: 
. 
I certify that a copy of this document was [/ one only] ( ) 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: 
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: _______________________ 
Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/09)
145 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
   
 
 
   
 
 
  
 
 
 
 
 
    
                                      
 
 
 
 
 
 
 
 
 
                                      
 
  
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
  
 
 
 
    
                                            
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
      
 
 
      
 
 
 
 
Signature of Party 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF 
_____________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced 
______________________________ 
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 
[
 √ 
one 
only] 
petitioner 
or 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/09)
146 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.980(a), PETITION FOR INJUNCTION FOR PROTECTION AGAINST
DOMESTIC VIOLENCE (03/09) 
When should this form be used? 
If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in 
imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a 
protective order prohibiting domestic violence. Because you are making a request to the court, you are 
called the petitioner. The person whom you are asking the court to protect you from is called the 
respondent. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, 
sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any 
other criminal offense resulting in physical injury or death to petitioner by any of petitioner’s family or 
household members. 
In determining whether you have reasonable cause to believe you are in 
imminent danger of becoming a victim of domestic violence, the court must consider all relevant factors 
alleged in the petition, including, but not limited to the following: 
1. 	
The history between the petitioner and the respondent, including threats, harassment, stalking, 
and physical abuse. 
2. 	
Whether the respondent has attempted to harm the petitioner or family members or individuals 
closely associated with the petitioner. 
3. 	
Whether the respondent has threatened to conceal, kidnap, or harm the petitioner=s child or 
children. 
4. 	
Whether the respondent has intentionally injured or killed a family pet. 
5. 	
Whether the respondent has used, or has threatened to use, against the petitioner any weapons 
such as guns or knives. 
6. 	
Whether the respondent has physically restrained the petitioner from leaving the home or 
calling law enforcement. 
7. 	
Whether the respondent has a criminal history involving violence or the threat of violence. 
8. 	
The existence of a verifiable order of protection issued previously or from another jurisdiction. 
9. 	
Whether the respondent has destroyed personal property, including, but not limited to, 
telephones or other communications equipment, clothing, or other items belonging to the 
petitioner. 
10. Whether the respondent engaged in any other behavior or conduct that leads the petitioner to 
have reasonable cause to believe that he or she is in imminent danger of becoming a victim of 
domestic violence. 
The domestic violence laws only apply to your situation if the respondent is your spouse, former spouse, 
related to you by blood or marriage, living with you now or has lived with you in the past (if you are or 
were living as a family), or the other parent of your child(ren) whether or not you have ever been 
married or ever lived together. With the exception of persons who have a child in common, the family 
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
147 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
or household members must be currently residing together or have in the past resided together in the 
same single dwelling unit. If the respondent is not one of the above, you should look at Petition for 
Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 
12.980(f), to determine if your situation will qualify for an injunction for protection against repeat 
violence, or Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court 
Approved Family Law Form 12.980(n), to determine if your situation will qualify for an injunction for 
protection against dating violence, or Petition for Injunction for Protection Against Sexual Violence, 
Florida Supreme Court Approved Family Law Form 12.980(q), to determine if your situation will qualify 
for an injunction for protection against sexual violence. 
If you are under the age of eighteen and you have never been married or had the disabilities of nonage 
removed by a court, then one of your parents or your legal guardian must sign this petition with you. 
This form should be typed or printed in black ink. You should complete this form (giving as much detail 
as possible) and sign it in front of a notary public or the clerk of the circuit court in the county where 
you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. 
If you have any questions or need assistance completing this form, the clerk or family law intake staff 
will help you. 
What should I do if the judge grants my petition? 
If the facts contained in your petition convince the judge that you are a victim of domestic violence or 
that an imminent danger of domestic violence exists, the judge will sign an immediate Temporary 
Injunction for Protection Against Domestic Violence with Minor Child(ren), Florida Supreme Court 
Approved Family Law Form 12.980(c)(1). A temporary injunction is issued without notice to the 
respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with 
your petition to the sheriff or other law enforcement officer for personal service on the respondent. The 
temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts 
until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend 
the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service 
on the respondent. 
The temporary injunction is issued ex parte. 
This means that the judge has considered only the 
information presented by one side‐‐ YOU. The temporary injunction gives a date that you should appear 
in court for a hearing. At that hearing, you will be expected to testify about the facts in your petition. 
The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge 
will decide whether to issue a Final Judgment of Injunction for Protection Against Domestic Violence 
with Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(1), 
which will remain in effect for a specific time period or until modified or dissolved by the court. If you 
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
148 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
and/or the respondent do not appear, the temporary injunction may be continued in force, extended, 
or dismissed, and/or additional orders may be granted, including the imposition of court costs. 
If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. 
Make sure that you keep one certified copy of the injunction with you at all times! 
What can I do if the judge denies my petition? 
If your petition is denied solely on the grounds that it appears to the court that no imminent danger of 
domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition, 
unless you request that no hearing be set. The respondent will be notified by personal service of your 
petition and the hearing. 
If your petition is denied, you may: amend your petition by filing a 
Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, 
Repeat or Dating Violence, Florida Family Law Form 12.980 (g); attend the hearing and present facts 
that support your petition; and/or dismiss your petition. 
Where can I look for more information? 
Before proceeding, you should read AGeneral Information for Self‐Represented Litigants found at the 
beginning of these forms. The words that are in bold underline are defined in that section. The clerk of 
the circuit court or family law intake staff will help you complete any necessary domestic violence forms 
and can give you information about local domestic violence victim assistance programs, shelters, and 
other related services. You may also call the Domestic Violence Hotline at 1‐800‐500‐1119. For further 
information, see chapter 741, Florida Statutes, and rule 12.610, Florida Family Law Rules of Procedure. 
Special notes... 
With this form you may also need to file the following: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the 
court to determine issues with regard to your parenting plan or time‐ sharing for a minor 
child(ren). “Parenting plan” means a document created to govern the relationship between the 
parties relating to the decisions that must be made regarding the minor child(ren) and shall 
contain a time‐sharing schedule for the parents and 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 
parties, including the parties’ historic relationship, domestic violence, and other factors must be 
taken into consideration. The parenting plan shall be developed and agreed to by the parents 
and approved by a court, or, if the parents cannot agree, established by the court. “Time‐
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
149 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
sharing schedule” means a timetable that must be included in the parenting plan that specifies 
the time, including overnights and holidays, that a minor child will spend with each parent. If 
developed and agreed to by the parents of a minor child, it must be approved by the court. If 
the parents cannot agree, the schedule shall be established by the court. 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), 
must be completed and filed if you are asking the court to determine issues of temporary child 
support. 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), 
must be completed and filed if you are seeking temporary alimony or temporary child support. 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), 
MUST be filed with the court at or prior to a hearing to establish or modify child support. 
Additionally, if you fear that disclosing your address to the respondent would put you in danger, you 
should complete Petitioner’s Request for Confidential Filing of Address, Florida Supreme Court 
Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write confidential 
in the space provided on the petition. 
Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
150 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
  
 
   
 
    
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
     
  
 
     
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
   
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE 
I, {full legal name} 
, being sworn, certify 
that the following statements are true: 
SECTION I. 
PETITIONER (This section is about you. It must be completed. However, if you fear 
that disclosing your address to the respondent would put you in danger, you should complete and file 
Petitioner’s Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law 
Form 12.980(h), and write confidential in the space provided on this form for your address and 
telephone number.) 
1. 	
Petitioner’s current address is: {street address} 
{city, state and zip code} 
Telephone Number: {area code and number} 
Physical description of Petitioner: 
Race: ____ 
Sex: Male ___ 
Female ___ 
Date of Birth: ____________________________ 
2. 	
Petitioner’s attorney’s name, address, and telephone number is: 
. 
(If you do not have an attorney, write none.) 
SECTION II. 
RESPONDENT (This section is about the person you want to be protected from. It 
must be completed.) 
1. 	
Respondent’s current address is: {street address, city, state, and zip code} 
. 
Respondent’s Driver’s License number is: {if known} 	
. 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
151 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
   
 
 
 
 
     
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
         
 
         
         
 
 
  
 
               
               
 
               
 
  
 
 
 
 
  
 
 
   
 
 
    
 
 
    
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
          
           
 
 
 
 
   
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
2. 
Respondent is: 
[ all that apply] 
a. 	
___the spouse of Petitioner. Date of Marriage: 
the former spouse of Petitioner. 
b. 
___Date of Marriage: 
c. 	
___Date of Dissolution of Marriage: 
related by blood or marriage to Petitioner. 
Specify relationship: 
d. 
___a person who is or was living in one home with Petitioner, as if a family. 
e. 	
___a person with whom Petitioner has a child in common, even if Petitioner and 
Respondent never were married or living together. 
3. 	
Petitioner has known Respondent since {date} 
. 
4. 	
Respondent’s last known place of employment: 
Employment address: 
Working hours: 
5. 	
Physical description of Respondent: 
Race: 
Sex: Male 
Female 
Date of Birth: 
Height: 
Weight: 
Eye Color: 
Hair Color: 
Distinguishing marks or scars: 
Vehicle: (make/model) 
Color: 
Tag Number: 
6. 	
Other names Respondent goes by (aliases or nicknames): 
7. 	
Respondent’s attorney’s name, address, and telephone number is: 
(If you do not know whether Respondent has an attorney, write unknown. If Respondent does 
not have an attorney, write none.) 
SECTION III. 
CASE HISTORY AND REASON FOR SEEKING PETITION 
(This section must be 
completed.) 
1. 	
Has Petitioner ever received or tried to get an injunction for protection against domestic 
violence against Respondent in this or any other court? 
Yes 
No 
If yes, what happened in that case? (include case number, if known) 
Has Respondent ever received or tried to get an injunction for protection against domestic violence 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
152 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
          
              
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
against Petitioner in this or any other court? 
Yes 
No 
If yes, what happened in that case? (include case number, if known) 
2. 	
Describe any other court case that is either going on now or that happened in the past, 
including a dissolution of marriage, paternity action, or child support enforcement action, 
between Petitioner and Respondent {include city, state, and case number, if known}: 
3. 	
Petitioner is either a victim of domestic violence or has reasonable cause to believe 
he or she is in imminent danger of becoming a victim of domestic violence because respondent 
has (mark all sections that apply and describe in the spaces below the incidents of violence or 
threats of violence, specifying when and where they occurred, including, but not limited to, 
locations such as a home, school, place of employment, or time‐sharing exchange): 
a. 	
___committed or threatened to commit domestic violence defined in s. 741.28, Florida 
Statutes, as any assault, aggravated assault, battery, aggravated battery, sexual assault, 
sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal 
offense resulting in physical injury or death of one family or household member by another. 
With the exception of persons who are parents of a child in common, the family or 
household members must be currently residing or have in the past resided together in the 
same single dwelling unit. 
b. 	
___previously threatened, harassed, stalked, or physically abused the petitioner. 
c. 	
___attempted to harm the petitioner or family members or individuals closely associated 
with the petitioner. 
d. 	
___threatened to conceal, kidnap, or harm the petitioner's child or children. 
e. 	
___intentionally injured or killed a family pet. 
f. 	
___used, or has threatened to use, against the petitioner any weapons such as guns or 
knives. 
g. 	
___physically restrained the petitioner from leaving the home or calling law enforcement. 
h. 	
___a criminal history involving violence or the threat of violence (if known). 
i. 	
___another order of protection issued against him or her previously or from another 
jurisdiction (if known). 
j. 	
___destroyed personal property, including, but not limited to, telephones or other 
communication equipment, clothing, or other items belonging to the petitioner. 
k. 	
___engaged in any other behavior or conduct that leads the petitioner to have reasonable 
cause to believe he or she is in imminent danger of becoming a victim of domestic violence. 
Below is a brief description of the latest act of violence or threat of violence that causes 
Petitioner to honestly fear imminent domestic violence by Respondent. (Use additional sheets if 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
153 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
      
 
  
 
 
 
  
 
   
 
 
          
 
 
 
 
 
 
           
  
 
   
 
 
 
 
    
 
 
 
        
 
 
 
 
 
 
 
   
 
 
         
             
 
 
 
 
 
 
 
 
 
 
         
            
 
 
   
 
 
 
 
         
             
 
necessary.) 
On {date} 
, at {location} 
, 
the Respondent 
. 
[ ] Check here if you are attaching additional pages to continue these facts. 
4. 
Additional Information 
[ all that apply] 
a. 
___Other acts or threats of domestic violence as described on attached sheet. 
b. 	
___This or other acts of domestic violence have been previously reported to {person or 
agency}:_____________________________________________________________ 
c. 
___Respondent owns, has, and/or is known to have guns or other weapons. 
Describe weapon(s): 
d. ___ Respondent has a drug problem. 
e. ___ Respondent has an alcohol problem. 
f. ___ 	 Respondent has a history of mental health problems. If checked, answer the following, if 
known. 
Has Respondent ever been the subject of a Baker Act proceeding? ( 
) Yes 
( 
) No 
Is Respondent supposed to take medication for mental health problems? ( 
) Yes 
( 
) No 
If yes, is Respondent currently taking his/her medication? ( 
) Yes 
( 
) No 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
154 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION IV. 
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME (Complete this section 
only if you want the Court to grant you temporary exclusive use and possession of the home that you 
share with the Respondent.) 
1. 
Petitioner claims the following about the home that Petitioner and Respondent share or that 
Petitioner left because of domestic violence: 
[ all that apply] 
a. 
___Petitioner needs the exclusive use and possession of the home that the parties share at 
{street address} 
, 
{city, state, zip code} 
. 
b. 
___Petitioner cannot get another safe place to live because: 
. 
c. 
___If kept out of the home, Respondent has the money to get other housing or may live 
without money at {street address} 
{city, state, zip code} 
, 
. 
2. 
The home is: 
[one only] 
a. 
___owned or rented by Petitioner and Respondent jointly. 
b. 
___solely owned or rented by Petitioner. 
c. 
___solely owned or rented by Respondent. 
SECTION V. 
TEMPORARY PARENTING PLAN WITH TEMPORARY TIME‐SHARING SCHEDULE FOR 
MINOR CHILD(REN) (Complete this section only if you are asking the court to provide a temporary 
parenting plan, including a temporary time‐sharing schedule with regard to, the minor child or children 
of the parties which might involve prohibiting or limiting time‐sharing or requiring that it be supervised 
by a third party. You must be the natural parent, adoptive parent, or guardian by court order of the 
minor child(ren). 
If you are asking the court to provide a temporary parenting plan, including a 
temporary time‐sharing schedule with regard to, the minor child or children of the parties which might 
involve prohibiting or limiting time‐sharing or requiring that it be supervised by a third party, you must 
also complete and file a Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, 
Florida Supreme Court Approved Family Law Form 12.902(d).) 
Note: If the paternity of the minor child(ren) listed below has not been established through either 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
155 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
marriage or court order, the Court may deny a request to provide a temporary parenting plan, 
including a temporary time‐sharing schedule with regard to, the minor child or children, and/or a 
request for child support. 
1. 	
Petitioner is the natural parent, adoptive parent, or guardian by court order of the minor 
child(ren) whose name(s) and age(s) is (are) listed below. 
Name 	
Place of Birth 
Birth date 
Sex 
2. 	
The minor child(ren) for whom Petitioner is asking the court to provide a temporary parenting 
plan, including a temporary time‐sharing schedule with regard to: 
[√ one only] 
a. 
___saw the domestic violence described in this petition happen. 
b. 
___were at the place where the domestic violence happened but did not see it. 
c. 	
___were not there when the domestic violence happened this time but have seen 
previous acts of domestic violence by Respondent. 
d. 
___have not witnessed domestic violence by Respondent. 
3. 	
Name any other minor child(ren) who were there when the domestic violence happened. 
Include child(ren)’s name, age, sex, and parents’ names. 
4. 
Temporary Parenting Plan and Temporary Time‐Sharing Schedule 
[all that apply] 
a. 
___Petitioner requests that the Court provide a temporary parenting plan, including a 
temporary time‐sharing schedule with regard to, the minor child or children of the parties, 
as follows: 
b. 
___Petitioner requests that the Court order supervised exchange of the minor child(ren) or 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
156 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
   
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
        
        
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
exchange through a responsible person designated by the Court. The following person is 
suggested as a responsible person for purposes of such exchange. Explain: 
c. 
___Petitioner requests that the Court limit time‐sharing by Respondent with the minor 
child(ren). Explain: 
d. 
___Petitioner requests that the Court prohibit time‐sharing by Respondent with the minor 
child(ren) because Petitioner genuinely fears that Respondent imminently will abuse, 
remove, or hide the minor child(ren) from Petitioner. Explain: 
e. 
___Petitioner requests that the Court allow only supervised time‐sharing by Respondent 
with the minor child(ren). Explain: ______________________________________________ 
Supervision 
should 
be 
provided 
by 
a 
Family 
Visitation 
Center, 
or 
other 
(specify):_______________________________________________________________________ 
SECTION VI. 
TEMPORARY SUPPORT (Complete this section only if you are seeking financial 
support from the Respondent. You must also complete and file a Family Law Financial Affidavit, Florida 
Family Law Rules of Procedure Form 12.902(b) or (c), and Notice of Social Security Number, Florida 
Supreme Court Approved Family Law Form 12.902(j), if you are seeking child support. A Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), must be filed with the 
court at or prior to a hearing to establish or modify child support.) 
[ all that apply] 
1. 	
___Petitioner claims a need for the money he or she is asking the Court to make Respondent 
pay, and that Respondent has the ability to pay that money. 
2. 	
___Petitioner requests that the Court order Respondent to pay the following temporary alimony 
to Petitioner. 
(Petitioner must be married to Respondent to ask for temporary alimony.) 
Temporary Alimony Requested $ 
every ( 
) week ( 
) other week ( 
) month. 
3. 	
___Petitioner requests that the Court order Respondent to pay the following temporary child 
support to Petitioner. 
(The respondent must be the natural parent, adoptive parent, or 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
157 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
                       
        
        
 
        
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
guardian by court order of the minor child(ren) for the court to order the respondent to pay 
child support.) Temporary child support is requested in the amount of $ 
every ( 
) 
week ( 
) other week ( 
) month. 
SECTION VII. 
INJUNCTION (This section summarizes what you are asking the Court to include in 
the injunction. This section must be completed.) 
1. 	
Petitioner asks the Court to enter a TEMPORARY INJUNCTION for protection against domestic 
violence that will be in place from now until the scheduled hearing in this matter. 
2. 	
Petitioner asks the Court to enter, after a hearing has been held on this petition, a final 
judgment on injunction prohibiting Respondent from committing any acts of domestic violence 
against Petitioner and: 
a. 	
prohibiting Respondent from going to or within 500 feet of any place the Petitioner 
lives; 
b. 	
prohibiting Respondent from going to or within 500 feet of the Petitioner’s place(s) 
of employment or school; the address of Petitioner’s place(s) of employment or school is: 
c. 	
prohibiting Respondent from contacting Petitioner by mail, by telephone, through 
another person, or in any other manner; 
d. 	
prohibiting Respondent from knowingly and intentionally going to or within 100 feet 
of Petitioner’s motor vehicle. 
e. 
prohibiting Respondent from defacing or destroying Petitioner=s personal property. 
[√ all that apply] 
f. 
___prohibiting Respondent from going to or within 500 feet of the following place(s) 
Petitioner or Petitioner=s minor child(ren) must go often {include address}: 
g. 
___granting Petitioner temporary exclusive use and possession of the home Petitioner and 
Respondent share; 
h. 
___granting Petitioner on a temporary basis 100% of the time sharing with the parties’ 
minor child(ren); 
i. 
___establishing a temporary parenting plan including a temporary time‐sharing schedule for 
the parties’ minor child(ren); 
j. 
___granting temporary alimony for Petitioner; 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
158 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_____________ 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
k. 
___granting temporary child support for the minor child(ren); 
l. 
___ordering Respondent to participate in treatment, intervention, and/or counseling 
services; 
m. 
___referring Petitioner to a certified domestic violence center; and 
any other terms the Court deems necessary for the protection of Petitioner and/or 
Petitioner’s child(ren), including injunctions or directives to law enforcement agencies, as 
provided in section 741.30, Florida Statutes. 
I UNDERSTAND THAT BY FILING THIS PETITION, I AM ASKING THE COURT TO HOLD A HEARING 
ON THIS PETITION, THAT BOTH RESPONDENT AND I WILL BE NOTIFIED OF THE HEARING, AND THAT I 
MUST APPEAR AT THE HEARING. 
I HAVE READ EVERY STATEMENT MADE IN THIS PETITION, AND EACH STATEMENT IS TRUE 
AND CORRECT. I UNDERSTAND THAT THE STATEMENTS MADE IN THIS PETITION ARE BEING MADE 
UNDER PENALTY OF PERJURY, PUNISHABLE AS PROVIDED IN SECTION 837.02, FLORIDA STATUTES. 
(initials) 
Dated: 
STATE OF FLORIDA 
COUNTY OF _________________________ 
Signature of Petitioner 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type 
of 
identification 
produced 
_______________________________________________ 
Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection 
Against Domestic Violence (03/09) 
159 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
                                                       
 
  
 
 
                                                         
 
 
 
 
  
 
   
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
     
 
 
   
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
COUNTY, FLORIDA 
JUDICIAL CIRCUIT, 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
TEMPORARY INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE 
WITH MINOR CHILD(REN) 
The Petition for Injunction for Protection Against Domestic Violence under section 741.30, 
Florida Statutes, and other papers filed in this Court have been reviewed. Under the laws of Florida, the 
Court has jurisdiction of the petitioner and the subject matter and has jurisdiction of the respondent 
upon service of the temporary injunction. 
It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and 
therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe 
and enforced as if it were the order of the enforcing state or of the Indian tribe. 
NOTICE OF HEARING 
Because this Temporary Injunction for Protection Against Domestic Violence has been issued without 
prior notice to Respondent, Petitioner and Respondent are instructed that they are scheduled to appear 
and testify at a hearing regarding this matter on {date} __________________, at ______ a.m./p.m., 
when the Court will consider whether the Court should issue a Final Judgment of Injunction for 
Protection Against Domestic Violence, which would remain in effect until modified or dissolved by the 
Court, and whether other things should be ordered, including, for example, such matters as time‐sharing 
and support. The hearing will be before The Honorable {name}_________________________________, 
at {room name/number, location, address, city} ______________________________________________ 
_____________________________, Florida. 
If Petitioner and/or Respondent do not appear, this 
temporary injunction may be continued in force, extended, dismissed, and/or additional orders may be 
granted, including the imposition of court costs. 
All witnesses and evidence, if any, must be presented at this time. In cases where temporary support 
issues have been alleged in the pleadings, each party is ordered to bring his or her financial affidavit 
Florida Family Law Rules of Procedure Form 12.902(b) or (c)), tax return, pay stubs, and other evidence 
of financial income to the hearing. 
NOTICE: Because this is a civil case, there is no requirement that these proceedings be transcribed at 
public expense. 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
160 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
YOU ARE ADVISED THAT IN THIS COURT: 
a. 	
___a court reporter is provided by the court. 
b. 	
___electronic audio tape recording only is provided by the court. A party may arrange in 
advance for the services of and provide for a court reporter to prepare a written transcript 
of the proceedings at that party’s expense. 
A RECORD, WHICH INCLUDES A TRANSCRIPT, MAY BE REQUIRED TO SUPPORT AN APPEAL. THE PARTY 
SEEKING THE APPEAL IS RESPONSIBLE FOR HAVING THE TRANSCRIPT PREPARED BY A COURT REPORTER. 
THE TRANSCRIPT MUST BE FILED WITH THE REVIEWING COURT OR THE APPEAL MAY BE DENIED. 
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 
{name} 
, 
{address} 
, {telephone} 
, 
within 2 working days of your receipt of this temporary injunction. If you are hearing or voice impaired, 
call TDD 1‐800‐955‐8771. 
FINDINGS 
The statements made under oath by Petitioner make it appear that section 741.30, Florida 
Statutes, applies to the parties. 
It also appears that Petitioner is a victim of domestic violence by 
Respondent, and/or Petitioner has reasonable cause to believe he/she is in imminent danger of 
becoming a victim of domestic violence by Respondent, and that there is an immediate and present 
danger of domestic violence to Petitioner or persons lawfully with Petitioner. 
TEMPORARY INJUNCTION AND TERMS 
This injunction shall be effective until the hearing set above and in no event for longer than 15 
days, unless extended by court order. 
If a final order of injunction is issued, the terms of this 
temporary injunction will be extended until service of the final injunction is effected upon 
Respondent. This injunction is valid and enforceable in all counties of the State of Florida. The terms 
of this injunction may not be changed by either party alone or by both parties together. Only the 
Court may modify the terms of this injunction. Either party may ask the Court to change or end this 
injunction. 
Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, 
may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of 
a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to 
vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, 
going to Petitioner’s place of employment, school, or other place prohibited in this injunction; 
telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly 
or intentionally coming within 100 feet of Petitioner’s motor vehicle, whether or not it is occupied; 
defacing or destroying Petitioner’s personal property; refusing to surrender firearms or ammunition if 
ordered to do so by the court; or committing an act of domestic violence against Petitioner 
constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by 
sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, 
punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or 
enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 
U.S.C. Section 2262. 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
161 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ORDERED and ADJUDGED: 
1. 	
Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any 
acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated 
assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, 
kidnaping, false imprisonment, or any other criminal offense resulting in physical injury or death 
to Petitioner or any of Petitioner's family or household members. Respondent shall not commit 
any other violation of the injunction through an intentional unlawful threat, word or act to do 
violence to the Petitioner. 
2. 	
No Contact. Respondent shall have no contact with Petitioner unless otherwise provided in 
this Section, or unless paragraph 14 below provides for contact connected with the temporary 
parenting plan and temporary time‐sharing with respect to the minor child(ren). 
a. 
Unless otherwise provided herein, Respondent shall have no contact with Petitioner. 
Respondent shall not directly or indirectly contact Petitioner in person, by mail, e‐mail, fax, 
telephone, through another person, or in any other manner. Further, Respondent shall not 
contact or have any third party contact anyone connected with Petitioner's employment or 
school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise 
provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner’s current 
residence {list address} 
or any residence to which Petitioner may move; Petitioner’s current or any subsequent 
place of employment {list address of current employment} ___________________________ 
________________________________________or place where Petitioner attends school 
{list address of school} 
; 
or the following other places (if requested by Petitioner) where Petitioner or Petitioner’s 
minor child(ren) go often: 
. 
Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. 
b. 
___Other provisions regarding contact: 
3. 
Firearms. 
[Initial all that apply; write N/A if does not apply] 
a. 	
___Respondent shall not use or possess a firearm or ammunition. 
b. 	
___Respondent shall surrender any firearms and ammunition in the Respondent's 
possession to the 
County Sheriff's Department until further order 
of the court. 
c. 	
___Other directives relating to firearms and ammunition: ____________________________ 
NOTE: RESPONDENT IS ADVISED THAT, IF A PERMANENT INJUNCTION FOR PROTECTION AGAINST 
DOMESTIC VIOLENCE IS ISSUED FOLLOWING A HEARING REGARDING THIS MATTER, IN MOST CASES IT 
WILL BE 
A VIOLATION OF SECTION 790.233, FLORIDA STATUTES, AND A FIRST DEGREE 
MISDEMEANOR, FOR RESPONDENT TO HAVE IN HIS OR HER CARE, CUSTODY, POSSESSION OR 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
162 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
       
       
 
 
 
 
 
 
       
 
     
   
 
 
 
 
 
 
 
         
        
 
 
 
 
   
 
 
 
  
 
 
 
 
 
        
 
                                      
 
 
           
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
   
     
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
       
 
 
 
   
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CONTROL ANY FIREARM OR AMMUNITION. ADDITIONALLY, IT WILL BE A FEDERAL CRIMINAL FELONY 
OFFENSE TO SHIP OR TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR 
AFFECTING COMMERCE, ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR 
AMMUNITION WHICH HAS BEEN SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE 
WHILE SUBJECT TO SUCH AN INJUNCTION. 18 U.S.C. SECTION 922(g)(8). 
4. 	
Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her 
mailing address within 10 days of the change. All further papers (excluding the final injunction, 
if entered without Respondent being present at the hearing, and pleadings requiring personal 
service) shall be served by mail to Respondent=s last known address. Such service by mail shall 
be complete upon mailing. Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida Statutes. 
5. 	
Additional order(s) necessary to protect Petitioner from domestic violence: 
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME 
[Initial all that apply; write N/A if does not apply] 
6. 	
___Possession of the Home. ( 
) Petitioner ( 
) Respondent shall have temporary exclusive use 
and possession of the dwelling located at: 
. 
7. 	
___Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the 
home shall accompany ( ) Petitioner ( ) Respondent to the home, and shall place ( ) Petitioner 
( ) Respondent in possession of the home. 
8. 	
___Personal Items. ( 
) Petitioner ( 
) Respondent, in the presence of a law enforcement 
officer, may return to the premises described above ( 
) on {date} 
, at 
______a.m./p.m., or ( 
) at a time arranged with the law enforcement department with 
jurisdiction over the home, for the purpose of obtaining his or her clothing and items of 
personal health and hygiene and tools of the trade. A law enforcement officer with jurisdiction 
over the home from which these items are to be retrieved shall accompany ( ) Petitioner 
( ) Respondent to the home and stand by to insure that he/she vacates the premises with only 
his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 
below. The law enforcement agency shall not be responsible for storing or transporting any 
property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO 
THE HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 
9. 	
___( 
) Petitioner ( 
) Respondent shall not damage or remove any furnishings or fixtures from 
the parties' former shared premises. 
10. ___Other:______________________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
163 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
     
       
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
TEMPORARY SUPPORT 
Temporary support, if requested by Petitioner in the Petition for Injunction for Protection 
Against Domestic Violence, will be addressed by the Court after notice to Respondent and hearing on 
the matter. 
TEMPORARY PARENTING PLAN WITH TIME‐ SHARING WITH MINOR CHILD(REN) 
11. Jurisdiction. [Initial one only] 
______ Jurisdiction to determine issues relating to parenting plan and time‐sharing with respect to any 
minor child(ren) listed in paragraph 12 below is proper under the Uniform Child Custody 
Jurisdiction and Enforcement Act (UCCJEA). 
______ Jurisdiction is exclusive to the dependency court, and accordingly no order is made herein. (Case 
Number ____________________________.) 
12. Temporary Order for 100% Time‐Sharing With Respect to Minor Child(ren). [ ] Petitioner [ ] 
Respondent shall, on a temporary basis, have 100% time sharing with respect to the parties’ 
minor child(ren) listed below: 
Name 
Birth date 
When requested by the parent to whom 100% time‐sharing is awarded on a temporary basis 
herein, law enforcement officers shall use any and all reasonable and necessary force to 
physically deliver the minor child(ren) listed above to the parent to whom 100% time‐sharing is 
awarded on a temporary basis herein. The other parent shall not take the child(ren) from the 
parent to whom 100% time‐sharing is awarded on a temporary basis herein or any child care 
provider or other person entrusted by the parent to whom 100% time‐sharing is awarded on a 
temporary basis herein with the care of the child(ren). 
[Initial if applies; write N/A if does not apply] 
______ Neither party shall remove the minor child(ren) from the State of Florida, which is the 
jurisdiction of this Court, prior to the hearing on this temporary injunction. Violation of this 
custody order may constitute a felony of the third degree under sections 787.03 and 787.04, 
Florida Statutes. 
13. Contact with Minor Child(ren). Unless otherwise provided in paragraph 14 below, the 
[ ] Petitioner [ ] Respondent (i.e., the parent to whom 100% time‐sharing is not awarded on a 
temporary basis herein) shall have no contact with the parties’ minor child(ren) until further 
order of the Court. 
14. Other Additional Provisions Relating to the Minor Child(ren). 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
164 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
OTHER SPECIAL PROVISIONS 
(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida 
Family Law Rule 12.610.) 
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION (Provisions in this 
injunction that do not include a line for the judge to either initial or write N/A are considered mandatory 
provisions and should be interpreted to be part of this injunction.) 
1. 	
The Sheriff of 
County, or any other authorized law enforcement officer, is 
ordered to serve this temporary injunction upon Respondent as soon as possible after its 
issuance. 
2. 	
This injunction is valid in all counties of the State of Florida. Violation of this injunction should 
be reported to the appropriate law enforcement agency. 
Law enforcement officers of the 
jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this 
injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida 
Statutes, for any violation of its provisions which constitutes a criminal act under section 741.31, 
Florida Statutes. 
3. 	
THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA AND LAW ENFORCEMENT 
OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The 
arresting agent shall notify the State Attorney's Office immediately after arrest. 
4. 	
THIS IS A “CUSTODY ORDER” FOR PURPOSES OF THE UCCJEA AND ALL STATUTES MAKING IT A 
CRIME TO INTERFERE WITH CUSTODY UNDER CHAPTER 787 OF FLORIDA STATUTES AND 
OTHER SIMILAR STATUTES. 
5. 	
Reporting alleged violations. If Respondent violates the terms of this injunction and there has 
not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which 
the violation occurred and complete an affidavit in support of the violation, or Petitioner may 
contact the State Attorney’s office for assistance in filing an action for indirect civil contempt or 
indirect criminal contempt. 
Upon receiving such a report, the State Attorney is hereby 
appointed to prosecute such violations by indirect criminal contempt proceedings, or the State 
Attorney may decide to file a criminal charge, if warranted by the evidence. 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
165 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
                                
 
 
 
 
 
 
        
 
   
          
 
 
   
 
 
           
 
 
 
 
 
          
 
 
 
         
 
 
 
 
     
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
                       
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
ORDERED on 
. 
CIRCUIT JUDGE 
COPIES TO: 
Sheriff of 
County 
Petitioner (or his or her attorney): 
by U. S. Mail 
by hand delivery in open court 
Respondent: 
forwarded to sheriff for service 
State Attorney’s Office 
Other:_________________________________________________________ 
I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk 
of the Circuit Court of 
County, Florida, and that I have furnished copies of this order as 
indicated above. 
CLERK OF THE CIRCUIT COURT 
(SEAL) 
By: 
Deputy Clerk 
Florida Supreme Court Approved Family Law Form 12.980(c)(1), Temporary Injunction for Protection Against 
Domestic Violence with Minor Child(ren) (03/09) 
166 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
  
 
 
                                                         
 
 
 
 
  
 
   
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
      
           
           
 
 
 
 
 
        
          
 
      
 
        
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
FINAL JUDGMENT OF INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE 
WITH MINOR CHILD(REN) (AFTER NOTICE) 
The Petition for Injunction for Protection Against Domestic Violence under section 741.30, 
Florida Statutes, and other papers filed in this Court have been reviewed. The Court has jurisdiction of 
the parties and the subject matter. 
It is intended that this protection order meet the requirements of 18 U.S.C. Section 2265 and 
therefore intended that it be accorded full faith and credit by the court of another state or Indian tribe 
and enforced as if it were the order of the enforcing state or of the Indian tribe. 
HEARING 
This cause came before the Court for a hearing to determine whether an Injunction for 
Protection Against Domestic Violence in this case should be: 
[ 
] issued 
[ 
] modified 
[ 
] extended. 
The hearing was attended by [ 
] Petitioner 
[ ] Respondent 
[ 
] Petitioner’s Counsel [ 
] Respondent’s Counsel 
FINDINGS 
On {date} 
, a notice of this hearing was served on Respondent 
together with a copy of Petitioner’s petition to this Court and the temporary injunction, if issued. Service 
was within the time required by Florida law, and Respondent was afforded an opportunity to be heard. 
After hearing the testimony of each party present and of any witnesses, or upon consent of 
Respondent, the Court finds, based on the specific facts of this case, that Petitioner is a victim of 
domestic violence or has reasonable cause to believe that he/she is in imminent danger of becoming a 
victim of domestic violence by Respondent. 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
169 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
       
 
 
 
 
 
  
     
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INJUNCTION AND TERMS 
This injunction shall be in full force and effect until [ ] further order of the Court or 
[ ] 
. This injunction is valid and enforceable in all counties of the State of Florida. 
The terms of this injunction may not be changed by either party alone or by both parties together. 
Only the Court may modify the terms of this injunction. Either party may ask the Court to change or 
end this injunction at any time. 
Any violation of this injunction, whether or not at the invitation of Petitioner or anyone else, 
may subject Respondent to civil or indirect criminal contempt proceedings, including the imposition of 
a fine or imprisonment. Certain willful violations of the terms of this injunction, such as: refusing to 
vacate the dwelling that the parties share; going to or being within 500 feet of Petitioner's residence, 
going to Petitioner’s place of employment, school, or other place prohibited in this injunction; 
telephoning, contacting or communicating with Petitioner if prohibited by this injunction; knowingly 
or intentionally coming within 100 feet of Petitioner’s motor vehicle, whether or not it is occupied; 
defacing or destroying Petitioner’s personal property; refusing to surrender firearms or ammunition if 
ordered to do so by the court; or committing an act of domestic violence against Petitioner 
constitutes a misdemeanor of the first degree punishable by up to one year in jail, as provided by 
sections 775.082 and 775.083, Florida Statutes. In addition, it is a federal criminal felony offense, 
punishable by up to life imprisonment, depending on the nature of the violation, to cross state lines or 
enter Indian country for the purpose of engaging in conduct that is prohibited in this injunction. 18 
U.S.C. SECTION 2262. 
ORDERED and ADJUDGED: 
1. 	
Violence Prohibited. Respondent shall not commit, or cause any other person to commit, any 
acts of domestic violence against Petitioner. Domestic violence includes: assault, aggravated 
assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, 
kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or 
death to Petitioner or any of Petitioner's family or household members. Respondent shall not 
commit any other violation of the injunction through an intentional unlawful threat, word or act 
to do violence to the Petitioner. 
2. 	
No Contact. Respondent shall have no contact with the Petitioner unless otherwise provided 
in this section, or unless paragraphs 13 through 19 below provide for contact connected with 
the temporary parenting plan and temporary time‐sharing with respect to the minor 
child(ren). 
a. 
Unless otherwise provided herein, Respondent shall have no contact with Petitioner. 
Respondent shall not directly or indirectly contact Petitioner in person, by mail, e‐mail, fax, 
telephone, through another person, or in any other manner. Further, Respondent shall not 
contact or have any third party contact anyone connected with Petitioner's employment or 
school to inquire about Petitioner or to send any messages to Petitioner. Unless otherwise 
provided herein, Respondent shall not go to, in, or within 500 feet of: Petitioner’s current 
residence {list address} 
or any residence to which Petitioner may move; Petitioner’s current or any subsequent 
place of employment {list address of current employment} ___________________________ 
______________________________________or place where Petitioner attends school {list 
address of school} 
; 
or the following other places (if requested by Petitioner) where Petitioner or Petitioner’s 
minor child(ren) go often:______________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection 
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
170 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
  
 
 
    
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
                             
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
Respondent may not knowingly come within 100 feet of Petitioner's automobile at any time. 
b. 
___Other provisions regarding contact: 
3. 	
Firearms. Unless paragraph a. is initialed below, Respondent shall not have in his or her care, 
custody, possession or control any firearm or ammunition. It is a violation of section 790.233, 
Florida Statutes, and a first degree misdemeanor, for the respondent to have in his or her 
care, custody, possession or control any firearm or ammunition. 
[Initial if applies; write N/A if not applicable] 
a. 	
___Respondent is a state or local officer as defined in section 
943.10(14), Florida Statutes, who holds an active certification, who receives or possesses a 
firearm or ammunition for use in performing official duties on behalf of the officer’s 
employing agency and is not prohibited by the court from having in his or her care, custody, 
possession or control a firearm or ammunition. The officer’s employing agency may prohibit 
the officer from having in his or her care, custody, possession or control a firearm or 
ammunition. 
b. 	
___Respondent shall surrender any firearms and ammunition in the 
Respondent's possession to the 
County Sheriff's Department. 
c. 
___Other 
directives 
relating 
to 
firearms 
and 
ammunition: 
____________________________ 
NOTE: 
RESPONDENT IS ADVISED THAT IT IS A FEDERAL CRIMINAL FELONY OFFENSE TO SHIP OR 
TRANSPORT IN INTERSTATE OR FOREIGN COMMERCE, OR POSSESS IN OR AFFECTING COMMERCE, 
ANY FIREARM OR AMMUNITION; OR TO RECEIVE ANY FIREARM OR AMMUNITION WHICH HAS BEEN 
SHIPPED OR TRANSPORTED IN INTERSTATE OR FOREIGN COMMERCE WHILE SUBJECT TO SUCH AN 
INJUNCTION. 18 U.S.C. SECTION 922(g)(8). 
4. 
Evaluation/Counseling. 
[Initial all that apply; write N/A if does not apply] 
a. 
The Court finds that Respondent has: 
i. 	
___willfully violated the ex parte injunction; 
ii. 	
___been convicted of, had adjudication withheld on, or pled nolo contendere to a 
crime involving violence or a threat of violence; and/or 
iii. 
___in this state or any other state, had at any time a prior injunction for protection 
entered 
against 
the 
respondent 
after 
a 
hearing 
with 
notice. 
Note: If respondent meets any of the above enumerated criteria, the Court must order the 
Respondent to attend a batterers' intervention program unless it makes written factual 
findings stating why such a program would not be appropriate. See Section 741.30(6)(e), 
Florida Statutes. 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
171 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
   
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
b. 	
Within [ 
]10 days [ 
] days, (but no more than 10 days) of the date of this injunction, 
Respondent shall enroll in and thereafter without delay complete the following, and 
Respondent shall provide proof of such enrollment to the Clerk of Circuit Court within 
[ ] 30 days or [ 
] days, (but no more than 30 days) of the date of this injunction: 
i. 
___A certified batterers’ intervention program from a list of programs to be provided by 
the Court or any entity designated by the Court. 
Respondent shall also successfully 
complete any substance abuse or mental health evaluation that the assessing program 
counselor deems necessary as a predicate to completion of the batterers’ intervention 
program. 
ii. 
___A substance abuse evaluation at:__________________________________________ 
or a similarly qualified facility and any substance abuse treatment recommended by that 
evaluation. 
iii. 
___A mental health evaluation by a licensed mental health professional at: 
or any other similarly qualified facility and any mental health treatment recommended 
by that evaluation. 
iv. 
___Other:_______________________________________________________________ 
c. 	
___Although Respondent meets the statutory mandate of attendance at a batterers’ 
intervention program, the Court makes the following written findings as to why the 
condition of batterers= = intervention program would be inappropriate: _________________ 
d. 	
___Petitioner is referred to a certified domestic violence center and is provided with a list of 
certified domestic violence centers in this circuit, which Petitioner may contact. 
5. 	
Mailing Address. Respondent shall notify the Clerk of the Court of any change in his or her 
mailing address within 10 days of the change. All further papers (excluding pleadings requiring 
personal service) shall be served by mail to Respondent’s last known address. Such service by 
mail shall be complete upon mailing. 
Rule 12.080, Fla.Fam.L.R.P., section 741.30, Florida 
Statutes. 
6. 	
Other provisions necessary to protect Petitioner from domestic violence: _________________ 
TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME 
[Initial if applies; write N/A if not applicable] 
7. 	
___Possession of the Home. [ 
] Petitioner [ 
] Respondent shall have temporary exclusive use 
and possession of the dwelling located at: 	 ________________________________________ 
. 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
172 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
  
 
       
       
 
 
 
 
 
 
 
 
     
         
   
 
 
 
 
 
 
 
         
        
 
 
 
 
   
 
 
 
 
 
 
 
 
 
        
  
 
 
 
  
        
 
           
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
       
  
      
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
       
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
       
       
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
 
 
     
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
  
 
 
 
 
 
8. 	
___Transfer of Possession of the Home. A law enforcement officer with jurisdiction over the 
home 
shall accompany [ ] Petitioner [ ] Respondent to the home, and shall place 
[ ] Petitioner [ ] Respondent in possession of the home. 
9. 	
___Personal Items. [ 
] Petitioner [ 
] Respondent, in the presence of a law enforcement 
officer, may return to the premises described above ( 
) on 
, at 
a.m./p.m., or [ 
] at a time arranged with the law enforcement department with 
jurisdiction over the home, accompanied by a law enforcement officer only, for the purpose of 
obtaining his or her clothing and items of personal health and hygiene and tools of the trade. A 
law enforcement officer with jurisdiction over the premises shall go with[ 
] Petitioner 
[ 
] Respondent to the home and stand by to insure that he/she vacates the premises with only 
his/her personal clothing, toiletries, tools of the trade, and any items listed in paragraph 10 
below. The law enforcement agency shall not be responsible for storing or transporting any 
property. IF THE RESPONDENT IS NOT AWARDED POSSESSION OF THE HOME AND GOES TO THE 
HOME WITHOUT A LAW ENFORCEMENT OFFICER, IT IS A VIOLATION OF THIS INJUNCTION. 
10. ___The following other personal possessions may also be removed from the premises at this 
time:__________________________________________________________________________ 
11. ___Other: ______________________________________________________________________ 
TEMPORARY PARENTING PLAN AND TIME‐ SHARING WITH MINOR CHILD(REN) 
12. Jurisdiction. [Initial one only.] 
_____ Jurisdiction to determine issues relating to parenting plan and time‐sharing with respect 
to any minor child(ren) listed in paragraph 13 below is proper under the Uniform Child Custody 
Jurisdiction and Enforcement Act (UCCJEA). 
_____ Jurisdiction is exclusive to the dependency court, and accordingly no order is made 
herein. (Case Number ____________________________.) 
13. Temporary Parenting Plan for Minor Child(ren). Except for that time‐sharing (if any) specified 
for the other parent in paragraph 14, below, [ ] Petitioner [ ] Respondent shall on a temporary 
basis have 100% of the time‐sharing with the parties’ minor child(ren) listed below and shall 
have sole decision‐making responsibility until further court order: 
Name 	
Birth date 
When requested by the parent to whom the majority of overnight time‐sharing with the 
child(ren) is awarded on a temporary basis herein, in this case the [ }Petitioner { } Respondent, 
law enforcement officers shall use any and all reasonable and necessary force to physically 
deliver the minor child(ren) listed above to the parent to whom the majority of overnight time­
sharing with the child(ren) is awarded on a temporary basis herein. The other parent shall not 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection 
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
173 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
     
 
 
 
 
 
 
       
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
      
     
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
 
 
 
   
 
 
 
 
      
      
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
       
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
         
 
 
 
         
 
 
take the child(ren) from the parent to whom the majority of overnight time‐sharing with the 
child(ren) is awarded on a temporary basis herein or any child care provider or other person 
entrusted by the parent to whom the majority of overnight time‐sharing with the child(ren) is 
awarded on a temporary basis herein with the care of the child(ren). 
14. Temporary Parenting Plan with Time‐Sharing for Minor Child(ren). 
The Petitioner and 
Respondent shall have time‐sharing with the minor child(ren) on the following schedule: 
[Initial one only] 
a. 	
____[ ] Petitioner[ ] Respondent shall have 100% of time‐sharing and [ ] Petitioner 
[ 
]Respondent shall have 0% of time sharing with the child(ren) until further order of the 
Court. Until further order of the Court, all parenting decisions shall be made by the parent 
with 100% of the time‐sharing. 
b. 	
___[ ] Petitioner[ ] Respondent shall have time‐sharing from ___________ a.m./p.m. 
to 
__________a.m./p.m 
on 
the 
following 
day(s)___________________________________The other parent will have the remaining 
time‐sharing. _________________________________ 
c. 
___Other:_______________________________________________________________ 
15. Limitations on Time‐Sharing The time‐sharing specified in paragraph 14, above, for 
[ 
] Petitioner [ 
]Respondent with the child(ren) shall be: 
[Initial all that apply; write N/A if does not apply] 
a. 
______ unsupervised. 
b. 	
______ 
supervised 
by 
the 
following 
specified 
responsible 
adult:_______________________. 
c. 	
______ at a supervised visitation center located at: _____________________________ 
. 
and shall be subject to the available times and rules of the supervised visitation center. The cost 
associated with the services of the supervised visitation center shall be paid by [ 
] parent to 
whom the majority of overnight time‐sharing with the child(ren) is awarded on a temporary 
basis herein [ ] other parent [ ] both: 
. 
If specified, the level of supervision shall be:__________________________________________. 
16. Arrangements for Time‐Sharing with Minor Child(ren). 
[Initial all that apply; write N/A if does not apply] 
a. 
___A responsible person shall coordinate the time‐sharing arrangements of with respect 
to the minor child(ren). 
If specified, the responsible person shall be: {name} 
b. 
___Other conditions for time‐sharing arrangements as follows: 
17. Exchange of Minor Child(ren). 
[Initial all that apply; write N/A if does not apply] 
a. 
___The parties shall exchange the child(ren) at [ 
] school or daycare, or [ 
] at the 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection 
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
174 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
  
       
  
       
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
   
 
 
  
 
 
  
 
          
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
   
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
following location(s): 
b. 
___A responsible person shall conduct all exchanges of the child(ren). The [ ] Petitioner 
[ 
] Respondent shall not be present during the exchange. If specified, the responsible 
person shall be: {name} 
c. 
Other conditions for exchange as follows: 
18. Other Additional Provisions Relating to the Minor Child(ren). 
TEMPORARY SUPPORT 
19. Temporary Alimony. 
[Initial all that apply; write N/A if does not apply] 
a. 
___The court finds that there is a need for temporary alimony and that [ 
] Petitioner [ 
] 
Respondent (hereinafter Obligor) has the present ability to pay alimony and shall pay 
temporary alimony to [ 
] Petitioner [ 
] Respondent (hereinafter Obligee) in the amount of 
$ 
per 
month, payable [ 
] in accordance with Obligor’s employer’s payroll cycle, and in any event, 
at least once a month [ 
] other {explain} 
beginning {date} 
. This alimony shall continue until modified by court order, until 
a final judgment of dissolution of marriage is entered, until Obligee dies, until this injunction 
expires, or until {date} 
, 
whichever 
occurs 
first. 
b. 
___[ 
] Petitioner [ 
] Respondent shall be required to maintain health insurance coverage 
for the other party. Any uncovered medical costs for the party awarded alimony shall be 
assessed as follows: 
. 
c. 
___Other provisions relating to alimony: 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
175 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
       
 
       
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
       
       
 
 
 
 
 
 
 
 
 
  
 
 
 
 
      
 
 
 
 
  
  
 
 
 
 
      
 
 
 
 
  
  
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
                 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
      
        
 
 
 
 
 
        
       
 
 
 
 
 
 
 
 
 
 
 
 
  
   
      
        
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
    
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
20. Temporary Child Support. 
[Initial all that apply; write N/A if does not apply] 
a. 	
___The Court finds that there is a need for temporary child support and that [ ] Petitioner 
[ 
] Respondent (hereinafter Obligor) has the present ability to pay child support. 
The 
amounts in the Child Support Guidelines Worksheet, Florida Family Law Form12.902(e), filed 
by [ ] Petitioner [ ] Respondent are correct OR the Court makes the following findings: 
The Petitioner’s net monthly income is $ 
, (Child Support Guidelines 
%). The 
Respondent’s net monthly income is $ 
, (Child Support Guidelines 
%). 
Monthly child care costs are $ 
. Monthly health/dental insurance costs are 
$
. 
b. 	
___Amount. Obligor shall pay temporary child support in the amount of $ 
, 
per 
month payable [ 
] in accordance with Obligor’s employer’s payroll cycle, and in any event 
at least once a month ( 
) other {explain}: ________________________________________ 
, 
beginning {date} 
, and continuing until further order of the court, or until 
{date/event} ________________________________________________________________, 
{explain} 
. 
If the child support ordered deviates from the guidelines by more than 5%, the factual 
findings which support that deviation are: 
c. 	
___( 
) Petitioner ( 
) Respondent shall be required to maintain ( 
) health ( 
) dental 
insurance coverage for the parties’ minor child(ren) so long as reasonably available. OR 
( 
) Health ( 
) dental insurance is not reasonably available at this time. 
d. 	
___Any reasonable and necessary uninsured medical/dental/prescription drug costs for 
the minor child(ren) shall be assessed as follows: ___________________________________ 
. 
e. 	
___Florida Supreme Court Approved Family Law Form 12.902(j), Notice of Social Security 
Number, is incorporated herein by reference. 
f. 	
___Other provisions relating to child support: 
Method of Payment. 
[Initial one only] 
a. 
______ Obligor shall pay any temporary child support/alimony ordered through income 
deduction, and such support shall be paid to the state disbursement unit. 
Obligor is 
individually responsible for paying this support obligation in the event that all or any portion 
of said support is not deducted from Obligor’s income. Obligor shall also pay the applicable 
state disbursement unit service charge. Until child support/alimony payments are deducted 
from Obligor’s paycheck pursuant to the Income Deduction Order, Obligor is responsible for 
making timely payments directly to the state disbursement unit. 
b. 
______ Temporary child support/alimony shall be paid through the state disbursement 
unit in the office of the {name of county} 
County 
Clerk 
of 
Circuit 
Court. 
Obligor shall also pay the applicable state disbursement unit service charge. 
Income 
deduction is not in the best interests of the child(ren) because: 
c. 
______ Other provisions relating to method of payment: _______________________ 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
176 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
OTHER SPECIAL PROVISIONS 
(This section to be used for inclusion of local provisions approved by the chief judge as provided in Florida 
Family Law Rule 12.610.) 
DIRECTIONS TO LAW ENFORCEMENT OFFICER IN ENFORCING THIS INJUNCTION 
(Provisions in this injunction that do not include a line for the judge to either initial or write N/A are 
considered mandatory provisions and should be interpreted to be part of this injunction.) 
1. 	
This injunction is valid in all counties of the State of Florida. Violation of this injunction should 
be reported to the appropriate law enforcement agency. Law enforcement officers of the 
jurisdiction in which a violation of this injunction occurs shall enforce the provisions of this 
injunction and are authorized to arrest without warrant pursuant to section 901.15, Florida 
Statutes, for any violation of its provisions, except those regarding child support and/or alimony, 
which constitutes a criminal act under section 741.31, Florida Statutes. When inconsistent with 
this order, any subsequent court order issued under Chapter 61 or Chapter 39, Florida 
Statutes, shall take precedence over this order on all matters relating to property division, 
alimony, parental responsibility, parenting plan, time‐sharing , child custody, or child support. 
2. 	
THIS INJUNCTION IS ENFORCEABLE IN ALL COUNTIES OF FLORIDA, AND LAW ENFORCEMENT 
OFFICERS MAY EFFECT ARRESTS PURSUANT TO SECTION 901.15(6), FLORIDA STATUTES. The 
arresting agent shall notify the State Attorney's Office immediately after arrest. 
3. 	
Reporting alleged violations. If Respondent violates the terms of this injunction and there has 
not been an arrest, Petitioner may contact the Clerk of the Circuit Court of the county in which 
the violation occurred and complete an affidavit in support of the violation, or Petitioner may 
contact the State Attorney’s office for assistance in filing an action for indirect civil contempt or 
indirect criminal contempt. 
Upon receiving such a report, the State Attorney is hereby 
appointed to prosecute such violations by indirect criminal contempt proceedings, or the State 
Attorney may decide to file a criminal charge, if warranted by the evidence. 
4. 	
Respondent, upon service of this injunction, shall be deemed to have knowledge of and to be 
bound by all matters occurring at the hearing and on the face of this injunction. 
5. 	
The temporary injunction, if any, entered in this case is extended until such time as service of 
this injunction is effected upon Respondent. 
6. 	
THIS IS A “CUSTODY ORDER” FOR PURPOSES OF THE UCCJEA AND ALL STATUTES MAKING IT A 
CRIME TO INTERFERE WITH CUSTODY UNDER CHAPTER 787 OF FLORIDA STATUTES AND 
OTHER SIMILAR STATUTES. 
ORDERED on 	
. 
CIRCUIT JUDGE 
COPIES TO: 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection 
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
177 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                
 
 
 
 
 
 
     
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
                       
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
      
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sheriff of 
County 
Petitioner (or his or her attorney): 
___ by U. S. Mail 
___ by hand delivery in open court (Petitioner must acknowledge receipt in writing on the face of the 
original order ‐ see below.) 
Respondent (or his or her attorney): 
___ forwarded to sheriff for service 
___ by hand delivery in open court (Respondent must acknowledge receipt in writing on the face of the 
original order ‐ see below.) 
___ by certified mail (may only be used when Respondent is present at the hearing and Respondent fails 
or refuses to acknowledge the receipt of a certified copy of this injunction.) 
___ State Attorney’s Office 
___ Batterer’s intervention program (if ordered) 
___ Central Governmental Depository (if ordered) 
___ Department of Revenue 
___ Other __________________________________________________ 
I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk 
of the Circuit Court of 
County, Florida, and that I have furnished copies of this order as 
indicated above. 
CLERK OF THE CIRCUIT COURT 
(SEAL) 
By: 
Deputy Clerk 
ACKNOWLEDGMENT 
I, {Name of Petitioner} 
, acknowledge receipt of a certified 
copy of this Injunction for Protection. 
Petitioner__________________________________________ 
ACKNOWLEDGMENT 
I, {Name of Respondent} 
, 
acknowledge 
receipt 
of 
a 
certified copy of this Injunction for Protection. 
Respondent_________________________________________ 
Florida Supreme Court Approved Family Law Form 12.980(d)(1), Final Judgment of Injunction for Protection
Against Domestic Violence with Minor Child(ren) (After Notice) (03/09)
178 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
    
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.981(a)(1), STEPPARENT ADOPTION: CONSENT AND WAIVER
BY PARENT (03/09) 
When should this form be used? 
This form is to be completed and signed by the parent who is giving up all rights to, custody of, and time 
sharing with the minor child to be adopted. This consent shall not be executed before the birth of the 
minor child. 
For more information about consenting to adoption, you should refer to Chapter 63, 
Florida Statutes, and sections 63.062 ‐ 63.082, Florida Statutes, in particular. 
This form should be typed or printed in black ink. It must be signed in the presence of a notary public or 
deputy clerk and two witnesses other than the notary or clerk. You should file this form with the Joint 
Petition for Adoption by Stepparent, Florida Supreme Court Approved Family Law Form 12.981(b)(1). 
After completing this form, you should hand deliver a copy or duplicate original to the parent giving 
consent and have them sign the original saying they received a copy. Then you should file the original 
with the clerk of the circuit court in the county where the Joint Petition for Adoption by Stepparent, 
Florida Supreme Court Approved Family Law Form 12.981(b)(1) is filed and keep a copy for your records. 
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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and 
Waiver by Parent (03/09) 
179 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
  
 
 
                                                       
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
     
 
  
      
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
      
  
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
    
 
 
     
 
 
 
 
 
   
 
 
 
    
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
     
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
IN THE MATTER OF THE ADOPTION OF 
_____________________________________, 
Adoptee(s). 
CONSENT AND WAIVER BY PARENT 
1. 	
I, {full legal name} 
, am the [ √one only] 
( 
) father or ( 
) mother of the minor child(ren) subject to this consent who is/are: 
Child’s Current Name 
Gender 
Birth date 
Birthplace 
{city, county, state} 
a. 
b. 
c. 
d. 
e. 
f. 
2. 	
I relinquish all rights to, custody of, and time sharing with 
this (these) minor child(ren), 
{name(s)} ______________________________________________________________________, 
with full knowledge of the legal effect of the stepparent adoption and consent to the adoption 
by the child(ren)’s stepparent whose name is: [ √ one only] 
(
) {name} 
( ) not required for my granting of this consent. 
3. 	
I understand my legal rights as a parent and I understand that I do not have to sign this consent 
and release of my parental rights. I acknowledge that this consent is being given knowingly, 
freely, and voluntarily. 
I further acknowledge that my consent is not given under fraud or 
duress. I understand that there is a “grace period” in Florida during which I may revoke my 
consent. If the child to be adopted is older than 6 months at the time of consent, this grace 
period is for 3 days or until the child has been placed with the prospective adoptive parents, 
whichever is later. I understand that, in signing this consent, I am permanently and forever 
giving up all my parental rights to and interest in this (these) minor child(ren) and that this 
consent may only be withdrawn if the Court finds it was obtained by fraud or duress. 
voluntarily, permanently relinquish all my parental rights to this (these) minor child(ren). 
4. 	
I consent, release, and give up permanently, of my own free will, my parental rights to this 
(these) minor child(ren), for the purpose of stepparent adoption. 
5. 	
I waive any further notice of the stepparent adoption proceeding. 
6. 	
I understand that pursuant to Chapter 63, Florida Statutes, “an action or proceeding of any kind 
Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and Waiver by 
Parent (03/09) 
180 
I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
   
  
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
  
  
 
 
  
 
  
 
  
 
 
 
 
 
 
  
 
  
 
  
 
 
  
 
 
 
 
 
 
 
 
  
 
  
 
  
 
 
 
 
 
 
 
to vacate, set aside, or otherwise nullify a judgment of adoption or an underlying judgment 
terminating parental rights on any ground may not be filed more than 1 year after entry of the 
judgment terminating parental rights.” 
7. 	
I understand I have the right to choose a person who does not have an employment, 
professional, or personal relationship with the adoption entity or the prospective adoptive 
parents to be present when this affidavit is executed and to sign it as a witness. The witness I 
selected is: {full legal name} ____________________________________. 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this consent and waiver and that the punishment for knowingly making a false statement 
includes fines and/or imprisonment. 
Dated: 
Signature of Parent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Signature of Witness 
Signature of Witness 
Printed Name: 
Printed Name: 
Business Address: 
Business Address: 
Home Address: 
Home Address: 
Driver’s License or 
Driver’s License or 
State ID Card No.: 
State ID Card No.: 
Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and Waiver by 
Parent (03/09) 
181 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
 
                                
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
                                               
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
__________________________________ 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
STATE OF FLORIDA 
COUNTY OF _________________________ 
Sworn to or affirmed and signed before me on {date} 
at {time} 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
deputy clerk.] 
Personally known 
Produced identification 
Type of identification produced ____________________________________ 
I hereby acknowledge receipt of a copy or duplicate original of this executed Consent and 
Waiver. 
Signature of Parent 
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} 
, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.981(a)(1), Stepparent Adoption: Consent and Waiver by 
Parent (03/09) 
182 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.981(b)(1),
JOINT PETITION FOR ADOPTION BY STEPPARENT (03/09) 
When should this form be used? 
This form should be used when a stepparent is adopting his or her spouse’s child. Both the stepparent 
and his or her spouse must sign this petition. 
You must attach all necessary consents or 
acknowledgments that apply to your case, as listed under the Special Notes section below. Florida 
Statutes require that consent to adoption be obtained from: 
• 	
the mother of the minor. 
• 	
the father of the minor if: 
1. 	
the minor was conceived or born while the father was married to the mother; 
2. 	
the minor is his child by adoption; 
3. 	
the minor has been established by a court proceeding to be his child; 
4. 	
he has filed an affidavit of paternity pursuant to section 382.013(2)(c) Florida Statutes; or 
5. 	
in the case of an unmarried biological father, he has acknowledged in writing, signed in the 
presence of a competent witness, that he is the father of the minor, has filed such 
acknowledgment with the Office of Vital Statistics of the Department of Health within the 
required timeframes, and has complied with the requirements of section 63.062(2). 
Determining whether someone’s consent is required, or when consent may not be required is a 
complicated issue and you may wish to consult an attorney. For more information about consenting to 
adoption, you should refer to Chapter 63, Florida Statutes, and sections 63.062 ‐ 63.082 in particular. 
This form should be typed or printed in black ink. The name to be given to the child(ren) after the 
adoption should be used in the heading of the petition. The stepparent is the petitioner, because he or 
she is the one who is asking the court for legal action. After completing this form, you and your spouse 
must sign it before a notary public or deputy clerk. You should then file the original and 1 copy with the 
clerk of the circuit court in the county where the minor resides unless the court changes the venue. 
What should I do next? 
For your case to proceed, you must have the written consent of the other birth parent and the child, if 
applicable. The court may choose not to require consent to an adoption in some circumstances. For 
more information about situations where consent may not be required, see section 63.064, Florida 
Statutes. If you are attempting to proceed without the consent of the other birth parent, you may wish 
to consult with an attorney. Section 63.054, Florida Statutes, requires that in each adoption proceeding, 
the Florida Putative Father Registry be searched. You will need an order from the judge to do this, 
which you can request by filing a Motion for Search of the Putative Father Registry, Florida Supreme 
Court Approved Family Law Form 12.981(a)(6). 
When you have filed all of the required forms and met the requirements as outlined above, you are 
ready to set a hearing on your petition. You should check with the clerk of court, family law intake staff 
or the judicial assistant to set a final hearing. If all persons required to consent have consented and the 
consents/affidavits of nonpaternity have been filed with the court, the hearing may be held 
immediately. If not, notice of the hearing must be given as provided by the Rules of Civil Procedure. See 
Form 1.902, Florida Rules of Civil Procedure. If you know where the other birth parent lives, you should 
use personal service. If you absolutely do not know where he or she lives, you may use constructive 
Instructions for Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by 
Stepparent (03/09) 
183 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
     
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
service. 
In order to use constructive service you will need to complete and submit to the court 
Stepparent Adoption: Affidavit of Diligent Search, Florida Supreme Court Approved Family Law Form 
12.981(a)(4). For more information about personal and constructive service, you should refer to the 
“General Instructions for Self‐Represented Litigants” found at the beginning of these forms and the 
instructions to 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). However, the law regarding constructive service 
is very complex and you may wish to consult an attorney regarding that issue. 
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. See Chapter 63, Florida Statutes, and Florida Family Law Rule 12.200(a)(2) for 
further information. 
Special notes... 
With this petition you must file the following: 
• 	
Consent form executed by the birth parent, Stepparent Adoption: Consent and Waiver by 
Parent, Florida Supreme Court Approved Family Law Form 12.981(a)(1) or Stepparent Adoption: 
Affidavit of Nonpaternity, Florida Supreme Court Approved Family Law Form 12.981(a)(3). 
• 	
If any person whose consent is required is deceased, a certified copy of the death certificate 
must be attached to this Petition. 
• 	
Consent form executed by the minor child(ren), if the child(ren) is/are over 12 years of age, 
Stepparent Adoption: Consent of Adoptee, Florida Supreme Court Approved Family Law Form 
12.981(a)(2). The court can excuse filing of this form under certain circumstances. 
• 	
Certified copy of the child(ren)’s birth certificate. 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
• 	
If applicable, Stepparent Adoption: Motion for Search of the Putative Father Registry, Florida 
Supreme Court Approved Family Law Form 12.981(a)(6). 
These family law forms contain a Final Judgment of Stepparent Adoption, Florida Supreme Court 
Approved Family Law Form 12.981(b)(2), which the judge may use. You should check with the clerk, 
family law intake staff, or judicial assistant to see if you need to bring a final judgment form with you to 
the hearing. If so, you should type or print the heading, including the circuit, county case number, 
division, and the child(ren)’s names, and leave the rest blank for the judge to complete at your hearing. 
You should decide how many certified copies of the final judgment you will need and be prepared to 
obtain them after the hearing. There is a charge for certified copies, and the clerk can tell you how 
much. The file will be sealed after the final hearing, and then it will take an order from a judge to open 
the file and obtain a copy of the final judgment. 
AN ADOPTIVE STEPPARENT WILL CONTINUE TO HAVE PARENTAL RIGHTS, INCLUDING CUSTODY AND 
TIME‐ SHARING, WHERE APPROPRIATE, IN THE EVENT OF A LATER DISSOLUTION OF MARRIAGE, AND 
MAY BE LIABLE FOR CHILD SUPPORT IN THE EVENT OF A LATER DISSOLUTION OF MARRIAGE. YOU 
COULD BE LIABLE IN LITIGATION FOR THE ACTIONS OF THE ADOPTEE(S). THIS ADOPTION MAY ALSO 
AFFECT THE ADOPTEE’S INHERITANCE. 
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 
Instructions for Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by 
Stepparent (03/09) 
184 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by
Stepparent (03/09)
185 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
        
        
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
  
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
  
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
IN THE MATTER OF THE ADOPTION OF 
________________________________________ , 
{use name to be given to child(ren)} Adoptee(s). 
JOINT PETITION FOR ADOPTION BY STEPPARENT 
Petitioner, {full legal name} _____________________________________________being sworn, 
joined by the above‐named child(ren)’s ( 
) mother ( 
) father, {full legal name} 
________________________, being sworn, files this joint petition for adoption of the above‐named 
minor child(ren), under chapter 63, Florida Statutes. 
1. 	
This is an action for adoption of a minor child(ren) by his or her (their) stepparent. 
2. 	
I desire to adopt the following child(ren): 
Name to be given to child(ren) 
Birth date 	
Birthplace 
a. 
b. 
c. 
d. 
e. 
f. 
A certified copy of the birth certificate(s) is/are attached. 
3. 	
The child(ren) has (have) resided with me since {date} _______________ 
I wish to adopt the child(ren) because I would like to legally establish the parent‐child 
relationship already existing between the child(ren) and me. Since the above date, I have been 
able to provide adequately for the material needs of the child(ren) and am able to continue 
doing so in the future, as well as to provide for the child(ren)’s mental and emotional well‐being. 
Other reasons I wish to adopt the children are: _______________________________________ 
4. 	
I am _________ years old, and have resided at {street address}, __________________________ 
{city} ____________________ {county} _______________ {state} __________ for ______ years. 
5. 	
I married the ( 
) father or ( 
) mother of the child(ren) on {date}________________________, 
in {city} _________________{county}_________________, {state} ____________ The following 
are the dates and places of my dissolutions of marriage, if any: 
Date 	
Place 
a. 
b. 
Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by Stepparent (03/09)
186 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
  
  
 
        
 
 
 
 
 
 
 
 
 
 
  
  
 
      
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
6. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act Affidavit (UCCJEA), 
Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
7. 	
A description and estimate of the value of any property of the adoptee(s) is as follows: 
. 
8. 	
Consent by the adoptee(s): 
( 
) is attached for: Name(s) 
( 
) is not required because the adoptee(s) is/are not 12 years of age: Name(s) 
( 
) was excused by the court for: Name(s) 
9. 	
The following person(s) is/are required to consent and the consent form or affidavit of 
nonpaternity is/are attached _____________________________________________________ 
10. The following person(s) whose consent is required has not consented. 	 The facts/circumstances 
that excuse the lack of consent and would justify termination of this person’s parental rights 
are: 
Name 
Address 	
Facts/circumstances 
11. A copy of this Petition was served on all known persons whose consent is required but did not 
waive notice, as well as on all persons whose consent is required but did not provide consent. 
Proof of service is attached. 
[√ if applies:] 
___ 	
A search of the Putative Father Registry maintained by the Office of Vital Statistics of the 
Department of Health has been requested, and if granted, the certificate from the State 
Registrar will be filed in this action. 
WHEREFORE, I request that this Court terminate the parental rights of ____________________, 
{name of parent whose rights are sought to be terminated}, enter a Final Judgment of Adoption of the 
Minor Child(ren) by Petitioner Stepparent and, as requested, change the name of the adoptee(s). 
Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by Stepparent (03/09)
187 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Stepparent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF_________________________ 
Sworn to or affirmed and signed before me on ___________________by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
_____ 
_____ 
_____________________________________________ 
[Print, type, or stamp commissioned name of notary or 
deputy clerk.] 
Personally known 
Produced identification 
Type of identification produced _______________________________ 
Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by Stepparent (03/09)
188 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
_____________________________________________ 
 
        
        
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 ______________________ 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
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 ( 
) mother ( 
) father 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF 
Sworn to or affirmed and signed before me on ____________________ by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
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] 
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. 
Florida Supreme Court Approved Family Law Form 12.981(b)(1), Joint Petition for Adoption by Stepparent (03/09)
189 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
          
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
    
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
IN THE MATTER OF THE ADOPTION OF 
________________________________________, 
{use name to be given to child(ren)} Adoptee(s). 
FINAL JUDGMENT OF STEPPARENT ADOPTION 
Upon consideration of the Joint Petition for Adoption by Stepparent and the evidence 
presented, the Court finds that: 
1. 	
The Court has subject matter jurisdiction over the Joint Petition for Adoption by Stepparent. 
2. 	
The Court has jurisdiction over the minor child(ren) subject to the Joint Petition for Adoption by 
Stepparent. 
3. 	
Petitioner desires the permanent responsibility of a parent in this adoption. 
4. 	
There is no pending litigation regarding the child(ren) in Florida or in any other state, nor is 
there any other person not a party to these proceedings who has or claims to have physical 
custody or rights to the minor child(ren). 
5. 	
The consent of the birth ( 
) mother ( 
) father who is not married to Petitioner is: 
[only one] 
____ 
attached to the petition 
____ 
not required because he or she is deceased. A certified copy of the death certificate is 
attached. 
____ 
waived because: 
[ all that apply] 
____ 
the parent has deserted the child without means of identification or has abandoned the 
child. 
____ 
the parent’s rights have been terminated by a court of competent jurisdiction. 
____ 
the parent has been declared incompetent and restoration of competency is medically 
improbable. 
____ 	
the legal guardian or lawful custodian of the adoptee(s), other than the birth parent, 
who has failed to respond in writing to a request for consent for a period of 60 days or 
the Court has examined the written reasons for withholding consent and has found the 
withholding of consent to be unreasonable. 
____ 	
other: ____________________________________________________________. 
6. 	
The best interests of the child(ren) will be promoted by this adoption. 
7. 	
The minor child(ren) is (are) suitable for adoption by Petitioner. 
NOW, THEREFORE, IT IS ORDERED that: 
1. 	
The minor child(ren) subject to the Petition is (are) declared to be the legal child(ren) of 
Florida Supreme Court Approved Family Law Form 12.981(b)(2), Final Judgment of Stepparent Adoption (03/09)
190 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
____________________________________________________________ 
____________________________________________________________ 
____________________________________________________________ 
____________________________________________________________ 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Petitioner, {name} 
2. 	
The minor child(ren) shall be the child(ren) and legal heir(s) at law of Petitioner, {name} 
_____________________, and shall be entitled to all rights and privileges, and subject to all 
obligations, of children born of Petitioner. 
3. 	
All legal relations between the adoptee(s) and the parent whose rights are being terminated and 
between the adoptee(s) and the relatives of that parent are terminated by this adoption, as are 
all parental rights and responsibilities of that birth parent. 
4. 	
This Final Judgment of Adoption creates a relationship between the adoptee(s) and Petitioner 
and all relatives of Petitioner that would have existed if the adoptee(s) was (were) a blood 
descendant of the Petitioner, born within wedlock, entitled to all rights and privileges thereof, 
and subject to all obligations of a child being born to Petitioner. 
5. 	
The minor child(ren) shall hereafter be known as {full legal name(s)}: 
ORDERED on 	
. 
CIRCUIT JUDGE 
COPIES TO: 
Petitioners (or their attorney) 
Florida Supreme Court Approved Family Law Form 12.981(b)(2), Final Judgment of Stepparent Adoption (03/09)
191 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.983(a), PETITION TO DETERMINE PATERNITY AND FOR
RELATED RELIEF (03/09) 
When should this form be used? 
This form should be used by a birth mother or father to ask the court to establish paternity, a time­
sharing schedule, and/or child support of a minor child or children. This means that you are trying to 
legally establish who is the father of the child(ren). 
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. 
What should I do next? 
For your case to proceed, you must properly notify the respondent 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, 
you may use constructive service. However, if constructive service is used, the court may only grant 
limited relief. 
You should seek legal advice on constructive service in a paternity case. 
For more 
information see chapter 49, Florida Statutes, or you may contact Child Support Enforcement at the 
Florida Department of Revenue if you need assistance with your case. 
If personal service is used, the respondent has 20 days to answer after being served with your petition. 
Your case will then generally proceed in one of the following three 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. Then, if you have filed all 
of the required papers, you may call the clerk, family law intake staff, or judicial assistant to set a final 
hearing. You must notify the other party 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. 
UNCONTESTED... If the respondent files an answer that agrees with everything in your petition or an 
answer and waiver, and you have complied with mandatory disclosure and filed all of the required 
papers, you may call the clerk, family law intake staff, or judicial assistant to set a final hearing. You 
must notify the other party 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 the respondent files an answer or an answer and counterpetition, which disagrees 
with or denies anything in your petition, and you are unable to settle the disputed issues, you should file 
a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied 
with mandatory disclosure, completed the scientific paternity testing, if necessary, and filed all of the 
required papers. Then you should contact the clerk, family law intake staff, or judicial assistant for 
instructions on how to set your case for trial (final hearing). If the respondent files an answer and 
counterpetition, you should answer the counterpetition within 20 days using an Answer to 
Counterpetition, Florida Supreme Court Approved Family Law Form 12.983(d). 
Where can I look for more information? 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and
for Relief (03/09)
192 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
   
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
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 742, 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. 
More than one child of the same alleged father may be listed on a single petition. However, if you are 
filing a paternity action involving more than one possible father, a separate petition must be filed for 
each alleged father. 
If the respondent files an answer denying that the person named in the petition is the child(ren)’s 
father, one of you should file a Motion for Scientific Paternity Testing, Florida Supreme Court Approved 
Family Law Form 12.983(e). This is used to ask the court to order a scientific test to determine who is 
the child(ren)’s father. 
If the father signed papers at the hospital acknowledging that he was the father, paternity was 
established as a matter of law. This should be checked on page 2, section 9a on this form. 
If the paternity of a child who was conceived or born during a marriage is at issue, the court may appoint 
a guardian ad litem to assist the court in this matter and to protect the rights of child. 
With this petition, you must file the following and provide a copy to the other party: 
• 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
• 	
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
• 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
• 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days, if not filed with the petition, unless you and the 
other party have agreed not to exchange these documents.) 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party’s income, you may file this worksheet after his or her financial 
affidavit has been filed.) 
• 	
Parenting 
Plan, 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form, 
12.995(a), 
or 
Supervised/Safety Focused Parenting Plan, Form 12.995(b). If the parents have reached an 
agreement, a signed and notarized Parenting Plan should be attached. If the parents have not 
reached an agreement, a proposed Parenting Plan may be filed. 
Parenting Plan and Time‐Sharing. If the parties are unable to agree on parenting arrangements and a 
time‐sharing schedule, a judge will decide as part of establishing a Parenting Plan. The judge will decide 
the parenting arrangements and time‐sharing based on the child(ren)’s best interests. Regardless of 
whether there is an agreement between the parties, the court reserves jurisdiction to modify issues 
relating to minor or dependent child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning parenting 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and 
for Relief (03/09) 
193 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) are being 
served. For more information, you may consult sections 61.401–61.405, Florida Statutes. 
Listed below are some terms with which you should become familiar before completing your petition. If 
you do not fully understand any of the terms below or their implications, you should speak with an 
attorney before going any further. 
• 
Shared Parental Responsibility 
• 
Sole Parental Responsibility 
• 
Supervised Time‐Sharing 
• 
No contact 
• 
Parenting Plan 
• 
Parenting Plan Recommendation 
• 
Time‐Sharing Schedule 
Many circuits require that parents of a minor or dependent child(ren) who are involved in dissolution or 
paternity actions attend mediation before being allowed to schedule a final hearing. 
A parenting 
course must be completed prior to entry of the final judgment. You should check with your local clerk of 
court’s office, family law intake staff, or judicial assistant for more information on the parenting course 
and mediation requirements in your area. 
Child Support. 
The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents. You should file a financial affidavit, and the other parent will be required to do the same. 
From your financial affidavits, you should be able to calculate the amount of child support that should 
be paid. Because the child support guidelines take several factors into consideration, change over time, 
and vary from state to state, your child support obligation may be more or less than that of other people 
in seemingly similar situations. 
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court 
Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family 
law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. 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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and
for Relief (03/09)
194 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
PETITION TO DETERMINE PATERNITY AND FOR RELATED RELIEF 
Petitioner, {full legal name}____________________________, being sworn, certifies that the 
following information is true: 
This is an action for paternity and to determine parental responsibility, time‐sharing, and child 
support under chapter 742, Florida Statutes. 
SECTION I. 
1. 
Petitioner is the [ 
] mother [ 
] father of the following minor child(ren): 
Name 	
Place of Birth 
Birth date 
Sex 
(1). _______________________________________________________________ 
(2). _______________________________________________________________ 
(3). _______________________________________________________________ 
(4). _______________________________________________________________ 
(5). _______________________________________________________________ 
(6). _______________________________________________________________ 
2. 	
Petitioner’ s current address is: {street address, city, state} _____________________________ 
. 
3. 
Respondent’s current address is: {street address, city, state} 
. 
4. 
Both parties are over the age of 18, and neither is, nor has been within a 30‐day period 
immediately prior to this date, a person in the military service of the United States as defined by 
the Amended Sailors’ and Soldiers’ Civil Relief Act of 1940. 
5. 
Neither Petitioner nor Respondent is mentally incapacitated. 
6. 
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, 
Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Relief (03/09)
195 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
   
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
         
        
   
 
 
 
 
 
 
  
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_____________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
      
        
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
       
     
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
       
       
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
     
 
 
 
                                       
         
 
     
 
 
 
 
 
         
         
 
     
 
 
 
  
 
         
         
 
     
 
 
 
 
 
 
 
     
 
 
 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
 
7. 
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this petition. 
8. 
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
9. 
Paternity Facts. 
[one only] 
a. 	
___Paternity has previously been established as a matter of law. 
b. 	
___The parties engaged in sexual intercourse with each other in the month(s) of {list 
month(s) and year(s)} 
,at {city and state} 
As a result of the sexual intercourse, 
[ 
] Petitioner [ 
] Respondent conceived and gave birth to the minor child(ren) named in 
paragraph 1. [ 
] Petitioner [ 
] Respondent is the natural father of the minor child(ren). 
The mother [ 
] was [ 
] was not married at the time of the conception and/or birth of the 
minor child(ren) named in paragraph 1. If the mother was married, the name and address 
of her husband at the time of conception and/or birth is: ___________________________ 
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY, AND TIME‐SHARING 
1. 	
The minor child(ren) currently reside(s) with [ 
] Mother [ 
]Father [ 
] Other: {explain} 
. 
2. 
Parental Responsibility. 
It is in the child(ren)’s best interests that parental 
responsibility be: 
[ one only] 
a. 	
___shared by both Father and Mother. 
b. 
___awarded solely to [ 
] Father [ 
] Mother. 
Shared parental responsibility would be 
detrimental to the child(ren) because: 
. 
3. 	
Parenting Plan and Time‐Sharing. It is in the best interests of the child(ren) that the 
family be ordered to comply with a Parenting Plan that [ ] includes [ ]does not include parental 
time‐sharing with the child(ren). The Petitioner states that it is in the best interests of the 
child(ren) that: 
( Choose only one) 
a. 	
___The attached proposed Parenting Plan should be adopted by the court. 
The parties [ ] have [ ] have not agreed to the Parenting Plan. 
b. 	
___The court should establish a Parenting Plan with the following provisions: 
[ ] No time‐sharing for the 
[ ] Father [ ] Mother 
[ ] Limited time‐sharing with the 
[ ] Father [ ] Mother 
[ ] Supervised time‐sharing for the 
[ ] Father [ ] Mother. 
[ ] Supervised or third‐party exchange of the child(ren). 
[ ] Time‐sharing schedule as follows: 
______________________________________________________________________________. 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Relief (03/09)
196 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
Explain why this schedule is in the best interests of the child(ren): 
4. 
The minor child(ren) should 
( only one] 
a. 
___retain his/her (their) present name(s). 
b. 
___receive a change of name as follows: 
present name(s) 
be changed to 
(1). ____________________________________ 
(1). ___________________________________ 
(2). ____________________________________ 
(2). ___________________________________ 
(3). ____________________________________ 
(3). ___________________________________ 
(4). ____________________________________ 
(4). ___________________________________ 
(5). ____________________________________ 
(5). ___________________________________ 
(6). ____________________________________ 
(6). ___________________________________ 
SECTION III. CHILD SUPPORT 
[ all that apply] 
1. 	
___Petitioner requests that the Court award child support as determined by Florida’s child 
support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines 
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such 
support should be ordered retroactive to 
[ one only] 
a. 	
___the date when the parents did not reside together in the same household with the child, 
not to exceed a period of 24 months before the date of filing of this petition. 
b. 	
___the date of the filing of this petition. 
c. 	
___other: {date}___________. {Explain} 
_______________________________________ 
2. 	
___Petitioner requests that the Court award a child support amount that is more than or less 
than Florida’s child support guidelines. Petitioner understands that a Motion to Deviate from 
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be 
completed before the Court will consider this request. 
3. 	
___Petitioner requests that medical/dental insurance coverage for the minor child(ren) be 
provided by: 
[one only] 
a. 	
___Father. 
b. 	
___Mother. 
4. 	
___Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid by: 
[ one only] 
a. 	
___Father. 
b. 	
___Mother. 
c. 	
___Father and Mother each pay one‐half. 
d. 	
___Father and Mother each pay according to the percentages in the Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
e. 	
___Other {explain}: ___________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Relief (03/09)
197 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
                                         
5. 	
___Petitioner requests that life insurance to secure child support be provided by: 
[one only] 
a. 	
___Father. 
b. 	
___Mother. 
c. 	
___Both 
6. 	
___[ 
] Petitioner [ 
] Respondent [ 
] Both has (have) incurred medical expenses in the 
amount of $ 
on behalf of the minor child(ren), including hospital and other expenses 
incidental to the birth of the minor child(ren). There should be an appropriate allocation or 
apportionment of these expenses. 
7. 	
___[ 
] Petitioner [ 
] Respondent [ 
] Both has (have) received past public assistance for this 
(these) minor child(ren). 
PETITIONER’S REQUEST 
1. 	
Petitioner requests a hearing on this petition and understands that he or she must attend the 
hearing. 
2. 
Petitioner requests that the Court enter an order that: 
[all that apply] 
a. 	
establishes paternity of the minor child(ren), ordering proper scientific testing, if necessary; 
b. 	
adopts or establishes a Parenting Plan containing provisions for parental responsibility and 
time‐sharing for the minor or dependent child(ren); 
c. 	
awards child support, including medical/dental insurance coverage for the minor child(ren); 
d. 	
determines the appropriate allocation or apportionment of all expenses incidental to the 
birth of the child(ren), including hospital and medical expenses; 
e. 	
determines the appropriate allocation or apportionment of all other past, present, and 
future medical and dental expenses incurred or to be incurred on behalf of the minor 
child(ren); 
f. 	
changes the child(ren)’s name(s); 
g. 
other relief as follows: 
; and 
grants such other relief as may be appropriate and in the best interests of the minor child(ren). 
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: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF __________________________ 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Relief (03/09)
198 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
, 
a nonlawyer, located at {street} 
, {city} 
, 
{state} 
, {phone} 
, helped {name} 
, 
who 
is 
the 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Relief (03/09)
199 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
    
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.983(b), ANSWER TO PETITION TO DETERMINE PATERNITY
AND FOR RELATED RELIEF (03/09) 
When should this form be used? 
This form should be used when you are responding to a petition to determine paternity. You may use 
this form to admit or deny the allegations contained in the petition. However, if you wish to ask the 
court for things not included in the petition, such as, parental responsibility and time‐sharing or child 
support, you should file an Answer to Petition and Counterpetition to Determine Paternity and for 
Related Relief, Florida Supreme Court Approved Family Law Form 12.983(c). 
This form should be typed or printed in black ink. After completing this form, you should sign this form 
before a notary public or deputy clerk. You should then file the original with the clerk of the circuit 
court in the county where the petition was filed and keep a copy for your records. 
What should I do next? 
If you deny that the person named in the petition is the child(ren)’s father, a Motion for Scientific 
Paternity Testing, Florida Supreme Court Approved Family Law Form 12.983(e), should be filed. This is 
used to ask the court to order a scientific test to determine who is the child(ren)’s father. 
You have 20 days to file an answer to the other party’s petition. A copy of this form, along with all of 
the other forms required with this answer, must be mailed or hand delivered to the other party in your 
case. After you file your answer, the case will generally proceed in one of the following two ways: 
UNCONTESTED. 
This case is uncontested if you and the petitioner agree on all issues raised in the 
petition. If this is the case, and you and the other party have complied with mandatory disclosure and 
filed all of the required papers, either party may call the clerk, family law intake staff, or judicial 
assistant to set a final hearing. If you request the hearing, you must notify the other party 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. 
This case is contested if you and the other party disagree on any issues raised in the 
petition. If you are unable to settle the disputed issues, either party may file a Notice for Trial Florida 
Supreme Court Approved Family Law Form 12.924, after you have complied with mandatory disclosure 
and filed all of the required papers. 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). 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(b), Answer to Petition to Determine 
Paternity and for Related Relief (03/09) 
200 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
     
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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 742, Florida Statutes. 
Special notes... 
With this answer, you must file the following and provide a copy to the other party: 
C 
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
C 
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
C 
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902 (b) or (c). 
(This must be filed within 45 days of the service of the petition on you, if not filed at the time 
you file this answer.) 
C 	
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of the service of the petition on you, if not filed 
at the time you file this answer, unless you and the other party have agreed not to exchange 
these documents.) 
C 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party’s income, you may file this form after the other party files his 
or her financial affidavit.) 
Many circuits require completion of mediation before being allowed to schedule a final hearing. A 
parenting course must be completed prior to entry of the final judgment. You should check with your 
local clerk, family law intake staff, or judicial assistant for more information on the parenting course and 
mediation requirements in your area. 
Parenting Plan and Time‐Sharing. If the parents are unable to agree on parenting arrangements and a 
time‐sharing schedule, a judge will decide for as part of establishing a Parenting Plan. The judge will 
decide the parenting arrangements and time‐sharing based on the child(ren)’s best interests. Regardless 
of whether there is an agreement between the parties, the court reserves jurisdiction to modify issues 
relating to minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning parenting 
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) are being 
served. For more information, you may consult sections 61.401 and 61.405, Florida Statutes. 
Listed below are some terms with which you should become familiar before completing your petition. If 
you do not fully understand any of the terms below or their implications, you should speak with an 
attorney before going any further. 
• 	
Shared Parental Responsibility 
• 	
Sole Parental Responsibility 
• 	
Supervised Time‐Sharing 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(b), Answer to Petition to Determine 
Paternity and for Related Relief (03/09) 
201 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 
No contact 
• 
Parenting Plan 
• 
Parenting Plan Recommendation 
• 
Time‐Sharing Schedule 
Child Support. 
The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents. You should file a financial affidavit, and the other parent will be required to do the same. 
From your financial affidavits, you should be able to calculate the amount of child support that should 
be paid. Because the child support guidelines take several factors into consideration, change over time, 
and vary from state to state, your child support obligation may be more or less than that of other people 
in seemingly similar situations. 
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court 
Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family 
law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. 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 a Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these 
forms also must put his or her name, address, and telephone number on the bottom of the last page of 
every form he or she helps you complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(b), Answer to Petition to Determine 
Paternity and for Related Relief (03/09) 
202 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
  
      
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
IN AND FOR 
JUDICIAL CIRCUIT, 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
ANSWER TO PETITION TO DETERMINE PATERNITY 
AND FOR RELATED RELIEF 
I, {full legal name} 
, Respondent, being 
sworn, certify that the following information is true: 
1. 	
I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the 
Petition and, therefore, admit those allegations: {indicate section and paragraph number} 
. 
2. 	
I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in 
the Petition and, therefore, deny those issues: {indicate section and paragraph number} 
. 
3. 	
I currently am unable to admit or deny the following paragraphs due to lack of information: 
{indicate section and paragraph number} _____________________________________________ 
. 
4. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, 
Florida Supreme Court Approved Family Law Form 12.902(d), is filed with this petition. 
5. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this petition. 
6. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
I certify that a copy of this document was [one only] [ 
] mailed [ 
] faxed and mailed 
[ 
] hand delivered to the person(s) listed below on {date} 
. 
Petitioner or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Florida Supreme Court Approved Family Law Form 12.983(b), Answer to Petition to Determine Paternity and for 
Related Relief (03/09) 
203 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
  
                                        
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this answer and that the punishment for knowingly making a false statement includes fines 
and/or imprisonment. 
Dated:__________________________ 
Signature of Respondent 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF __________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced___________________________ 
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 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.983(b), Answer to Petition to Determine Paternity and for 
Related Relief (03/09) 
204 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(c),
ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE 
PATERNITY AND FOR RELATED RELIEF (03/09) 
When should this form be used? 
This form should be used when you are responding to a petition to determine paternity and asking the 
court for something different than what was in the petition, such as parental responsibility, time­
sharing, and child support. The answer is used to admit or deny the allegations contained in the 
petition, and the counterpetition is used to ask for whatever you want the court to do for you. The 
other party has 20 days to answer your counterpetition after being served with your counterpetition. 
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 the original with the clerk of the circuit 
court in the county where the petition was filed and keep a copy for your records. 
What should I do next? 
You have 20 days to file an answer or answer and counterpetition to the other party’s petition. A copy 
of this form, along with all of the other forms required with this answer and counterpetition, must be 
mailed or hand delivered to the other party in your case. 
If you deny that the person named in the petition is the child(ren)’s father, a Motion for Scientific 
Paternity Testing Florida Supreme Court Approved Family Law Form 12.983(e), should be filed. This is 
used to ask the court to order a scientific test to determine who is the child(ren)’s father. 
After you file an answer and counterpetition, the case will then generally proceed as follows: 
UNCONTESTED. This case is uncontested if you and the other party agree on all issues raised in the 
petition and the counterpetition. If this is the case, and you and the other party have complied with 
mandatory disclosure and filed all of the required papers, either party may call the clerk, family law 
intake staff, or judicial assistant to set a final hearing. If you request the hearing, you must notify the 
other party 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. 
This case is contested if you and the other party disagree on any issues raised in the 
petition or counterpetition. If you are unable to settle the disputed issues, either party may file a Notice 
for Trial, Florida Supreme Court Approved Family Law Form 12.924, after you have complied with 
mandatory disclosure and filed all of the required papers. 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). 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and 
Counterpetition to Determine Paternity and for Related Relief (03/09)
205 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
 
 
 
 
 
    
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
Where can I look for more information? 
Before proceeding, you should read General Information for Self‐Represented Litigants@ for some 
basic information. The words that are in bold underline in these instructions are defined there. For 
further information, see chapter 742, Florida Statutes. 
Special notes... 
If the child(ren)’s father signed papers at the hospital acknowledging that he was the father, paternity 
was established as a matter of law. This should be checked on page 2, section 9a of the counterpetition 
part of this form. With this answer, you must file the following: 
C 	
Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme 
Court Approved Family Law Form 12.902(d). 
C 	
Notice of Social Security Number Florida Supreme Court Approved Family Law Form 12.902(j). 
C 	
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c). 
(This must be filed within 45 days of service of the petition on you if not filed with this answer.) 
C 	
Certificate of Compliance with Mandatory Disclosure Florida Family Law Rules of Procedure 
Form 12.932. (This must be filed within 45 days of service of the petition on you, if not filed with 
this answer, unless you and the other party have agreed not to exchange these documents.) 
• 	
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). (If 
you do not know the other party’s income, you may file this worksheet after his or her financial 
affidavit has been filed.) 
• 	
Parenting 
Plan, 
Florida 
Supreme 
Court 
Approved 
Family 
Law 
Form 
12.995(a) 
or 
Supervised/Safety‐Focused Parenting Plan, Form 12.995(b). If the parents have reached an 
agreement, a signed and notarized Parenting Plan should be attached. If the parents have not 
reached an agreement, a proposed Parenting Plan may be filed. 
Many jurisdictions may require the completion of mediation before a final hearing may be set. 
A 
parenting course must be completed prior to entry of the final judgment. You should contact the office 
of your local clerk of court, family law intake staff, or the judicial assistant about requirements for 
parenting courses or mediation where you live. 
Parenting Plan and Time‐Sharing. 
If the parties are unable to agree on parenting arrangements and a 
time‐sharing schedule, a judge will decide as part of establishing a Parenting Plan.The judge will decide 
the parenting arrangements and time‐sharing schedule based on the child(ren)’s best interests. 
Regardless of whether there is an agreement between the parties, the court reserves jurisdiction to 
modify issues relating to minor child(ren). 
The judge may request a parenting plan recommendation or appoint a guardian ad litem in your case. 
This means that a neutral person will review your situation and report to the judge concerning parenting 
issues. The purpose of such intervention is to be sure that the best interests of the child(ren) is being 
served. For more information, you may consult section 61.401 and 61.405, Florida Statutes. 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and 
Counterpetition to Determine Paternity and for Related Relief (03/09)
206 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Listed below are some terms with which you should become familiar before completing your petition. If 
you do not fully understand any of the terms below or their implications, you should speak with an 
attorney before going any further. 
C 
Shared Parental Responsibility 
C 
Sole Parental Responsibility 
C 
Supervised Time‐Sharing 
C 
No contact 
C 
Parenting Plan 
C 
Parenting Plan Recommendations 
C 
Time‐Sharing Schedule 
Child Support. 
The court may order one parent to pay child support to assist the other parent in 
meeting the child(ren)’s material needs. Both parents are required to provide financial support, but 
one parent may be ordered to pay a portion of his or her support for the child(ren) to the other parent. 
Florida has adopted guidelines for determining the amount of child support to be paid. These guidelines 
are based on the combined income of both parents and take into account the financial contributions of 
both parents. You should file a financial affidavit, and the other parent will be required to do the same. 
From your financial affidavits, you should be able to calculate the amount of child support that should 
be paid. Because the child support guidelines take several factors into consideration, change over time, 
and vary from state to state, your child support obligation may be more or less than that of other people 
in seemingly similar situations. 
Parenting Plan. In all cases involving minor or dependent child(ren), a Parenting Plan shall be approved 
or established by the court. If the parties have reached an agreement, you should file a Parenting Plan, 
Florida Supreme Court Approved Family Law Form 12.995(a)or a Supervised/Safety Focused Parenting 
Plan, Florida Supreme Court Approved Family Law Form 12.995(b) which addresses the time‐sharing 
schedule for the child(ren). If you have not reached an agreement, a proposed Parenting Plan may be 
filed. A Parenting Plan will be established by the court. 
Final Judgments. These family law forms contain a Final Judgment of Paternity, Florida Supreme Court 
Approved Family Law Form 12.983(g), which the judge may use. You should check with the clerk, family 
law intake staff, or judicial assistant to see if you need to bring it with you to the hearing. 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. 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and 
Counterpetition to Determine Paternity and for Related Relief (03/09)
207 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
        
        
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner/Counterrespondent, 
and 
, 
Respondent/Counterpetitioner. 
ANSWER TO PETITION AND COUNTERPETITION 
TO DETERMINE PATERNITY AND FOR RELATED RELIEF 
I, {full legal name} 
, Respondent, 
being sworn, certify that the following information is true: 
ANSWER TO PETITION 
1. 	
I agree with Petitioner as to the allegations raised in the following numbered paragraphs in the 
Petition and, therefore, admit those allegations: {indicate section and paragraph number} 
. 
2. 	
I disagree with Petitioner as to the allegations raised in the following numbered paragraphs in 
the Petition and, therefore, deny those issues: {indicate section and paragraph number} 
. 
3. 	
I currently am unable to admit or deny the following paragraphs due to lack of information: 
{indicate section and paragraph number} _____________________________________________ 
. 
COUNTERPETITION TO DETERMINE PATERNITY 
AND FOR RELATED RELIEF 
SECTION I. PATERNITY 
1. 	
Respondent is the [ 
] mother [ 
] father of the following minor child(ren): 
Name 
Place of Birth 	
Birth Date 
Sex 
(1). 
_________________________________________________________________________ 
(2). __________________________________________________________________________ 
(3). __________________________________________________________________________ 
(4). __________________________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
208 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
       
        
 
 
 
 
 
 
 
 
 
 
 
 
         
        
   
 
 
 
 
 
 
  
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
        
        
  
 
 
 
 
 
(5). __________________________________________________________________________ 
(6). __________________________________________________________________________ 
2. 	
Petitioner’s current address is: {street address, city, state} _______________________________ 
. 
3. 
Respondent’s current address is: {street address, city, state} _____________________________ 
. 
4. 	
Both parties are over the age of 18, and neither is, nor has been within a 30 day period 
immediately prior to this date, a person in the military service of the United States as defined by 
the Amended Sailors’ and Soldiers’ Civil Relief Act of 1940. 
5. 	
Neither Petitioner nor Respondent is mentally incapacitated. 
6. 	
A completed Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida 
Supreme Court Approved Family Law Form 12.902(d), is filed with this counterpetition. 
7. 	
A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this counterpetition. 
8. 	
A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
9. 
Paternity Facts. 
[one only] 
a. 	
___Paternity has previously been established as a matter of law. 
b. 	
___ The parties engaged in sexual intercourse with each other in the month(s) of {list 
month(s) and year(s)} 
, at {city and state} ___________________________________. 
As a result of the sexual intercourse, [ ] Petitioner [ 
] Respondent conceived and gave 
birth to the minor child(ren) named in paragraph 1. [ 
] Petitioner [ 
] Respondent is the 
natural father of the minor child(ren). The mother [ 
] was [ 
] was not married at the time 
of the conception and/or birth of the minor child(ren) named in paragraph l. If the mother 
was married, the name and address of her husband at the time of conception and/or birth 
is: 
. 
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME‐SHARING 
1. 	
The minor child(ren) currently reside(s) with [ 
] Mother [ 
] Father [ 
] Other: {explain} 
. 
2. 
Parental Responsibility. It is in the child(ren)’s best interests that parental responsibility be: 
[one only] 
a. 
___shared by both Father and Mother. 
b. 
___ awarded solely to [ 
] Father [ 
] Mother. Shared parental responsibility would be 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
209 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
       
       
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
       
       
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
     
 
 
 
  
 
 
 
   
 
     
 
 
 
     
 
 
 
 
     
 
 
 
  
 
 
 
 
     
 
 
 
 
 
 
 
     
 
 
 
 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
     
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
  
 
 
detrimental to the child(ren) because: ____________________________________________ 
. 
3. 	
Parenting Plan and Time‐Sharing. It is in the best interests of the child(ren) that the family be 
ordered to comply with a Parenting Plan that [ 
] includes [ 
] does not include parental time­
sharing with the child(ren). 
The Respondent 
states that it is in the best interests of the 
child(ren) that: 
(Choose only one) 
a. 
___The attached proposed Parenting Plan should be adopted by the court. 
The parties [ ] have [ ] have not agreed to the Parenting Plan. 
b. 
___The court should establish a Parenting Plan with the following provisions: 
[ ] 
No time‐sharing for the 
[___] Father [___ ] Mother. 
[ ] 
Limited time‐sharing with the 
[___] Father [___] Mother. 
[ ] 
Supervised time‐sharing for the [___] Father [___] Mother 
[ ] 
Supervised or third‐party exchange for the child(ren). 
[ ] 
Time‐sharing schedule as follows: 
______________________________________________________________________________. 
4. 	
Explain why this request is in the best interests of the child(ren): 
5. 
The minor child(ren) should: 
[only one] 
a. 
retain his/her (their) present name(s). 
b. 
receive a change of name as follows: 
present name(s) 
be changed to 
(1). ____________________________ 
(1). ______________________________ 
(2). ____________________________ 
(2). ______________________________ 
(3). ____________________________ 
(3). ______________________________ 
(4). ____________________________ 
(4). ______________________________ 
(5). ____________________________ 
(5). ______________________________ 
(6). ____________________________ 
(6). ______________________________ 
SECTION III. CHILD SUPPORT 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
210 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
[ all that apply] 
1. 	
Respondent requests that the court award child support as determined by Florida’s child 
support guidelines, section 61.30, Florida Statutes. A completed Child Support Guidelines 
Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), is, or will be, filed. Such 
support should be ordered retroactive to: 
[one only] 
a. 	
___the date when the parents did not reside together in the same household with the child, 
not to exceed a period of 24 months before the date of filing of this counterpetition. 
b. 	
___the date of the filing of this petition. 
c. 	
___other: {date} 
. {Explain} _____________________________________ 
2. 	
___Respondent requests that the Court award a child support amount that is more than or less 
than Florida’s child support guidelines. Respondent understands that a Motion to Deviate from 
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, must be 
completed before the Court will consider this request. 
3. 	
___Respondent requests that medical/dental insurance coverage for the minor child(ren) be 
provided by: 
[one only] 
a. 	
___Father. 
b. 	
___Mother. 
4. 	
___Respondent requests that uninsured medical/dental expenses for the child(ren) be paid by: 
[one only] 
a. 
___Father. 
b. 
___Mother. 
c. 
___Father and Mother each pay one‐half. 
d. 
___Father and Mother each pay according to the percentages in the Child Support 
Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e). 
e. 
___Other {explain}: ___________________________________________________________ 
. 
5. 	
___Respondent requests that life insurance to secure child support be provided by: 
[one only] 
a. 	
___Father. 
b. 	
___Mother. 
c. 	
___Both. 
6. 	
___[ 
] Petitioner [ 
] Respondent [ 
] Both has (have) incurred medical expenses in the 
amount of $ 
on behalf of the minor child(ren), including hospital and other expenses 
incidental to the birth of the minor child(ren). There should be an appropriate allocation or 
apportionment of these expenses. 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
211 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
 
        
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
7. 	
___[ 
] Petitioner [ 
] Respondent [ 
] Both has (have) received past public assistance for this 
(these) minor child(ren). 
RESPONDENT’S REQUEST 
1. 	
Respondent requests a hearing on this petition and understands that he or she must 
attend the hearing. 
2. 
Respondent requests that the Court enter an order that: 
[all that apply] 
a. 	
___establishes paternity of the minor child(ren), ordering proper scientific testing, if 
necessary; 
b. 	
___establishes a Parenting Plan containing provisions for parental responsibility and time­
sharing for the minor or dependent child(ren); 
c. 	
___awards child support, including medical/dental insurance coverage, for the minor 
child(ren); 
d. 	
___determines the appropriate allocation or apportionment of all expenses incidental to the 
birth of the child(ren), including hospital and medical expenses; 
e. 	
___determines the appropriate allocation or apportionment of all other past, present, and 
future medical and dental expenses incurred or to be incurred on behalf of the minor 
child(ren); 
f. 	
___changes the child(ren)’s name(s); and 
g. 	
___other relief as follows:______________________________________________________ 
; and 
grants such other relief as may be appropriate and in the best interests of the minor 
child(ren). 
I certify that a copy of this document was [one only] [ 
] mailed [ 
] faxed and mailed 
[ 
] hand delivered to the person(s) listed below on {date} 
. 
Petitioner or his/her attorney: 
Name: 
Address: 
City, State, Zip: 
Fax Number: 
I understand that I am swearing or affirming under oath to the truthfulness of the claims 
made in this answer and counterpetition and that the punishment for knowingly making a false 
statement includes fines and/or imprisonment. 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
212 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
  
 
   
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
Dated:____________________ 
Signature of Respondent/Counterpetitioner 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF _____________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced__________________________________ 
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 
respondent, 
fill 
out 
this 
form. 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (03/09) 
213 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
        
 
 
 
        
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
               
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
FINAL JUDGMENT OF PATERNITY 
This cause came before the Court upon a Petition to Determine Paternity and for Related Relief, 
under chapter 742, Florida Statutes. The Court having reviewed the file and having heard the testimony, 
makes these findings of fact and reaches these conclusions of law: 
1. 	
The Court has jurisdiction of the subject matter and the parties. 
2. 	
Paternity. [ one only] [ 
] By operation of law, [ 
] The Court finds that 
{full legal name} 
, 
is the natural and biological father of the minor child(ren), listed below: 
The parties’ dependent or minor child(ren) is (are): 
Name 
Birth date 
SECTION I. PARENTAL RESPONSIBILITY AND PARENTING PLAN ESTABLISHING TIME‐SHARING WITH 
DEPENDENT OR MINOR CHILD(REN) 
1. 	
Jurisdiction. The Court has jurisdiction to determine parental responsibility and to adopt or 
establish a Parenting Plan with time‐sharing with regards to the child(ren) listed in paragraph 2 
above. 
2. 	
Parental Responsibility and Parenting Plan for the Minor Child(ren). 
[one only] 
a. 	
___Not adjudicated. 
Since no request for relief was made in this action, parental 
responsibility of the minor child(ren) is governed by sections 742.031 and 744.301, Florida 
Statutes. 
b. 	
___Parenting Plan. The parties shall comply with the Parenting Plan which is attached 
hereto and incorporated herein as Exhibit ___. 
SECTION II. CHILD SUPPORT 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
214 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                          
 
 
  
 
 
 
 
 
                          
 
 
  
   
 
 
 
 
 
                      
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
 
  
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
              
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
       
        
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
        
 
 
 
 
 
 
        
 
 
 
 
   
        
 
  
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
         
 
  
 
 
 
1. 	
The Court finds that there is a need for child support and that the [ 
] Mother [ 
] Father 
(hereinafter Obligor) has the present ability to pay child support. The amounts in the Child 
Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), filed by 
the [ 
] Mother [ 
] Father are correct OR the Court makes the following findings: The Mother’s 
net monthly income is $ 
, (Child Support Guidelines 
%). The Father’s net monthly 
income is $ 
, (Child Support Guidelines 
%). 
Monthly child care costs are 
$ 
. Monthly health/dental insurance costs are $ 
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of 
$ 
per month payable ( 
) in accordance with Obligor’s employer’s payroll cycle, 
and in any event at least once a month ( 
) other {explain}: 
beginning {date} 
, and continuing until 
( 
) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, 
marries, dies, or otherwise becomes self‐supporting OR one of the minor children reaches the 
age of 18, become(s) emancipated, marries, dies, or otherwise becomes self‐supporting and 
either party files a supplemental petition to modify child support and the court enters such an 
order. 
OR 
(
) {date/event} 
, 
{explain} 
. 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings 
which support that deviation are: 
3. 
Arrearage/Retroactive Child Support. 
[if applies] 
a. 
b. 
___There is no retroactive child support or arrearage at the time of this Final Judgment. 
___( 
) Mother [ ]) Father [ 
] both has (have) incurred medical expenses in the amount of 
$ 
on behalf of the minor child(ren), including hospital and other expenses 
incidental to the birth of the minor child(ren). Petitioner shall pay 
%, Respondent shall 
pay 
%, which shall be paid as follows: [ 
] added to arrearage in paragraph c below ( 
) 
other {explain} 
____________________________________________________________________________ 
c. 	
___The [ 
] Mother [ 
] Father shall pay to the other party the child support arrearage of: 
$ 
for retroactive child support, as of {date} 
. 
$ 
for previously ordered unpaid child support, as of {date} 
. 
$ 
for previously incurred medical expenses. 
The total of $ 
in child support arrearage shall be repaid at the rate of $ 
per month, payable [ 
] in accordance with Obligor’s employer’s payroll cycle, and in any 
event at least once a month [ 
] other {explain} 
, 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
215 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
               
 
 
 
 
 
 
         
        
 
 
 
 
 
        
 
      
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
        
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
        
 
        
 
        
 
 
 
        
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
       
 
 
beginning {date} 
, until paid in full including statutory interest. 
4. 
Insurance. 
[all that apply] 
a. 
___ Health/Dental Insurance. [ ] Mother [ 
] Father shall be required to maintain [ 
] 
health 
[ 
] dental insurance coverage for the parties’ minor child(ren), so long as reasonably 
available. 
The party providing coverage shall be required to convey insurance cards 
demonstrating said coverage to the other party. OR [ 
] Health [ 
] dental insurance is not 
reasonably available 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 guideline percentages. 
[ 
] Other {explain}: 
. 
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the 
expense shall submit request for reimbursement to the other party within 30 days, and the 
other party, within 30 days of receipt, shall submit the applicable reimbursement for that 
expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). To secure the child support obligations in this 
judgment, [ 
] Mother [ 
] Father [ 
] each party shall maintain life insurance coverage, in an 
amount of at least $ 
, on [ 
] his life [ 
] her life [ 
] his/her life naming the [ 
] 
minor child(ren) as the beneficiary(ies) [ 
] primary residential parent as the beneficiary as 
Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the 
life insurance coverage shall continue until the youngest child turns 18, becomes emancipated, 
marries, dies, or otherwise becomes self‐supporting. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall 
be as follows: ___________________________________________________________________ 
. 
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of 
this paragraph. 
7. 	
Other provisions relating to child support: ___________________________________________ 
SECTION III. METHOD OF PAYMENT 
Obligor shall pay court‐ordered child support/alimony and arrears, if any, as follows: 
1. 
Central Governmental Depository. 
[if applies] 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
216 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
   
 
 
 
   
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
          
 
          
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
a. 	
___Obligor shall pay court‐ordered support directly to the Central Governmental Depository 
in {name} 
County, along with any depository service charge. 
b. 	
___Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
section 
61.13(1)(d)3, 
Florida 
Statutes, 
to 
require 
payments 
through 
the 
Central 
Governmental Depository. 
2. 	
Income Deduction. 
[ if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this support obligation until all of said support is deducted from Obligor’s income. 
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for 
making timely payments directly to the Central Governmental Depository or the Obligee, 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 in cases of modification, 
AND 
[ 
] there is an agreement by the Obligor to advise the central governmental depository of 
any change in payor and health insurance OR [ 
] there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. [ 
] 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 Obligee pursuant to the 
payment method prescribed above. 
4. 	
Other provisions relating to method of payment. 
SECTION IV. CHILD(REN)’S NAME(S) 
a. 	
___There shall be no change to the child(ren)’s name(s). 
b. 	
___It is in the child(ren)’s best interests that the child(ren)’s 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
217 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
  
 
 
  
 
  
 
  
 
 
 
 
 
  
 
  
 
  
 
 
 
  
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
  
      
        
 
 
 
 
 
 
 
 
 
                       
 
 
 
   
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
                      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
         
 
           
 
  
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
present name(s) 
(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
shall be changed to 
(1) 
(2) 
(3) 
by which the minor child(ren) shall hereafter be known. 
(4) 
(5) 
(6) 
SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 
[ 
] Petitioner’s [ 
] Respondent’s request(s) for attorney fees, costs, and suit money is (are) 
denied because 
. 
2. 	
___The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. 
[ 
] Petitioner [ 
] Respondent is hereby ordered to pay to the other party $ 
in 
attorney fees, and $ 
in costs. 
The Court further finds that the attorney fees 
awarded are based on the reasonable rate of $ 
per hour and 
reasonable 
hours. Other provisions relating to attorney fees, costs, and suit money are as follows:________ 
3. 	
The costs of the scientific paternity testing shall be assessed: 
[ 
] against Petitioner [ ] against Respondent 
[ 
] Other {explain} 
. 
SECTION VI. OTHER PROVISIONS 
1. 	
Other Provisions. 
2. 
The Court reserves jurisdiction to modify and enforce this Final Judgment. 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
218 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
 
 
 
 
 
 
     
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
                       
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
      
 
 
ORDERED on 
. 
CIRCUIT JUDGE 
COPIES TO: 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: _______________________________________ 
I CERTIFY the foregoing is a true copy of the original as it appears on file in the office of the Clerk of the 
Circuit Court of 
County, Florida, and that I have furnished copies of this order as indicated 
above. 
CLERK OF THE CIRCUIT COURT 
(SEAL) 
By: 
Deputy Clerk 
Florida Supreme Court Approved Family Law Form 12.983(g), Final Judgment of Paternity (03/09)
219 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
        
  
 
 
 
 
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE WITH MINOR CHILD(REN) (UNCONTESTED) 
This cause came before this Court for a hearing on a Petition for Dissolution of Marriage. The 
Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these 
conclusions of law: 
1. 	
The Court has jurisdiction over the subject matter and the parties. 
2. 	
At least one party has been a resident of the State of Florida for more than 6 months 
immediately before filing the Petition for Dissolution of Marriage. 
3. 	
The marriage between the parties is irretrievably broken. Therefore, the marriage between the 
parties is dissolved, and the parties are restored to the status of being single. 
4. 	
Marital Settlement Agreement. The parties have voluntarily entered into a Marital Settlement 
Agreement and Parenting Plan, and each has filed the required Family Law Financial Affidavit. 
Therefore, the Marital Settlement Agreement and Parenting Plan is filed as AExhibit A@ in this 
case and is ratified and made a part of this final judgment. The parties are ordered to obey all of 
the provisions. 
5. 	
The Court finds that the parties have the present ability to pay support as agreed to in the 
marital settlement agreement as ratified and made part of this final judgment. 
6. 	
( 
) yes ( 
) no. The wife’s former name of 
{full legal name}______________________________ is restored. 
7. 	
The Court reserves jurisdiction to modify and enforce this final judgment. 
ORDERED on 	
. 
Florida Supreme Court Approved Family Law Form 12.990(b)(1), Final Judgment of Dissolution of Marriage with 
Minor Child(ren) (Uncontested) (03/09) 
220 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Other: 
Florida Supreme Court Approved Family Law Form 12.990(b)(1), Final Judgment of Dissolution of Marriage with 
Minor Child(ren) (Uncontested) (03/09) 
221 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
 
  
 
 
 
 
 
                                                                         
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.:______________________________ 
Division: ______________________________ 
, 
Petitioner, 
and 
, 
Respondent. 
FINAL JUDGMENT OF DISSOLUTION OF MARRIAGE 
WITH DEPENDENT OR MINOR CHILD(REN) 
This cause came before this Court for a trial on a Petition for Dissolution of Marriage. The Court, having 
reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of 
law: 
1. 	
The Court has jurisdiction over the subject matter and the parties. 
2. 	
At least one party has been a resident of the State of Florida for more than 6 months 
immediately before filing the Petition for Dissolution of Marriage. 
3. 	
The marriage between the parties is irretrievably broken. Therefore, the marriage between the 
parties is dissolved, and the parties are restored to the status of being single. 
SECTION I. MARITAL ASSETS AND LIABILITIES 
A. 	
Date of Valuation of Property. The assets and liabilities listed below are divided as indicated. The 
date of valuation of these assets and liabilities is, unless otherwise indicated: 
a. 	
___ date of filing petition for dissolution of marriage. 
b. 	
___ date of separation. 
c. 	
___ date of divorce trial. 
B. 	
Division of Assets. 
1. 	
The assets listed below are nonmarital assets. Each party shall keep, as his or her own, the 
assets found to be nonmarital, and the other party shall have no further rights or responsibilities 
regarding these assets. 
ASSETS: DESCRIPTION OF ITEM(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current 
Fair 
Market Value 
Wife=s 
Nonmarital 
Property 
Husband=s 
Nonmarital 
Property 
$ 
$ 
$ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
222 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ASSETS: DESCRIPTION OF ITEM(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current 
Fair 
Market Value 
Wife=s 
Nonmarital 
Property 
Husband=s 
Nonmarital 
Property 
Total Nonmarital Assets 
2. 	
The assets listed below are marital assets. Each party shall keep, as his or her own, the assets 
awarded in this section, and the other party shall have no further rights or responsibilities 
regarding these assets. Any personal item(s) not listed below are awarded to the party 
currently in possession or control of the item(s). 
ASSETS: DESCRIPTION OF ITEM(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current Fair 
Market 
Value 
Wife 
Shall 
Receive 
Husband 
Shall Receive 
Cash (on hand or in banks/credit unions) 
$ 
$ 
$ 
Stocks/bonds 
Notes 
Business interests 
Real estate: (Home) 
Automobiles 
Boats 
Furniture & furnishings 
Jewelry 
Life insurance (cash surrender value) 
Retirement Plans (Profit sharing, Pension, IRA, 401(k)s, etc.) 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
223 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ASSETS: DESCRIPTION OF ITEM(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current Fair 
Market 
Value 
Wife 
Shall 
Receive 
Husband 
Shall Receive 
Other assets 
Total Marital Assets 
$ 
$ 
$ 
C. 	
Division of Liabilities/Debts. 
1. 	
The liabilities listed below are nonmarital liabilities and, therefore, are owed as indicated. Each 
party shall owe, as his or her own, the liabilities found to be nonmarital, and the other party 
shall have no responsibilities regarding these debts. 
LIABILITIES: DESCRIPTION OF DEBT(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current 
Amount 
Owed 
Wife=s 
Nonmarital 
Liability 
Husband=s 
Nonmarital 
Liability 
$ 
$ 
$ 
Total Nonmarital Liabilities 
$ 
$ 
$ 
2. 
The liabilities listed below are marital liabilities and are divided as indicated. Each party shall 
hold the other party harmless and pay, as his or her own, the marital liabilities awarded below. 
LIABILITIES: DESCRIPTION OF DEBT(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current 
Amount 
Owed 
Wife 
Shall Pay 
Husband 
Shall Pay 
Mortgages on real estate: (Home) 
$ 
$ 
$ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
224 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
________________________________________________________________________________ 
________________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
________________________________________________________________________________ 
________________________________________________________________________________ 
________________________________________________________________________________ 
________________________________________________________________________________ 
 
 
  
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LIABILITIES: DESCRIPTION OF DEBT(S) 
(Describe each item as clearly as possible. You do not need to list account numbers.) 
Current 
Amount 
Owed 
Wife 
Shall Pay 
Husband 
Shall Pay 
(Other) 
Charge/credit card accounts 
Auto loan 
Auto loan 
Bank/Credit Union loans 
Other 
Total Marital Liabilities 
$ 
$ 
$ 
D. 	 Contingent assets and liabilities will be divided as follows: _________________________________ 
E. 	
The distribution of assets and liabilities in this final judgment is equitable; if each party does not 
receive approximately one‐half, the distribution is based on the following facts and reasoning: 
SECTION II. EXCLUSIVE USE AND POSSESSION OF HOME 
[ √ all that apply] 
1. 	
___Petitioner ( 
) Respondent, as a condition of support, shall have exclusive use and 
possession of the dwelling located at: ________________________________________ until 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
225 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
        
        
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
          
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
      
 
 
 
 
 
 
 
 
      
 
 
 
 
 
   
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
 
 
{date or event} __________________________________________________________________ 
2. 	
___ ( 
) Petitioner ( 
) Respondent may make visits to the premises described in the paragraph 
above for the purpose of obtaining any items awarded in this Final Judgment. These visits shall 
occur after notice to the person granted exclusive use and possession of the dwelling and at the 
earliest convenience of both parties or as ordered in paragraph 4 below. 
3. 	
___Upon the termination of the right of exclusive use and possession, the dwelling shall be sold 
and the net proceeds divided 
% to Petitioner and 
% to Respondent, with the following 
credits and/or setoffs being allowed: ________________________________________________ 
4. 	
___Other: ______________________________________________________________________ 
SECTION III. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME‐SHARING WITH 
DEPENDENT OR MINOR CHILD(REN) 
1. 	
Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or 
adopt a Parenting Plan, and time‐sharing schedule with regards to the minor child(ren) listed in 
paragraph 2 below. 
2. 
The parties’ dependent or minor child(ren) is (are): 
Name 
Birth date 
3. 	
Parenting Plan. The parties shall comply with the Parenting Plan which is attached and 
incorporated herein as Exhibit ___. 
SECTION IV. ALIMONY 
1. 
( 
) The Court denies the request(s) for alimony OR 
( 
) The Court finds that there is a need for, and that ( 
) Petitioner ( 
) Respondent (hereinafter 
Obligor) has/had the present ability to pay, alimony as follows: 
[ √ all that apply] 
a. 	
___Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the 
amount of $ 
per month, payable ( 
) in accordance with Obligor=s employer’s 
payroll cycle, and in any event, at least once a month ( 
) other {explain} _______________ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
226 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
__________________________________________________________________________  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
 
 
  
 
 
 
 
   
 
 
                       
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
        
        
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
___________________________________________________________________________ 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
                     
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
                
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
______________________________________________________________________________ 
________________________________________________________________________________ 
 
beginning {date} ___________This alimony shall continue until modified by court order, the death of 
either party, or remarriage of Obligee, whichever occurs first. 
b. 
___Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $________. 
This amount shall be paid as follows: _____________________________________________ 
c. 
___Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of 
$______ per month, payable ( 
) in accordance with Obligor’s employer’s payroll cycle, and 
in any event, at least once a month ( 
) other {explain}______________________________ 
beginning {date}___________________. This rehabilitative alimony shall continue until modified by 
court order, the death of either party or until {date/event} ________________, 
whichever occurs first. The rehabilitative plan presented demonstrated the following: _____ 
d. 	
___Retroactive. Obligor shall pay retroactive alimony in the amount of $ 
for the 
period of {date}_______________,through {date} __________________, which shall be paid 
pursuant to paragraph 3 below. 
2. 	
Reasons for ( 
) Awarding ( 
) Denying Alimony. The Court has considered all of the following 
in awarding/denying alimony: 
a. 	
The standard of living established during the marriage; 
b. 	
The duration of the marriage; 
c. 	
The age and the physical and emotional condition of each party; 
d. 	
The financial resources of each party, the nonmarital and the marital assets and liabilities 
distributed to each; 
e. 	
The contribution of each party to the marriage, including, but not limited to, services 
rendered in homemaking, child care, education, and career building of the other party; and 
f. 
All sources of income available to either party. 
Additionally, the Court has considered the following factors in reaching its decision: 
( )Check here if additional pages are attached. 
3. 
Arrearage/Retroactive Alimony. 
[√ one only] 
a. 
___There is no alimony arrearage at the time of this Final Judgment. 
b. 	
___The ( 
) Petitioner ( 
) Respondent shall pay to the other party the alimony arrearage 
of: $ 
for retroactive alimony, as of {date}___________. $ 
for 
previously ordered unpaid alimony, as of {date} _________________. The total of 
$ ______ in alimony arrearage shall be repaid in the amount of $ 
_ 
per month, payable ( 
) in 
accordance with Obligor’s employer’s payroll cycle, and in any event at least once a month ( 
) other 
{explain}_______________________________________________________________________ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
227 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
          
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
______________________________________________________________________________ 
______________________________________________________________________________ 
_____________________________________________________________________________________
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                        
 
 
 
 
 
 
 
 
                          
 
 
 
 
 
 
 
 
                        
 
 
 
 
                        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                        
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
_____________________________________________________________________________________  
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
beginning {date}______________, until paid in full including statutory interest. 
4. 
Insurance. 
[√ all that apply] 
a. 	
___ Health Insurance. 
( 
) Petitioner ( 
) Respondent shall be required to pay health 
insurance premiums for the other party not to exceed $__________ per month. Further, 
( 
) Petitioner ( 
) Respondent shall pay any reasonable and necessary uninsured medical 
costs for the other party not to exceed $_________ per year. As to these uninsured medical 
expenses, the party who is entitled to reimbursement of the uninsured medical expense 
shall submit request for reimbursement to the other party within 30 days, and the other 
party shall, within 30 days after receipt, submit the applicable reimbursement for that 
expense. 
b. 	
___ Life Insurance (to secure payment of support). To secure the alimony obligations set 
forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming 
Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance 
shall be in the amount of at least $_______ and shall remain in effect until the obligation for 
alimony terminates. 
5. 	
Other provisions relating to alimony: 
_______________________________________________________________________. 
SECTION V. CHILD SUPPORT 
1. 	
The Court finds that there is a need for child support and that the ( 
) Mother ( 
) Father 
(hereinafter Obligor) has the present ability to pay child support. The amounts in the Child 
Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), filed by 
the ( 
) Mother ( 
) Father are correct OR the Court makes the following findings: The Mother’s 
net monthly income is $ 
, (Child Support Guidelines %). The Fathers net monthly 
income is $ 
, (Child Support Guidelines %). Monthly child care costs are $ 
. 
Monthly health/dental insurance costs are $ 
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of $ 
, per 
month payable ( 
) in accordance with Obligor’s employer’s payroll cycle, and in any event at 
least once a month ( 
) other {explain}: ______________________________________________ 
beginning {date}_____________, and continuing until 
( 
) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, marries, dies, 
or otherwise becomes self‐supporting OR one of the minor children reaches the age of 18, become(s) 
emancipated, marries, dies, or otherwise becomes self‐supporting and either party files a supplemental 
petition to modify child support and the court enters such an order. 
OR 
(
) {date/event} _________________________________________________________________, 
{explain} _______________________________________________________________________. 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings which 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
228 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
 
                       
 
 
 
 
 
 
 
 
                            
 
 
                       
 
 
 
 
 
 
 
 
 
 
                       
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
      
 
 
 
______________________________________________________________________________ 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
         
         
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
 
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
        
 
        
 
 
 
        
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
support that deviation are: _________________________________________________________ 
3. 
Arrearage/Retroactive Child Support. 
[√ one only] 
a. 	
___There is no child support arrearage at the time of this Final Judgment. 
b. 	
___The ( 
) Mother ( 
) Father shall pay to the other party the child support arrearage of: 
$ 
for retroactive child support, as of {date} ________. $ 
for previously 
ordered unpaid child support, as of {date} 
. The total of $ 
in child 
support arrearage shall be repaid in the amount of $ 
per month, payable ( 
) in 
accordance with Obligor=s employer=s payroll cycle, and in any event at least once a month 
( 
) other {explain} ___________________________________________________________ 
beginning {date}_________, until paid in full including statutory interest. 
4. 
Insurance. 
[√ all that apply] 
a. 	
___Health/Dental Insurance. ( 
) Mother ( 
) Father shall be required to maintain ( 
) 
health ( 
) dental insurance coverage for the parties= = minor child(ren), so long as reasonably 
available. The party providing coverage shall be required to convey insurance cards 
demonstrating said coverage to the other party. OR ( 
) Health ( 
) dental insurance is not 
reasonably available 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 guideline percentages. 
( 
) Other {explain}: _______________________________________________________________ 
As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense 
shall submit request for reimbursement to the other party within 30 days, and the other party, within 30 
days of receipt, shall submit the applicable reimbursement for that expense, according to the schedule 
of reimbursement set out in this paragraph. 
5. 	
___Life Insurance (to secure payment of support). To secure the child support obligations in 
this judgment, ( 
) Petitioner ( 
) Respondent ( 
) Each party shall maintain life insurance 
coverage, in an amount of at least $______, on ( 
) his life ( 
) her life ( 
) his/her life naming 
the ( 
) minor child(ren) as the beneficiary(ies) ( 
) primary residential parent as the beneficiary 
as Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain 
the life insurance coverage shall continue until the youngest child turns 18, becomes 
emancipated, marries, dies, or otherwise becomes self‐supporting. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall 
be as follows: __________________________________________________________________ 
______________________________________________________________________________. 
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of this 
paragraph. 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
229 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
   
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
______________________________________________________________________________ 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
        
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
7. 
Other provisions relating to child support: __________________________________________ 
SECTION VI. METHOD OF PAYMENT 
Obligor shall pay court‐ordered child support/alimony and arrears, if any, as follows: 
1. 
Central Governmental Depository. 
[ √ if applies] 
a. 	
___Obligor shall pay court‐ordered support directly to the Central Governmental Depository 
in {name} ______________________ County, along with any depository service charge. 
b. 	
___Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
section 
61.13(1)(d)3, 
Florida 
Statutes, 
to 
require 
payments 
through 
the 
Central 
Governmental Depository. 
2. 
Income Deduction. 
[√ if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate 
Income Deduction Order which shall be effective immediately. Obligor is individually 
responsible for paying this support obligation until all of said support is deducted from 
Obligor’s income. Until support payments are deducted from Obligor’s paycheck, Obligor is 
responsible for making timely payments directly to the Central Governmental Depository or 
the Obligee, 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 
in cases of modification, 
AND 
( 
) there is an agreement by the Obligor to advise the central governmental depository of any change 
in payor and health insurance OR ( 
) there is a signed written agreement providing an alternative 
arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant 
to the payment method prescribed above. 
4. 	
Other provisions relating to method of payment. _____________________________________ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
230 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
  
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
   
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
_______________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
           
       
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION VII. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___( 
) Petitioner’s ( 
) Respondent’s request(s) for attorney fees, costs, and suit money is (are) 
denied because _________________________________________________________________ 
______________________________________________________________________________. 
2. 	
___The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. 
( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party $_______ in attorney 
fees, and $ _______ in costs. The Court further finds that the attorney fees awarded are based 
on the reasonable rate of $ _______ per hour and __________ reasonable hours. Other 
provisions relating to attorney fees, costs, and suit money are as follows: __________________ 
SECTION VIII. OTHER PROVISIONS 
1. 	
Former Name. The wife’s former name of {full name} __________________________________ 
is restored. 
2. 	
Other Provisions. _______________________________________________________________ 
3. 	
The Court reserves jurisdiction to modify and enforce this Final Judgment. 
ORDERED on 	
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} _________________________________ was [T only one] 
( 
) 
mailed ( 
)faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee} ______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other __________________________________ 
Florida Supreme Court Approved Family Law Form 12.990(c)(1), Final Judgment of Dissolution of Marriage with 
Dependent or Minor Child(ren) (03/09) 
231 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
SUPPLEMENTAL FINAL JUDGMENT MODIFYING PARENTAL RESPONSIBILITY, VISITATION, OR 
PARENTING PLAN/TIME‐SHARING SCHEDULE AND OTHER RELIEF 
This cause came before this Court on a Supplemental Petition to Modify Custody, Visitation, or 
Parenting Plan/Time‐Sharing Schedule and Other Relief. The Court, having reviewed the file, heard the 
testimony, and being otherwise fully advised, 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 last order establishing or modifying parental responsibility, visitation, or time‐sharing was 
entered on {date} 
. 
3. 	
There has been a substantial change in circumstances of the parties since the entry of the last 
order, specifically: ____________________________________________________________ 
4. 
It is in the best interests of the minor child(ren) that the current parental responsibility, 
visitation, time‐sharing order or Parenting Plan be changed because: ______________________ 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
232 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
     
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
  
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
                          
 
 
 
     
 
 
 
 
 
                        
 
 
 
 
 
                      
 
 
 
 
 
 
 
 
 
 
   
 
 
    
 
 
 
 
          
 
 
 
 
 
 
   
 
 
 
 
   
        
 
   
 
 
 
  
 
 
 
 
 
SECTION II. PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME‐SHARING WITH 
DEPENDENT OR MINOR CHILD(REN) 
1. 	
Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or 
approve a Parenting Plan, and time‐sharing with regard to the parties’ minor child(ren) listed in 
paragraph 2 below. 
2. 	
The parties’ dependent or minor child(ren) is (are): 
Name 
Birth date 
3. 	
Parenting Plan. 
The parties shall comply with the Parenting Plan which is attached and 
incorporated herein as Exhibit ___. 
SECTION III. CHILD SUPPORT 
1. 	
Modification of Child Support. 
[ √ one only] 
a. 	
___The modification of parental responsibility or time‐sharing entered above does not 
necessitate a modification of child support. The previous order or final judgment 
establishing or modifying child support shall remain in effect. 
b. 	
___ The Court finds that there is a need for modification of child support and that the ( 
) 
Mother ( 
) Father (hereinafter Obligor) has the present ability to pay child support. The 
amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure 
Form 12.902(e), filed by the ( 
) Mother ( 
) Father are correct OR the Court makes the 
following findings: The Mother’s net monthly income is $ 
, 
(Child 
Support 
Guidelines %). The Father’s net monthly income is $ 
, (Child Support Guidelines 
%). Monthly child care costs are $ 
. Monthly health/dental insurance costs are 
$
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of $ 
, per 
month payable ( 
) in accordance with Obligor=s employer=s payroll cycle, and in any event at 
least once a month ( 
) other {explain}: 
, 
beginning {date} 
, and continuing until: 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
233 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
                
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
  
 
 
 
                     
 
 
 
 
 
 
 
 
                                  
 
 
 
                     
 
 
 
 
 
 
 
 
 
 
                        
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
                 
 
 
 
 
 
        
        
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
___________________________________________________________________________
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
( 
) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, 
marries, dies, or otherwise becomes self‐supporting OR one of the minor children reaches the 
age of 18, become(s) emancipated, marries, dies, or otherwise becomes self‐supporting and 
either party files a supplemental petition to modify child support and the court enters such an 
order. 
OR 
(
) {date/event} 
, 
{explain} 
. 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings 
which support that deviation are: 
3. 
Arrearage/Retroactive Child Support. 
[ one only] 
a. 
___There is no child support arrearage at the time of this Supplemental Final Judgment. 
b. 
___The ( 
) Mother ( 
) Father shall pay to the other party the child support arrearage of: 
$ 
for retroactive child support, as of {date} 
. 
$ 
for previously ordered unpaid child support, as of {date} 
. The total of 
$ 
in child support arrearage shall be repaid in the amount of $ 
, per 
month payable ( 
) in accordance with Obligor=s employer=s payroll cycle, and in any event 
at least once a month ( 
) other {explain} _________________________________________ 
beginning {date} 
, until paid in full including statutory interest. 
4. 	
Insurance. 
[ all that apply] 
a. 	
___Health/Dental Insurance. ( 
) Mother ( 
) Father shall be required to maintain 
( 
) health ( 
) dental insurance coverage for the parties= = minor child(ren), so long as 
reasonably available. The party providing coverage shall be required to convey insurance 
cards demonstrating said coverage to the other party. OR ( 
) Health ( 
) dental insurance is 
not reasonably available 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 guideline 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 other party within 30 days, and 
the other party, within 30 days of receipt, shall submit the applicable reimbursement for 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
234 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
        
 
        
 
        
 
        
 
 
 
        
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
that expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). To secure the child support obligations in this 
judgment, ( 
) Petitioner ( 
) Respondent ( 
) Each party shall maintain life insurance coverage, 
in an amount of at least $ 
, on ( 
) his life ( 
) her life ( 
) his/her life naming the ( 
) 
minor child(ren) as the beneficiary(ies) ( 
) primary residential parent as the beneficiary as 
Trustee for the minor child(ren), so long as reasonably available. The obligation to maintain the 
life insurance coverage shall continue until the first of the parties= = minor children reaches the 
age of 18 or until one of the parties’ children becomes emancipated, marries, dies, otherwise 
becomes self‐supporting, at which time the amount of life insurance shall be recomputed. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be 
as follows: _____________________________________________________________________ 
. 
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of 
this paragraph. 
7. 
Other provisions relating to child support: ___________________________________________ 
SECTION IV. METHOD OF PAYMENT 
Obligor shall pay court‐ordered child support and arrears, if any, as follows: 
1. 	
Central Governmental Depository. 
[if applies] 
a. 	
___Obligor shall pay court‐ordered support directly to the Central Governmental Depository 
in {name of county} 
County, along with any depository service charge. 
b. 	
___Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
section 
61.13(1)(d)3, 
Florida 
Statutes, 
to 
require 
payments 
through 
the 
Central 
Governmental Depository. 
2. 	
Income Deduction. 
[if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this support obligation until all of said support is deducted from Obligor’s income. 
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for 
making timely payments directly to the Central Governmental Depository or the Obligee, as 
previously set forth in this order. 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
235 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
          
 
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
   
 
 
 
 
 
 
 
   
 
   
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
                      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
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 to advise the central governmental depository of 
any change in payor and health insurance OR ( 
) there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant to the 
payment method prescribed above. 
4. 	
Other provisions relating to method of payment. _____________________________________ 
SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___( 
) Petitioner’s ( 
) Respondent=s request(s) for attorney fees, costs, and suit money is (are) 
denied because _________________________________________________________________ 
. 
2. 	
___The Court finds there is a need for and an ability to pay attorney fees, costs, and suit money. 
( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party $ 
in 
attorney fees, and $ 
in costs. The Court further finds that the attorney fees awarded 
are based on the reasonable rate of $ 
per hour and 
reasonable hours. 
Other provisions relating to attorney fees, costs, and suit money are as follows: _____________ 
SECTION VI. OTHER 
1. 	
Other Provisions. 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
236 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
2. 	
The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment. 
3. 	
Unless specifically modified by this supplemental final judgment, the provisions of all final 
judgments or orders in effect remain the same. 
ORDERED on 	
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [√ only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: 
Florida Supreme Court Approved Family Law Form 12.993(a), Supplemental Final Judgment Modifying Parental 
Responsibility Visitation, or Parenting Plan/Time‐Sharing Schedule and Other Relief (03/09)
237 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_________________________________________________________________________ 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
SUPPLEMENTAL FINAL JUDGMENT MODIFYING CHILD SUPPORT 
This cause came before this Court on a Supplemental Petition for Modification of Child Support. 
The Court, having heard the testimony and reviewed the file and financial affidavits of the parties and 
being otherwise fully advised, 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 parties’ dependent or minor child(ren) is (are): 
Name 
Birth date 
3. 	
The last order awarding or modifying child support was entered on {date} _______________ 
4. 	
There has been a substantial change in circumstances of the parties since the entry of the last 
order, specifically: _________________________________________________________________ 
5. 
It is in the best interests of the minor child(ren) that the current child support order be changed 
because: 
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child 
Support (03/09) 
238 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
        
 
      
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
  
 
 
 
 
                          
 
 
   
 
 
 
 
 
                          
 
 
    
 
 
 
 
 
   
 
 
 
 
 
 
  
                                                
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                    
 
 
          
 
 
 
 
 
 
   
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
               
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
  
 
 
   
                     
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
 
 
 
   
 
 
   
 
 
 
 
          
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
                
 
 
 
. 
SECTION II. CHILD SUPPORT 
1. 	
The Court finds that there is a need for modification of child support and that the ( 
) Mother 
( 
) Father (hereinafter Obligor) has the present ability to pay child support. The amounts in the 
Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), 
filed by the ( 
) Mother ( 
) Father are correct OR the Court makes the following findings: The 
Mother=s net monthly income is $ 
, (Child Support Guidelines 
%). The Father=s 
net monthly income is $ 
, (Child Support Guidelines 
%). Monthly child care 
costs are $ 
. Monthly health/dental insurance costs are 
$
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of $ 
, per month 
payable ( 
) in accordance with Obligor’s employer’s payroll cycle, and in any event at least once a 
month ( 
) other {explain} __________________________________________________________ 
, 
beginning {date} 
, and continuing until: 
( 
) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, 
marries, dies, or otherwise becomes self‐supporting OR one of the minor children reaches the 
age of 18, become(s) emancipated, marries, dies, or otherwise becomes self‐supporting and 
either party files a supplemental petition to modify child support and the court enters such an 
order. 
OR 
(
) {date/event} 
, 
{explain} 
. 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings 
which support that deviation are: 
3. 	
Arrearage/Retroactive Child Support. 
[one only] 
a. 	
___There is no child support arrearage at the time of this Supplemental Final Judgment. 
b. 	
___( 
) Mother ( 
) Father shall pay to the other party the child support arrearage of: 
$ 
for retroactive child support, as of {date} 
.
$ 
for previously ordered unpaid child support, as of {date} _______________The total of 
$ 
in child support arrearage shall be repaid in the amount of $ 
, 
per 
month payable ( 
) in accordance with his or her employer=s payroll cycle, and 
in 
any 
event at least once a month ( 
) other {explain} ____________________________________ 
beginning {date} 	
, until paid in full including statutory interest. 
4. 	
Insurance. 
[ all that apply] 
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child 
Support (03/09) 
239 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
        
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
        
        
        
 
 
 
 
 
 
   
 
 
 
 
   
 
        
 
        
 
        
 
 
 
        
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
a. 	
___Health/Dental Insurance. ( 
) Mother ( 
) Father shall be required to maintain ( 
) 
health 
( 
) dental insurance coverage for the parties= = minor child(ren), so long as reasonably 
available. The party providing coverage shall be required to convey insurance cards 
demonstrating said coverage to the other party. OR ( 
) Health ( 
) Dental insurance is not 
reasonably available at this time. 
b. 	
___Reasonable and necessary uninsured medical/dental/prescription costs for the minor 
child(ren) shall be assessed as follows: 
( 
) Shared equally by both parents. 
( 
) Prorated according to the child support guideline percentages. 
( 
) Other {explain}: 
As to these uninsured medical/dental/prescription expenses, the party who incurs the 
expense shall submit a request for reimbursement to the other party within 30 days, and 
the other party, within 30 days of receipt, shall submit the applicable reimbursement for 
that expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). To secure the child support obligations in this 
judgment, ( 
) Mother ( 
) Father ( 
) Each party shall maintain life insurance coverage, in an 
amount of at least $ 
, on ( 
) his life ( 
) her life ( 
) his/her life naming the ( 
) minor 
child(ren) as the beneficiary(ies) ( 
) primary residential parent as the beneficiary as Trustee 
for the minor child(ren), so long as reasonably available. The obligation to maintain the life 
insurance coverage shall continue until the first of the parties= = minor children reaches the age 
of 18 or until one of the parties= = children becomes emancipated, marries, dies, otherwise 
becomes self‐supporting, at which time the amount of life insurance coverage shall be 
recomputed. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall 
be as follows: ________________________________________________________________ 
. 
Further, each party shall execute any and all IRS forms necessary to effectuate the 
provisions of this paragraph. 
7. 	
Other provisions relating to child support: ________________________________________ 
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child 
Support (03/09) 
240 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
          
 
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION III. METHOD OF PAYMENT 
1. 	
Central Governmental Depository. 
[if applies] 
a. 	
___Obligor shall pay court‐ordered support directly to the Central Governmental Depository 
in {name of county} 
County, along with any depository service charge. 
b. 	
___Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
section 
61.13(1)(d)3, 
Florida 
Statutes, 
to 
require 
payments 
through 
the 
Central 
Governmental Depository. 
2. 	
Income Deduction. 
[ if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this support obligation until all of said support is deducted from Obligor’s income. 
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for 
making timely payments directly to the Central Governmental Depository or the Obligee, 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 to advise the central governmental depository of 
any change in payor and health insurance OR ( 
) there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant to the 
payment method prescribed above. 
4. 	
Other provisions relating to method of payment ______________________________________ 
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child 
Support (03/09) 
241 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
         
        
   
 
 
 
 
 
 
 
   
 
   
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
           
         
 
 
         
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___( 
) Petitioner’s ( 
) Respondent’s request(s) for attorney fees, costs, and suit 
money is (are) denied because ______________________________________________ 
_______________________________________________________________________. 
2. 	
___The Court finds there is a need for and an ability to pay attorney fees, costs, and suit 
money. ( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party $ 
in attorney fees, and $ 
in costs. The Court further finds that the 
attorney fees awarded are based on the reasonable rate of $ 
per hour and 
reasonable hours. Other provisions relating to attorney fees, costs, and suit 
money are as follows: 
SECTION V. OTHER 
1. 
Other Provisions. 
2. 
The Court reserves jurisdiction to modify and enforce this Supplemental Final Judgment. 
3. 
Unless specifically modified by this supplemental final judgment, the provisions of all 
final judgments or orders in effect remain the same. 
ORDERED on 	
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ was 
[only one] 
( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: _______________________ 
Florida Supreme Court Approved Family Law Form 12.993(b), Supplemental Final Judgment Modifying Child 
Support (03/09) 
242 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
 
 
 
 
                                                                         
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 
 
 
   
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
     
   
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
SUPPLEMENTAL TEMPORARY JUDGMENT MODIFYING PARENTING ISSUES FOR CHILD(REN) OF A 
PARENT ACTIVATED, DEPLOYED, OR TEMPORARILY ASSIGNED TO MILITARY SERVICE 
This cause came before this Court on a Supplemental Petition for Temporary Modification of 
Custody or Parenting Plan/Time‐Sharing Schedule for Child(ren) of a Parent Activated, Deployed, or 
Temporarily Assigned to Military Service. The Court, having reviewed the file, heard the testimony, and 
being otherwise fully advised, 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 last order establishing or modifying parental responsibility, visitation, or time‐sharing was 
entered on {date} 
. 
3. 	
There is clear and convincing evidence that it is in the best interests of the minor child(ren) that 
the current order establishing parental responsibility, visitation, and time‐sharing be temporarily 
changed as the ( ) Mother ( )Father is activated, deployed, or temporarily assigned to military 
service. Specifically, _____________________________________________________________ 
______________________________________________________________________________. 
SECTION II. TEMPORARY PARENTING PLAN ESTABLISHING PARENTAL RESPONSIBILITY AND TIME­
SHARING WITH DEPENDENT OR MINOR CHILD(REN) 
1. 	
Jurisdiction. The Court has jurisdiction to determine parental responsibility, to establish or 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
243 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
   
  
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
               
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
     
 
 
     
 
 
     
 
 
 
 
 
 
 
 
 
  
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
  
 
 
 
 
     
 
 
 
 
 
 
 
 
 
                          
 
 
       
 
 
 
 
 
 
                      
 
 
 
 
                        
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
 
  
 
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
approve a Parenting Plan, and time‐sharing with regards to the parties’ minor child(ren) listed in 
paragraph 2 below. 
2. 	
The parties’ dependent or minor child(ren) is (are): 
Name 
Birth date 
3. 	
Parenting Plan. The parties shall comply with the temporary Parenting Plan which is attached 
and incorporated herein as Exhibit ___. 
SECTION III. CHILD SUPPORT 
1. 	
Temporary Modification of Child Support. 
[one only] 
a. 	
___The ( 
) Mother’s ( 
) Father’s current obligation to pay child support is:(Choose only 
one) 
( ) Abated 
( ) Suspended 
( ) Modified to $______________ per ________________. 
b. 	
___ The Court finds that there is a need for temporary modification of child support and 
that the service member( 
) Mother ( 
) Father (hereinafter Obligor) has the present ability 
to pay child support. The amounts in the Child Support Guidelines Worksheet, Florida Family 
Law Rules of Procedure Form 12.902(e), filed by the ( 
) Mother ( 
) Father are correct OR 
the Court makes the following findings: The Mother’s net monthly income is $ 
, (Child 
Support Guidelines_ %). The Father’s net monthly income is $ 
, (Child Support 
Guidelines 
%). Monthly child care costs are $ 
. Monthly health/dental 
insurance costs are $ 
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of 
$ 
, per month payable ( 
) in accordance with Obligor’s employer’s payroll cycle, 
and in any event at least once a month ( 
) other {explain}: 
, 
beginning {date} 
, and continuing until 
( 
) the youngest of the minor child(ren) reaches the age of 18, become(s) emancipated, 
marries, dies, or otherwise becomes self‐supporting OR one of the minor children 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
244 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
 
 
 
 
  
 
 
 
                     
 
 
 
 
 
 
 
 
                                  
 
 
 
                     
 
 
 
 
 
 
 
 
 
 
                        
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
   
 
 
          
        
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
       
        
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
         
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
reaches the age of 18, become(s) emancipated, marries, dies, or otherwise becomes 
self‐supporting and either party files a supplemental petition to modify child support 
and the court enters such an order OR upon the service member parent’s return from 
active military service, deployment, or temporary assignment. 
OR 
(
) {date/event} 
, 
{explain} 
. 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings 
which support that deviation are: 
3. 
Arrearage/Retroactive Child Support. 
[one only] 
a. 
___There is no child support arrearage at the time of this Supplemental Temporary 
Judgment. 
b. 
___The ( 
) Mother ( 
) Father shall pay to the other party the child support arrearage of: 
$ 
for retroactive child support, as of {date} 
. 
$ 
for previously ordered unpaid child support, as of {date} 
. The total of 
$ 
in child support arrearage shall be repaid in the amount of $ 
, per 
month payable ( 
) in accordance with Obligor’s employer’s payroll cycle, and in any event 
at least once a month ( 
) other {explain} _____________________________________ 
beginning {date} 
, until paid in full including statutory interest. 
4. 	
Insurance. 
[all that apply] 
a. 
___Health/Dental Insurance. 
(Choose only one) 
____ 
The service member 
( 
) Mother ( 
) Father shall enroll the child(ren) as a military 
dependent(s) with DEERs, TriCare, or other similar benefits available to military dependents as 
provided by the service member’s branch or service and federal regulations. 
OR 
____ The ( 
) Mother ( 
) Father shall maintain ( 
) health ( 
) dental insurance coverage for 
the parties’ minor child(ren), so long as reasonably available. The party providing coverage shall 
be required to convey insurance cards demonstrating said coverage to the other party. 
OR 
____ ( 
) Health ( 
) dental insurance is not reasonably available at this time. 
b. 	
___Reasonable and necessary uninsured medical/dental/prescription drug costs for the 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
245 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
       
        
 
 
 
 
 
 
 
 
 
 
 
 
          
        
 
        
 
        
 
 
 
        
 
 
 
 
  
 
 
        
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
minor child(ren) shall be assessed as follows: 
( 
) Shared equally by both parents. 
( 
) Prorated according to the child support guideline 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 other party within 30 days, and the 
other party, within 30 days of receipt, shall submit the applicable reimbursement for that 
expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). To secure the child support obligations in this 
judgment, ( 
) Mother( 
) Father ( 
) Each party shall maintain life insurance coverage, in an 
amount of at least $ 
, on ( 
) his life ( 
) her life ( 
) his/her life naming the ( 
) minor 
child(ren) as the beneficiary(ies) OR naming the ( 
) Mother ( 
)Father 
( 
) Other (name) ____________________________as the beneficiary as Trustee for the minor 
child(ren), so long as reasonably available. The obligation to maintain the life insurance coverage 
shall continue until the first of the parties’ minor children reaches the age of 18, until one of the 
parties’ children becomes emancipated, marries, dies, otherwise becomes self‐supporting, at 
which time the amount of life insurance shall be recomputed, or until the temporary child 
support obligation is terminated. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall be 
as follows: _____________________________________________________________________ 
. 
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of 
this paragraph. 
7. 	
Other provisions relating to child support: ___________________________________________ 
SECTION IV. METHOD OF PAYMENT 
Obligor shall pay court‐ordered child support and arrears, if any, as follows: 
1. 	
Central Governmental Depository. 
[if applies] 
a. 	
___Obligor shall pay court‐ordered support directly to the Central Governmental Depository 
in {name of county} 
County, along with any depository service charge. 
b. 	
___Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
246 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
               
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
  
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
          
 
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
        
        
   
 
 
 
 
 
 
 
   
 
 
section 
61.13(1)(d)3, 
Florida 
Statutes, 
to 
require 
payments 
through 
the 
Central 
Governmental Depository. 
2. 	
Income Deduction. 
[if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this support obligation until all of said support is deducted from Obligor’s income. 
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for 
making timely payments directly to the Central Governmental Depository or the Obligee, 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 to advise the central governmental depository of 
any change in payor and health insurance OR ( 
) there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant to the 
payment method prescribed above. 
4. 	
Other provisions relating to method of payment. _____________________________________ 
SECTION V. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___ ( 
) Petitioner’s ( 
) Respondent’s request(s) for attorney fees, costs, and suit money is 
(are) denied because ____________________________________________________________ 
. 
2. 	
___ The Court finds there is a need for and an ability to pay attorney fees, costs, and suit 
money. ( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party $ 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
247 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
                      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
in attorney fees, and $ 
in costs. The Court further finds that the attorney fees awarded 
are based on the reasonable rate of $ 
per hour and 
reasonable hours. 
Other provisions relating to attorney fees, costs, and suit money are as follows: _____________ 
SECTION VI. OTHER 
1. 	
Other Provisions. _______________________________________________________________ 
2. 	
The Court reserves jurisdiction to modify and enforce this Supplemental Temporary Judgment. 
3. 	
Unless specifically modified by this supplemental temporary judgment, the provisions of all final 
judgments or orders in effect remain the same. 
ORDERED on 	
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} ______________________________________________ 
was [only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}________________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: 
Florida Supreme Court Approved Family Law Form 12.993(d), Supplemental Temporary Judgment 
Modifying 
Parenting Issues for Child(ren) of a Parent Activated, Deployed, or Temporary Assigned to Military Service. (03/09) 
248 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                       
 
 
 
 
                                                       
 
 
 
 
  
 
  
 
                                                                        
               
 
 
 
 
                                                                         
             
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
      
 
 
 
 
 
 
 
 
      
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
      
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
                   
 
 
 
 
 
 
  
 
 
 
IN THE CIRCUIT COURT OF THE 
JUDICIAL CIRCUIT, 
IN AND FOR 
COUNTY, FLORIDA 
Case No.: 
Division: 
, 
Petitioner, 
and 
, 
Respondent. 
FINAL JUDGMENT FOR SUPPORT UNCONNECTED 
WITH DISSOLUTION OF MARRIAGE WITH DEPENDENT OR MINOR CHILD(REN) 
This cause came before this Court on a Petition for Support Unconnected with Dissolution of 
Marriage under section 61.09, Florida Statutes. The Court, having reviewed the file and heard the 
testimony, makes these findings of fact and reaches these conclusions of law: 
1. 	
The Court has jurisdiction over the subject matter and the parties. 
2. 	
The following child(ren) are common to the parties: 
Name 	
Birth date 
SECTION I. ALIMONY 
1. 	
( 
) The Court denies the request(s) for alimony. OR 
( 
) The Court finds that there is a need for alimony and that Respondent has/had the ability to 
support Petitioner and has failed to do so. Respondent (hereinafter Obligor) has the present 
ability to pay alimony as follows: 
[ all that apply] 
a. 	
___ Permanent Periodic. Obligor shall pay permanent periodic alimony to Obligee in the 
amount of $ 
per 
month, 
payable 
( 
) 
in 
accordance 
with 
Obligor’s 
employer’s payroll cycle, and in any event, at least once a month ( 
) other {explain} 
beginning {date} 
. This alimony shall continue until modified by court 
order, the death of either party, or remarriage of Obligee, whichever occurs first. 
b. 	
___ Lump Sum. Obligor shall pay lump sum alimony to Obligee in the amount of $ 
. 
This amount shall be paid as follows: 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
249 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
                     
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
    
    
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
              
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                       
 
 
 
 
 
                                                       
 
 
 
 
 
 
 
                                 
 
 
                       
 
 
 
 
 
 
 
 
 
 
                     
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
   
        
 
  
 
 
  
 
 
 
 
 
 
 
 
c. 	
___ Rehabilitative. Obligor shall pay rehabilitative alimony to Obligee in the amount of 
$ 
per month, payable ( 
) in accordance with Obligor’s employer’s payroll cycle, 
and in any event, at least once a month ( 
) other {explain} ________________________ 
beginning {date} 
. This rehabilitative alimony shall continue until modified by 
court order, the death of either party or until {date/event} _________________________, 
whichever occurs first. The rehabilitative plan presented demonstrated the following: 
d. 	
___ Retroactive. Obligor shall pay retroactive alimony in the amount of $ _____________ 
for the period of {date} 
, through {date} 
, which 
shall be paid pursuant to paragraph 3 below. 
2. 	
Reasons for ( 
) Awarding ( 
) Denying Alimony. The Court has considered all of the following 
in awarding/denying alimony: 
a. 	
The standard of living established during the marriage; 
b. 	
The duration of the marriage; 
c. 	
The age and the physical and emotional condition of each party; 
d. 	
The financial resources of each party, the nonmarital and the marital assets and liabilities 
distributed to each; 
e. 	
The contribution of each party to the marriage, including, but not limited to, services 
rendered in homemaking, child care, education, and career building of the other party; and 
f. 	
All sources of income available to either party. 
Additionally, the Court has considered the following factors in reaching its decision: 
[ ] Check here if additional pages are attached. 
3. 	
Arrearage/Retroactive Alimony. 
[one only] 
a. 	
There is no alimony arrearage at the time of this Final Judgment. 
b. 
Respondent shall pay to Petitioner the alimony arrearage of: $ 
for retroactive 
alimony, as of {date} 
. $ 
for previously ordered unpaid alimony, 
as of {date} 
. The total of $ 
in alimony arrearage shall be repaid 
in the amount of $ 
per month, payable ( 
) in accordance with Obligor’s 
employer’s payroll cycle, and in any event, at least once a month ( 
) other {explain} 
beginning {date} 
, 
until 
paid 
in 
full 
including 
statutory 
interest. 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
250 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
               
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
      
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
            
 
 
 
 
 
     
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
   
 
 
 
         
 
 
 
 
 
 
   
 
 
 
 
 
 
        
 
  
 
 
 
 
  
 
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
  
 
  
 
4. 	
Insurance. 
[all that apply] 
a. 	
___Health Insurance. ( 
) Petitioner ( 
) Respondent shall be required to pay health 
insurance premiums for the other party not to exceed $ 
per month. 
Further, 
( 
) Petitioner ( 
) Respondent shall pay any reasonable and necessary uninsured medical 
costs for the other party not to exceed $ 
per year. As to these uninsured medical 
expenses, the party who is entitled to reimbursement of the uninsured medical expense 
shall submit a request for reimbursement to the other party within 30 days, and the other 
party shall, within 30 days after receipt, submit the applicable reimbursement for that 
expense. 
b. 	
___ Life Insurance (to secure payment of support). To secure the alimony obligations set 
forth in this judgment, Obligor shall maintain life insurance coverage on his/her life naming 
Obligee as the sole irrevocable beneficiary, so long as reasonably available. This insurance 
shall be in the amount of at least $ 
and shall remain in effect until the obligation for 
alimony terminates. 
5. 	
Other provisions relating to alimony: _______________________________________________ 
. 
SECTION II. CHILD SUPPORT 
1. 	
The Court finds that there is a need for child support and that the ( 
) Mother ( 
) Father 
(hereinafter Obligor) has the present ability to pay child support. The amounts in the Child 
Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), filed by 
the ( 
) Mother ( 
) Father are correct OR the Court makes the following findings: The Mother’s 
net monthly income is $ _____,(Child Support Guidelines 
%). The Father’s net monthly 
income is $ 
, (Child Support Guidelines 
%). Monthly child care costs are $ 
. Monthly health/dental insurance costs are $ 
. 
2. 	
Amount. Obligor shall be obligated to pay child support in the amount of $ 
, 
per 
month 
payable ( ) in accordance with Obligor’s employer’s payroll cycle, and in any event at least once 
a month ( 
) other {explain}: ______________________________________________________ 
, 
beginning {date} 
, and continuing 
( 
) until the first of the parties’ minor children reaches the age of 18 or until one of the parties’ 
children becomes emancipated, marries, dies, otherwise becomes self‐supporting, at which time 
the child support shall be recomputed under the then current Child Support Guidelines 
OR 
( 
) until {date/event} 
, 
{explain} 
. 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
251 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
              
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
   
 
 
    
             
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
   
        
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
              
 
 
 
 
   
 
         
        
 
 
 
 
 
        
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
 
 
 
 
 
      
 
 
 
 
 
 
 
 
      
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
        
        
        
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
        
 
        
 
        
 
 
 
 
      
 
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If the child support ordered deviates from the guidelines by more than 5%, the factual findings 
which support that deviation are: 
3. 
Arrearage/Retroactive Child Support. 
[one only] 
a. 
___ There is no child support arrearage at the time of this Final Judgment. 
b. 
___ The ( 
) Mother ( 
) Father shall pay to the other party the child support for previously 
ordered unpaid child support, as of {date} ____________. The total of $ 
child 
support arrearage shall be repaid in the amount of $ 
per month, payable ( 
) 
in accordance with Obligor’s employer’s payroll cycle, and in any event, at least once a 
month ( 
) other {explain} _____________________________________________________ 
beginning {date} 
, until paid in full including statutory interest. 
4. 
Insurance. 
[all that apply] 
a. 
___ 
Health/Dental Insurance. ( 
) Mother ( 
) Father shall be required to maintain ( 
) 
health ( 
) dental insurance coverage for the parties’ minor child(ren), so long as reasonably 
available. The party providing coverage shall be required to convey insurance cards 
demonstrating said coverage to the other party. OR ( 
) Health ( 
) dental insurance is not 
reasonably available 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 guideline 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 other party within 30 days, and 
the other party, within 30 days of receipt, shall submit the applicable reimbursement for 
that expense, according to the schedule of reimbursement set out in this paragraph. 
5. 	
Life Insurance (to secure payment of support). To secure the child support obligations in this 
judgment, ( 
) Petitioner ( 
) Respondent ( 
) Each party shall maintain life insurance coverage, 
in an amount of at least $ 
, on ( 
) his life ( 
) her life ( 
) his/her life naming the 
( 
) minor child(ren) as the beneficiary(ies) ( 
) primary residential parent as the beneficiary as 
Trustee for the minor child(ren). The obligation to maintain the life insurance coverage shall 
continue until the youngest child turns 18, becomes emancipated, marries, dies, or otherwise 
becomes self‐supporting. 
6. 	
IRS Income Tax Exemption(s). The assignment of any tax exemption(s) for the child(ren) shall 
be as follows: ___________________________________________________________________ 
. 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
252 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
               
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
   
 
 
 
   
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
      
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
          
 
        
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Further, each party shall execute any and all IRS forms necessary to effectuate the provisions of 
this paragraph. 
7. 	
Other provisions relating to child support: ___________________________________________ 
SECTION III. METHOD OF PAYMENT 
Obligor shall pay court‐ordered child support/alimony and arrears, if any, as follows: 
1. 	
Central Governmental Depository. 
[if applies] 
a. 	
___ 
Obligor shall pay court‐ordered support directly to the Central Governmental 
Depository in {name} 
County, along with any depository service 
charge. 
b. 	
___ Both parties have requested and the court finds that it is in the best interests of the 
child(ren) that support payments need not be directed through the Central Governmental 
Depository. However, either party may subsequently apply to the depository pursuant to 
section 61.08 or 61.13, Florida Statutes, to require payments through the Central 
Governmental Depository. 
2. 	
Income Deduction. 
[ if applies] 
a. 	
___Immediate. Obligor shall pay through income deduction, pursuant to a separate Income 
Deduction Order which shall be effective immediately. Obligor is individually responsible for 
paying this support obligation until all of said support is deducted from Obligor’s income. 
Until support payments are deducted from Obligor’s paycheck, Obligor is responsible for 
making timely payments directly to the Central Governmental Depository or the Obligee, 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 in cases of modification, 
AND 
( 
) there is an agreement by the Obligor to advise the central governmental depository of 
any change in payor and health insurance OR ( 
) there is a signed written agreement 
providing an alternative arrangement between the Obligor and the Obligee. 
3. 	
Bonus/one‐time payments. ( 
) 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 Obligee pursuant to the 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
253 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
         
        
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
        
        
   
 
 
 
 
 
 
 
   
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
       
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
payment method prescribed above. 
4. 	
Other provisions relating to method of payment. _____________________________________ 
SECTION IV. ATTORNEY FEES, COSTS, AND SUIT MONEY 
1. 	
___ ( 
) Petitioner’s ( 
) Respondent’s request(s) for attorney fees, costs, and suit money is 
(are) denied because ____________________________________________________________ 
. 
2. 	
___ The Court finds there is a need for and an ability to pay attorney fees, costs, and suit 
money. ( 
) Petitioner ( 
) Respondent is hereby ordered to pay to the other party $ 
in attorney fees, and $ 
in costs. The Court further finds that the attorney fees awarded 
are based on the reasonable rate of $ 
per hour and 
reasonable 
hours. 
Other 
provisions relating to attorney fees, costs, and suit money are as follows: ___________________ 
SECTION V. OTHER PROVISIONS 
1. 	
Other Provisions: _______________________________________________________________ 
2. 
The Court reserves jurisdiction to modify and enforce this Final Judgment. 
ORDERED on 
. 
CIRCUIT JUDGE 
A copy of the {name of document(s)} _____________________________________________ 
was [only one] ( 
) mailed ( 
) faxed and mailed ( 
) hand delivered to the parties listed below on 
{date}_____________ by {clerk of court or designee}______________________________________. 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
Central Governmental Depository 
Other: 
Florida Supreme Court Approved Family Law Form 12.994(a), Final Judgment for Support Unconnected with 
Dissolution of Marriage with Dependent or Minor Child(ren) (03/09)
254 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
   
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.995(a), PARENTING PLAN (03/09) 
When should this form be used? 
A Parenting Plan is required in all cases involving time‐sharing with minor child(ren), even when time­
sharing is not in dispute. This form or a similar form should be used in the development of a Parenting 
Plan. If the case involves supervised time‐sharing, the Supervised/Safety Focused Parenting Plan, 
Florida Supreme Court Approved Family Law Form 12.995 (b) or a similar form should be used. 
This form should be typed or printed in black ink. If an agreement has been reached, both parties must 
sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After 
completing this form, you should file the original with the clerk of the circuit court in the county where 
the petition was filed and keep a copy for your records. You should then refer to the instructions for 
your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or 
trial (final hearing). If an agreed Parenting Plan is not filed by the parties, the Court shall establish a 
Plan. 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the 
beginning of these forms. The words that are in “bold underline” in these instructions are defined 
there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition 
and/or answer that were filed in this case. 
Special notes... 
At a minimum, the Parenting Plan must describe in adequate detail: 
• 	
How the parties will share and be responsible for the daily tasks associated with the upbringing 
of the child(ren), 
• 	
The time‐sharing schedule arrangements that specify the time that the minor child(ren) will 
spend with each parent, 
• 	
A designation of who will be responsible for any and all forms of health care, school‐related 
matters, other activities, and 
• 	
The methods and technologies that the parents will use to communicate with the child(ren). 
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the 
Parenting Plan, all circumstances between the parties, including the parties’ historic relationship, 
domestic violence, and other factors must be taken into consideration. 
Determination of the best 
interests of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest 
of the minor child(ren), including, but not limited to: 
• 	
The demonstrated capacity and disposition of each parent to facilitate and encourage a 
close and continuing parent‐child relationship, to honor the time‐sharing schedule, and to be 
reasonable when changes are required; 
• 	
The anticipated division of parental responsibilities after the litigation, including the 
extent to which parental responsibilities will be delegated to third parties; 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09) 
255 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
• 	
The demonstrated capacity and disposition of each parent to determine, consider, and 
act upon the needs of the child(ren) as opposed to the needs or desires of the parent; 
• 	
The length of time the child(ren) has lived in a stable, satisfactory environment and the 
desirability of maintaining continuity; 
• 	
The geographic viability of the parenting plan, with special attention paid to the needs 
of school‐age children and the amount of time to be spent traveling to effectuate the parenting 
plan. This factor does not create a presumption for or against relocation of either parent with a 
child(ren); 
• 
The moral fitness of the parents; 
• 
The mental and physical health of the parents; 
• 
The home, school, and community record of the child(ren); 
• 	
The reasonable preference of the child(ren), if the court deems the child(ren) to be of 
sufficient intelligence, understanding, and experience to express a preference; 
• 	
The demonstrated knowledge, capacity, and disposition of each parent to be informed 
of the circumstances of the minor child(ren), including, but not limited to, the child(ren)’s 
friends, teachers, medical care providers, daily activities, and favorite things; 
• 	
The demonstrated capacity and disposition of each parent to provide a consistent 
routine for the child(ren), such as discipline, and daily schedules for homework, meals, and 
bedtime; 
• 	
The demonstrated capacity of each parent to communicate with and keep the other 
parent informed of issues and activities regarding the minor child(ren), and the willingness of 
each parent to adopt a unified front on all major issues when dealing with the child(ren); 
• 	
Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child 
neglect, regardless of whether a prior or pending action relating to those issues has been 
brought; 
• 	
Evidence that either parent has knowingly provided false information to the court 
regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, 
child abandonment, or child neglect; 
• 	
The particular parenting tasks customarily performed by each parent and the division or 
parental responsibilities before the institution of litigation and during the pending litigation, 
including the extent to which parenting responsibilities were undertaken by third parties; 
• 	
The demonstrated capacity and disposition of each parent to participate and be 
involved in the child(ren)’s school and extracurricular activities; 
• 	
The demonstrated capacity and disposition of each parent to maintain an environment 
for the child(ren) which is free from substance abuse; 
• 	
The capacity and disposition of each parent to protect the child(ren) from the ongoing 
litigation as demonstrated by not discussing the litigation with the child(ren), not sharing 
documents or electronic media related to the litigation with the child(ren), and refraining from 
disparaging comments about the other parent to the child)ren); and 
• 	
The developmental stages and needs of the child(ren) and the demonstrated capacity 
and disposition of each parent to meet the child(ren)’s developmental needs. 
This standard form does not include every possible issue that may be relevant to the facts of your case. 
The Parenting Plan should be as detailed as possible to address the time‐sharing schedule. Additional 
provisions should be added to address all of the relevant factors. The parties should give special 
consideration to the age and needs of each child. 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09) 
256 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In developing the Parenting Plan, you may wish to consult or review other materials which are available 
at your local library, law library or through national and state family organizations. 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form 
he 
or 
she 
helps 
you 
complete. 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09) 
257 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_______________________________ 
 
 
_______________________________ 
 
 
 
 
  
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
       
 
 
 
 
 
 
 
       
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
 
  
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT 
IN AND FOR _________________ COUNTY, FLORIDA 
Case No: _____________________ 
Division: _____________________ 
Petitioner, 
and 
Respondent. 
PARENTING PLAN 
This parenting plan is: (Choose only one) 
[ ] A Parenting Plan submitted to the court with the agreement of the parties. 
[ ] A proposed Parenting Plan submitted by or on behalf of: 
{Parent’s Name}_______________________________________________. 
[ ] A Parenting Plan established by the court. 
This parenting plan is: (Choose only one) 
[ ] A final Parenting Plan established by the court. 
[ ] A temporary Parenting Plan established by the court. 
[ ] A modification of a prior final Parenting Plan or prior final order. 
I. 	
PARENTS 
Mother 
Name:__________________________________________________________________ 
Address: ________________________________________________________________ 
Telephone Number: ______________________________________________________ 
E‐Mail: _________________________________________________________________ 
Father 
Name:__________________________________________________________________ 
Address: ________________________________________________________________ 
Telephone Number: ______________________________________________________ 
E‐Mail: _________________________________________________________________ 
II. 	
CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties: 
(add additional lines as needed) 
Name 
Date of Birth 
Sex 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
258 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
   
 
   
 
 
 
   
 
   
 
 
 
   
 
   
 
 
 
   
 
   
 
 
 
 
 
     
 
 
 
 
   
 
 
 
 
 
 
 
 
     
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
III. JURISDICTION 
The United States is the country of habitual residence of the child(ren). 
The State of Florida is the child(ren)’s home state for the purposes of the Uniform Child Custody 
Jurisdiction and Enforcement Act. 
This 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. 
Sections 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, and for all 
other state and federal laws. 
Other: ___________________________________________________________________________. 
IV. PARENTAL RESPONSIBILITY AND DECISION MAKING 
1. 
Parental Responsibility (Choose only one) 
[ ] 	
Shared Parental Responsibility. 
It is in the best interests of the child(ren) that the parents confer and jointly make all 
major decisions affecting the welfare of the child(ren). Major decisions include, but are 
not limited to, decisions about the child(ren)’s education, healthcare, and other 
responsibilities unique to this family. 
OR 
[ ] 	
Shared Parental Responsibility with Decision Making Authority 
It is in the best interests of the child(ren) that the parents confer and attempt to agree 
on the major decisions involving the child(ren). If the parents are unable to agree, the 
authority for making major decisions regarding the child(ren) shall be as follows: 
Education/Academic decisions 
Non‐emergency health care 
___________________________ 
___________________________ 
___________________________ 
[ ] Mother 
[ ] Mother 
[ ] Mother 
[ ] Mother 
[ ] Mother 
[ ] Father 
[ ] Father 
[ ] Father 
[ ] Father 
[ ] Father 
OR 
[ ] 	
Sole Parental Responsibility: 
It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole 
authority to make major decisions for the child(ren.) 
2. 
Day‐to‐Day Decisions 
Each parent shall make decisions regarding day‐to‐day care and control of each child while 
the child is with that parent. 
Regardless of the allocation of decision making in the 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
259 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
     
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
parenting plan, either parent may make emergency decisions affecting the health or safety 
of the child(ren) when the child is residing with that parent. 
A parent who makes an 
emergency decision shall share the decision with the other parent as soon as reasonably 
possible. 
3. 
Extra‐curricular Activities ( Choose all that apply) 
[ ] 	
Either parent may register the child(ren) and allow them to participate in the activity of 
the child(ren)’s choice. 
[ ] 	
The parents must mutually agree to all extra‐curricular activities. 
[ ] 	
The parent with the minor child(ren) shall transport the minor child(ren) to and/or from 
all mutually agreed upon extra‐curricular activities, providing all necessary uniforms and 
equipment within the parent’s possession. 
[ ] 	
The costs of the extra‐curricular activities shall be paid by: 
Mother ______% 
Father __________ % 
[ ] 	
The uniforms and equipment required for the extra‐curricular activities shall be paid by: 
Mother _______ % 
Father ____________% 
[ ] 	
Other: _____________________________________________________ . 
V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court: 
Both parents shall have access to medical and school records pertaining to the child(ren) and 
shall be permitted to independently consult with any and all professionals involved with the 
child(ren). The parents shall cooperate with each other in sharing information related to the 
health, education, and welfare of the child(ren) and they shall sign any necessary 
documentation ensuring that both parents have access to said records. 
Each parent shall be responsible for obtaining records and reports directly from the school and 
health care providers. 
Both parents have equal rights to inspect and receive governmental agency and law 
enforcement records concerning the child(ren). 
Both parents shall have equal and independent authority to confer with the child(ren)’s 
school, day care, health care providers, and other programs with regard to the child(ren)’s 
educational, emotional, and social progress. 
Both parents shall be listed as “emergency contacts” for the child(ren). 
Each parent has a continuing responsibility to provide a residential, mailing, or contact address 
and contact telephone number to the other parent. Each parent shall notify the other parent in 
writing within 24 hours of any changes. Each parent shall notify the court in writing within seven 
(7) days of any changes. 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
260 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
     
 
 
 
     
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
     
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
       
 
       
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
  
 
 
 __________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         
       
 
       
 
  
 
Other: _________________________________________________________________ 
________________________________________________________________. 
VI. SCHEDULING 
1. 	
School Calendar 
If necessary, on or before ______________ of each year, both parents should obtain a copy 
of the school calendar for the next school year. The parents shall discuss the calendars and 
the time‐sharing schedule so that any differences or questions can be resolved. 
The parents shall follow the school calendar of: (Choose all that apply) 
[ ] 
the oldest child 
[ ] 
the youngest child 
[ ] 
the school calendar for ______________ County 
[ ] 
the school calendar for _________________ School 
2. 	
Academic Break Definition 
When defining academic break periods, the period shall begin at the end of the last 
scheduled day of classes before the holiday or break and shall start on the first day of 
regularly scheduled classes after the holiday or break. 
3. 	
Schedule Changes (Choose all that apply) 
[ ] 	
A parent making a request for a schedule change will make the request as soon as 
possible, 
but 
in 
any 
event, 
except 
in 
cases 
of 
emergency, 
no 
less 
than 
________________ before the change is to occur. 
[ ] 	
A parent requesting a change of schedule shall be responsible for any additional child 
care, or transportation costs caused by the change. 
[ ] 	
Other ______________________________________________________. 
VII. TIME‐SHARING SCHEDULE 
1. 
Weekday and Weekend Schedule 
The following schedule shall apply beginning on ________________________ with the 
[ ] Mother [ ] Father and continue as follows: 
The child(ren) shall spend time with the Mother on the following dates and times: 
WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify) _____________________ 
From____________________________ to ________________________________ 
WEEKDAYS: Specify days ______________________________________________ 
From _____________________________ to ______________________________ 
OTHER: (Specify) ____________________________________________________ 
__________________________________________________________________. 
A. 	
The child(ren) shall spend time with the Father on the following dates and times: 
WEEKENDS: [ 
] Every [ ] Every Other [ ] Other (specify) ____________________ 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
261 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
  
 
 __________________________________________________________________ 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
     
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
From____________________________ to ________________________________ 
WEEKDAYS: Specify days ______________________________________________ 
From _____________________________ to ______________________________ 
OTHER: (Specify) ____________________________________________________ 
__________________________________________________________________. 
B. 	
Check box if there is a different time sharing schedule for any child. Complete a 
separate Attachment for each child for whom there is a different time sharing 
schedule. 
[ ] There is a different time‐sharing schedule for the following child(ren) in Attachment 
____. 
______________________________, and _________________________. 
(Name of Child) 
(Name of Child) 
2. 
Holiday Schedule (Choose only one) 
[ ] 	
No holiday time sharing shall apply. The regular time‐sharing schedule set forth above 
shall apply. 
[ ] 	
Holiday time‐sharing shall be as the parties agree. 
[ ] 	
Holiday time‐sharing shall be in accordance with the following schedule. The Holiday 
schedule will take priority over the regular weekday, weekend, and summer schedules. 
Fill in the blanks with Mother or Father to indicate where the child(ren) will be for the 
holidays. Provide the beginning and ending times. If a holiday is not specified as even, 
odd, or every year with one parent, then the child(ren) will remain with the parent in 
accordance with the regular schedule 
Holidays 
Even Years 
Odd Years 
Every Year 
Begin/End Time 
Mother’s Day 
__________ 
_________ 
__________ 
_________________ 
Father’s day 
__________ 
_________ 
__________ 
_________________ 
President’s Day 
__________ 
_________ 
__________ 
_________________ 
Martin Luther King Day __________ 
_________ 
__________ 
_________________ 
Easter 
__________ 
_________ 
__________ 
_________________ 
Passover 
__________ 
_________ 
__________ 
_________________ 
Memorial Day Weekend __________ 
4th of July 
__________ 
_________ 
_________ 
__________ 
__________ 
_________________ 
_________________ 
Labor Day Weekend 
__________ 
_________ 
__________ 
_________________ 
Columbus Day Weekend _________ 
_________ 
__________ 
_________________ 
Halloween 
__________ 
_________ 
__________ 
_________________ 
Thanksgiving 
__________ 
_________ 
__________ 
_________________ 
Veteran’s Day 
__________ 
_________ 
__________ 
_________________ 
Hanukkah 
__________ 
_________ 
__________ 
_________________ 
Yom Kippur 
__________ 
_________ 
__________ 
_________________ 
Rosh Hashanah 
__________ 
_________ 
__________ 
_________________ 
Child(ren)’s Birthdays 
__________ 
_________ 
__________ 
_________________ 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
262 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_______________ 
__________ 
_________ 
__________ 
_________________ 
 
_______________ 
__________ 
_________ 
__________ 
_________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
     
      
       
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
    
 
       
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
      
       
 
 
 
 
 
 
 
 
 
 
 
       
 
       
 
       
 
 
 
     
   
 
 
 
 
 ______________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
______________________________________________________________________ 
______________________________________________________________________ 
______________________________________________________________________ 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
     
     
     
 
 
 
 
 
 
 
 
 
 
 
 
 
This holiday schedule may affect the regular Time‐Sharing Schedule. Parents may wish to specify 
one or more of the following options: 
[ ] 	
When the parents are using an alternating weekend plan and the holiday schedule 
would result in one parent having the child(ren) for three weekends in a row, the 
parents will exchange the following weekend, so that each has two weekends in a row 
before the regular alternating weekend pattern resumes. 
[ ] 	
If a parent has the child(ren) on a weekend immediately before or after an unspecified 
holiday or non‐school day, they shall have the child(ren) for the holiday or non‐school 
day. 
3. 
Winter Break 
A. 	
Entire Winter Break (Choose only one) 
[ ] 	
The [ ] Mother [ 
] Father shall have the child(ren) from the day and time school is 
dismissed until December _____ at ___ a.m./p. m in [ ]odd‐numbered years [ 
] even‐
numbered years [ 
] every year. The other parent will have the children for the second 
portion of the Winter Break. The parties shall alternative the arrangement each year. 
[ ] 
The [ ] Mother [ ] Father shall have the child(ren) for the entire Winter Break during 
[ ] odd‐numbered years [ ] even‐numbered years [ ] every year. 
[ ] 	
Other: ______________________________________________________________ 
______________________________________________________________. 
B. 	
Specific Winter Holidays 
If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve, 
Hanukkah, Kwanzaa, etc. and shall be shared as follows: 
______________________________________________________________________. 
4. 
Spring Break (Choose only one) 
[ ] 	
The parents shall follow the regular schedule. 
[ ] 	
The parents shall alternate the entire Spring Break with the Mother having the 
child(ren) during the [ ]odd‐numbered years [ ]even numbered years. 
[ ] 	
The [ ] Father [ ] Mother shall have the child(ren) for the entire Spring Break every year. 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
263 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
     
       
       
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
       
 
 
 
 
       
 
 
 
       
       
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
         
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
      
       
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
[ ] 	
The Spring Break will be evenly divided. The first half of the spring Break will go to the 
parent whose regularly scheduled weekend falls on the first half and the second half 
going to the parent whose weekend falls during the second half. 
[ ] 	
Other:_________________________________________________________________. 
5. 
Summer Break (Choose only one) 
[ ] 	
The parents shall follow the regular schedule through the summer. 
[ ] 	
The [ 
] Mother [ 
] Father shall have the entire Summer Break from __________ after 
school is out until _______________ before school starts. 
[ ] 	
The parents shall equally divide the Summer Break. During [ ] odd‐numbered years 
[ 
] even numbered years, the [ 
] Mother [ 
] Father shall have the children from 
________ after school is out until ________. The other parent shall have the child(ren) 
for the second one‐half of the summer break. The parents shall alternate the first and 
second one‐halves each year unless otherwise agreed. During the extended periods of 
time‐sharing, 
the 
other 
parent 
shall 
have 
the 
child(ren) 
______________________________. 
[ ] 
Other:__________________________________________________________________ 
_______________________________________________________________________. 
6. Number of Overnights: 
Based upon the time‐sharing schedule, the Mother has a total of _____ overnights per year 
and the Father has a total of _____ overnights per year. Note: The two numbers must 
equal 365. 
7. [ ] If not set forth above, the parties shall have time‐sharing in accordance with the schedule 
which is attached and incorporated herein. 
VIII. 
TRANSPORTATION AND EXCHANGE OF CHILD(REN) 
1. 
Transportation (Choose only one) 
[ ] 
The [ ] Mother [ ] Father shall provide all transportation. 
[ ] 
The parent beginning their time‐sharing shall provide transportation for the child(ren). 
[ ] 
The parent ending their time‐sharing shall provide transportation for the child(ren). 
[ ] 
Other: _________________________________________________________________. 
2. 
Exchange (Choose only one) 
Both parents shall have the child(ren) ready on time with sufficient clothing packed and 
ready at the agreed upon time of exchange. If a parent is more than ______ minutes late 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
264 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
without contacting the other parent to make other arrangements, the parent with the 
child(ren) may proceed with other plans and activities. 
[ ] 	
Exchanges shall be at Mother’s and Father’s homes unless both parents agree to a 
different meeting place. 
[ ] 	
Exchanges shall occur at __________________________________________________ 
____________________________________________________________ 
unless 
both 
parties agree in advance to a different meeting place. 
[ ] 	
Other: ________________________________________________________________. 
3. 
Transportation Costs (Choose only one) 
[ ] 	
Transportation costs are included in the Child Support Worksheets and/or the Order for 
Child Support and should not be included here. 
[ ] 	
The Mother shall pay ______% and the Father shall pay ______ % of the transportation 
costs. 
[ ] 	
Other: __________________________________________________________________. 
4. 
Foreign and Out‐Of‐State Travel (Choose only one) 
[ ] 	
Either parent may travel with the child(ren) during his/her time‐sharing. The parent 
traveling with the child(ren) shall give the other parent at least ____ days written notice 
before traveling out of state unless there is an emergency, and shall provide the other 
parent with a detailed itinerary, including locations and telephone numbers where the 
child(ren) and parent can be reached at least ____ days before traveling. 
[ ] 	
Either parent may travel out of the country with the child(ren) during his/her time­
sharing. At least ___ days prior to traveling, the parent shall provide a detailed itinerary, 
including locations, and telephone numbers where the child(ren) and parent may be 
reached during the trip. 
Each parent agrees to provide whatever documentation is 
necessary for the other parent to take the child(ren) out of the country. 
[ ] 	
If a parent wishes to travel out of the country with the child(ren), he/she shall provide 
the following security for the return of the child _____________________________ 
_____________________________________________________________________. 
[ ] 	
Other ________________________________________________________________. 
IX. EDUCATION 
1. 	
School designation. For school and school district purposes, the [ ] Mother 
[ ] Father’s address shall be designated. 
2. 	
(If Applicable) The following provisions are made regarding private or home 
schooling: 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
265 
 
 
 
 
 
 
 
 
 
 
 
 
 
___________________________________________________________________________
___________________________________________________________________________
 
 
 
___________________________________________________________________________
___________________________________________________________________________
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
     
 
 
     
 
 
     
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
      
      
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
     
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_________________________________________________________________________ 
_____________________________________________________________________. 
3. 
Other. 
_____________________________________________________________________. 
X. 
DESIGNATION FOR OTHER LEGAL PURPOSES 
The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with 
the [ 
] Mother [ 
] Father. This majority designation is SOLELY for purposes of all other state 
and federal laws which require such a designation. This designation does not affect either 
parent’s rights and responsibilities under this parenting plan. 
XI. COMMUNICATION 
1. 
Between Parents 
All communications regarding the child(ren) shall be between the parents. The parents shall 
not use the child(ren) as messengers to convey information, ask questions, or set up 
schedule changes. 
The parents shall communicate with each other by: (Choose all that apply) 
[ ] 
in person 
[ ] 
by telephone 
[ ] 
by letter 
[ ] 
by e‐mail 
[ ] 
Other:__________________________________________________________________. 
2. 
Between Parent and Child(ren) 
Both parents shall keep contact information current. 
Telephone or other electronic 
communication between the child(ren) and the other parent shall not be monitored by or 
interrupted by the other parent. 
“Electronic communication” includes telephones, 
electronic mail or e‐mail, webcams, video‐conferencing equipment and software or other 
wired or wireless technologies or other means of communication to supplement face to face 
contact. 
The child(ren) may have [ ] telephone [ ] e‐mail [ ] other electronic communication in the 
form of ___________________________________ with the other parent: (Choose only one) 
[ ] 
Anytime 
[ ] 
Every day during the hours of ____________________ to ______________________. 
[ ] 
On the following days____________________________________________________ 
during the hours of __________________________ to _________________________. 
[ ] 
Other: ________________________________________________________________. 
3. 
Costs of Electronic Communication shall be addressed as follows: 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
266 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
_________________________________________________________________________. 
XII. CHILD CARE (Choose only one) 
{ } 
Each parent may select appropriate child care providers 
[ ] 
All child care providers must be agreed upon by both parents. 
[ ] 
Each parent must offer the other parent the opportunity to care for the child(ren) 
before using a child care provider for any period exceeding _______ hours. 
[ ] 
Other ________________________________________________________________. 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
267 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
___________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
  
                                        
XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN 
This Parenting Plan may be modified or varied on a temporary basis when both parents agree in 
writing. When the parents do not agree, the Parenting Plan remains in effect until further order 
of the court. 
Any substantial changes to the Parenting Plan must be sought through the filing of a 
supplemental petition for modification. 
XIV. 
RELOCATION 
Any relocation of the child(ren) is subject to and must be sought in compliance with section 
61.13001, Florida Statutes. 
XV. DISPUTES OR CONFLICT RESOLUTION 
Parents shall attempt to cooperatively resolve any disputes which may arise over the terms of 
the Parenting Plan. The parents may wish to use mediation or other dispute resolution methods 
and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court 
action. 
XVI. 
OTHER PROVISIONS 
___________________________________________________________________________. 
SIGNATURE OF PARENTS 
I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this 
Plan and intend to be bound by it. 
Dated: 	
_____________________________________________ 
Signature of Mother 
Printed Name: ___________________________ 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF ___________________________ 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
268 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
        
 
 
 
 
 
   
                                             
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
       
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 _____________________________________ 
I certify that I have been open and honest in entering into this settlement agreement. I am satisfied 
with this agreement and intend to be bound by it. 
Dated:________________________ 	
_____________________________________________ 
Signature of Father 
Printed Name: ___________________________ 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF ________________________________ 
Sworn to or affirmed and signed before me on 
by 	
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of 
notary or clerk.] 
Personally known 
Produced identification 
Type of identification produced ____________________________________ 
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
269 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
  
 
 
 
   
  
 
   
 
 
       
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_____________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[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 [one only] 
petitioner or 
respondent, fill out this form. 
ORDER OF THE COURT 
IT IS HEREBY ORDERED AND ADJUDGED THAT THE PARENTING PLAN SET FORTH ABOVE IS 
ADOPTED AND ESTABLISHED AS AN ORDER OF THIS COURT. 
ORDERED ON ___________________________. 
CIRCUIT JUDGE 
COPIES TO: 
Father (or his Attorney) 
Mother (or her Attorney) 
Other 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
270 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.995(b),
SUPERVISED/SAFETY­FOCUSED PARENTING PLAN (03/09) 
When should this form be used? 
A Parenting Plan is required in all cases involving minor child(ren). This form or a similar form should be 
used in cases when you feel your child(ren) cannot be safely alone with the other parent or if you 
believe shared parental responsibility presents a detriment to the child(ren). In this case, a Parenting 
Plan must be developed that allows time‐sharing with any minor child(ren), while providing protection 
for the child(ren). If safety or supervised time‐sharing is not a concern, Parenting Plan, Florida Supreme 
Court Approved Family Law Form 12.995(a) should be used. 
This form should be typed or printed in black ink. If an Agreement has been reached, both parties must 
sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After 
completing this form, you should file the original with the clerk of the circuit court in the county where 
the petition was filed and keep a copy for your records. You should then refer to the instructions for 
your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or 
trial (final hearing). If an agreed Parenting Plan is not filed by the parties, the Court shall establish a 
Plan. 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the 
beginning of these forms. The words that are in “bold underline” in these instructions are defined 
there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition 
and/or answer that were filed in this case. 
Special notes... 
At a minimum, the Parenting Plan must describe in adequate detail: 
• 	
How the parties will share and be responsible for the daily tasks associated with the upbringing of the 
child(ren), 
• 	
The time‐sharing schedule arrangements that specify the time that the minor child(ren) will spend with 
each parent, 
• 	
A designation of who will be responsible for any and all forms of health care, school‐related matters, 
other activities, and 
• 	
The methods and technologies that the parents will use to communicate with the child(ren). 
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the 
Parenting Plan, all circumstances between the parties, including the parties’ historic relationship, 
domestic violence, and other factors must be taken into consideration. 
Determination of the best 
interests of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest 
of the minor child(ren), including, but not limited to: 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan 
(03/09) 
271 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
• 	
The demonstrated capacity and disposition of each parent to facilitate and encourage a close 
and continuing parent‐child relationship, to honor the time‐sharing schedule, and to be 
reasonable when changes are required; 
• 	
The anticipated division of parental responsibilities after the litigation, including the extent to 
which parental responsibilities will be delegated to third parties; 
• 	
The demonstrated capacity and disposition of each parent to determine, consider, and act upon 
the needs of the child(ren) as opposed to the needs or desires of the parent; 
• 	
The length of time the child(ren) has lived in a stable, satisfactory environment and the 
desirability of maintaining continuity; 
• 	
The geographic viability of the parenting plan, with special attention paid to the needs of school‐
age children and the amount of time to be spent traveling to effectuate the parenting plan. This 
factor does not create a presumption for or against relocation of either parent with a child(ren); 
• 	
The moral fitness of the parents; 
• 	
The mental and physical health of the parents; 
• 	
The home, school, and community record of the child(ren); 
• 	
The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient 
intelligence, understanding, and experience to express a preference; 
• 	
The demonstrated knowledge, capacity, and disposition of each parent to be informed of the 
circumstances of the minor child(ren), including, but not limited to, the child(ren)’s friends, 
teachers, medical care providers, daily activities, and favorite things; 
• 	
The demonstrated capacity and disposition of each parent to provide a consistent routine for 
the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime; 
• 	
The demonstrated capacity of each parent to communicate with and keep the other parent 
informed of issues and activities regarding the minor child(ren), and the willingness of each 
parent to adopt a unified front on all major issues when dealing with the child(ren); 
• 	
Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child 
neglect, regardless of whether a prior or pending action relating to those issues has been 
brought; 
• 	
Evidence that either parent has knowingly provided false information to the court regarding any 
prior or pending action regarding domestic violence, sexual violence, child abuse, child 
abandonment, or child neglect; 
• 	
The particular parenting tasks customarily performed by each parent and the division or 
parental responsibilities before the institution of litigation and during the pending litigation, 
including the extent to which parenting responsibilities were undertaken by third parties; 
• 	
The demonstrated capacity and disposition of each parent to participate and be involved in the 
child(ren)’s school and extracurricular activities; 
• 	
The demonstrated capacity and disposition of each parent to maintain an environment for the 
child(ren) which is free from substance abuse; 
• 	
The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation 
as demonstrated by not discussing the litigation with the child(ren), not sharing documents or 
electronic media related to the litigation with the child(ren), and refraining from disparaging 
comments about the other parent to the child)ren); and 
• 	
The developmental stages and needs of the child(ren) and the demonstrated capacity and 
disposition of each parent to meet the child(ren)’s developmental needs. 
This standard form does not include every possible issue that may be relevant to the facts of your case. 
The Parenting Plan should be as detailed as possible to address the time‐sharing schedule. Additional 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan 
(03/09) 
272 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
   
     
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
provisions should be added to address all of the relevant factors. The parties should give special 
consideration to the age and needs of each child. 
In developing the Parenting Plan, you may wish to consult or review other materials which are available 
at your local library, law library or through national and state family organizations. 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form 
he 
or 
she 
helps 
you 
complete. 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan 
(03/09) 
273 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_______________________________ 
 
 
_______________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
     
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
_______________________________________________________________________ 
 
_______________________________________________________________________ 
 
_______________________________________________________________________ 
 
_______________________________________________________________________ 
 
 
 
 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT 
IN AND FOR _________________ COUNTY, FLORIDA 
Case No: _____________________ 
Division: _____________________ 
Petitioner, 
and 
Respondent. 
SUPERVISED/SAFETY­FOCUSED PARENTING PLAN 
This parenting plan is: (Choose only one) 
[ } 
A Parenting Plan submitted to the court with the agreement of the parties. 
{ } 
A proposed Parenting Plan submitted by or on behalf of: 
(Parent’s Name)_________________________________________. 
[ ] 
A Parenting Plan established by the court. 
This parenting plan is: (Choose only one) 
[ ] 
A final Parenting Plan established by the court. 
[ ] 
A temporary Parenting Plan established by the court. 
[ ] 
A modification of a prior final Parenting Plan or prior final order. 
I. 	
PARENTS 
Mother 
Name:__________________________________________________________________ 
Address:________________________________________________________________ 
Telephone Number:_______________________________________________________ 
E‐Mail:_________________________________________________________________ 
Father 
Name:__________________________________________________________________ 
Address:________________________________________________________________ 
Telephone Number: _______________________________________________________ 
E‐Mail: _________________________________________________________________ 
II. 	
CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties: 
(add additional lines as needed) 
Name 	
Date of Birth 
Sex 
III. JURISDICTION 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
274 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
      
    
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
    
 
    
 
 
 
 
 
 
 
    
 
    
 
 
              
 
    
 
    
 
 
 
 
    
 
    
 
 
 
 
    
 
    
 
     
 
 
 
 
  
 
 
  
 
 
 
 
     
 
 
      
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
       
      
 
 
 
 
 
  
      
      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
  
 
 
 
 
 
 
 
 
       
 
   
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The United States is the country of habitual residence of the child(ren). 
The State of Florida is the child(ren)’s home state for the purposes of the Uniform Child Custody 
Jurisdiction and Enforcement Act. 
This 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. Section 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, and for 
other state and federal laws. 
Other: _________________________________________________________________. 
IV. PARENTAL RESPONSIBILITY (Choose only one) 
[ ] 	
It is in the best interests of the child(ren) that the [ ] Mother [ ]Father shall have sole 
authority to make major decisions for the child(ren.) 
[ ] 
Shared Parental Responsibility with Decision Making Authority 
It is in the best interests of the child(ren) that the parents confer and attempt to agree 
on the major decisions involving the child(ren). If the parents are unable to agree, the 
authority for making major decisions regarding the child(ren) shall be as follows: 
Education/Academic decisions 
[ ] Mother 
[ ] Father 
Non‐emergency health care 
[ ] Mother 
[ ] Father 
___________________________ 
[ ] Mother 
[ ] Father 
___________________________ 
[ ] Mother 
[ ] Father 
___________________________ 
[ ] Mother 
[ ] Father 
[ ] 	
Other: (Explain) __________________________________________________. 
V. TIME SHARING SCHEDULE (Choose only one) 
[ ] 	
No Time‐Sharing: The [ ] Mother [ ] Father shall have no contact with the child(ren) 
until further order of the court. All parenting decisions shall be made by the other 
parent. 
[ ] 	
Supervised Time‐Sharing: Whenever the child(ren) are with the [ ] Mother [ ] Father, 
the supervisor shall be present. The [ ] Mother [ ] Father has the right to spend time 
with the child(ren) even though the other parent will be making most, if not all, of the 
parenting decisions which are made on the child(ren)’s behalf. 
The time‐sharing 
schedule shall be mutually agreed to between the parents, but not less than the 
schedule set forth below: (Choose only one) 
[ ] 	
____________ hours per week. The place(s), and time(s) shall be set by the [ ] Mother 
[ ]Father. 
[ ] 	
From 
________ 
__ 
m. 
to 
____________ 
__ 
m, 
on 
the 
following 
day(s) 
______________________________________________. 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
275 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
  
 
 
   
 
 
    
        
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
       
       
 
 
     
 
 
 
       
       
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
_____________________________________________________________________ 
   
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
       
       
 
 
     
 
 
 
  
 
 
 
  
 
 
     
      
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
      
        
 
 
 
 
     
 
 
 
 
       
         
 
 
 
 
 
 
 
 
     
 
 
[ ] 	
Other: _____________________________________________________________. 
VI. SUPERVISOR AND SUPERVISION (Choose only one) 
1. 
Supervisor. The person supervising the time‐sharing shall: (Choose only one) 
[ ] 
Be selected by the [ ] Mother [ ] Father. 
[ ] 
Be selected by the [ ] Mother [ ] Father, subject to the other parent’s approval. 
[ ] 
Other: ____________________________________________________________. 
2. 	
Restrictions or Level of Supervision: _________________________________________ 
_____________________________________________________________________ . 
3. 	
Costs of Supervision 
[ ] 
The costs of the supervision shall be paid by the [ ] Mother [ ] Father 
[ ] 
Other: ______________________________________________________. 
VII. LOCATION: (Choose only one) 
The [ ] Mother [ ] Father shall spend his/her time‐sharing with the child(ren) at the following 
location(s): 
[ ] 	
Supervised visitation center (name of facility) _____________________________ 
________________________________________________________________. 
[ ] 	
_____________________ (location) or other location designated by the 
[ ] Mother [ ] Father 
[ ] 	
Any location designated by the [ 
] Mother [ 
] Father with the approval of the 
supervisor. 
[ ] 	
Other: 
___________________________________________________________ 
. 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
276 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
  
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
      
       
 
 
 
 
 
 
     
 
 
 
 
     
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
     
 
 
 
     
       
       
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
     
 
 
     
 
 
     
 
 
     
 
VIII. DESIGNATION FOR OTHER LEGAL PURPOSES 
The child(ren) named in this Supervised/Safety‐Focused Parenting Plan are scheduled to reside 
the majority of the time with the [ ] Mother [ ] Father. This majority designation is SOLELY for 
purposes of all other state and federal statutes which require such a designation. 
This 
designation does not affect either parent’s rights and responsibilities under this parenting 
plan. 
IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN) 
1. 
Transportation 
The child(ren) shall not be driven in a car unless the driver has a valid driver’s license, 
automobile insurance, seat belts, and child safety seats as required by Florida law. 
The [ ] Mother [ ] Father or mutually agreed upon person shall be responsible for 
transporting the child(ren) to the exchange point. The child(ren) shall be picked up and/or 
returned to the exchange point by (Choose only one); 
[ ] 
The [ ] Mother [ ] Father with the supervisor present. 
[ ] 
The supervisor alone. 
[ ] 
A monitored exchange location (specify) __________________________________. 
[ ] 
Other: ____________________________________________________________. 
2. 
Exchange 
The exchange of the child(ren) shall occur at: (Choose all that apply) 
[ ] 
The site of the supervised visit. 
[ ] 
Other: _____________________________________________________. 
[ ] 
The [ ] Mother [ ] Father may not come to the exchange point. 
X. COMMUNICATION 
1. 	
Between Parents (Choose only one) 
[ ] 	
All communications regarding the child(ren) shall be between the parents. The parents 
shall not use the child(ren) as messengers to convey information, ask questions, or set 
up schedule changes. 
The parents shall communicate with each other by: (Choose all that apply) 
[ ] 	
in person 
[ ] 	
by telephone 
[ ] 	
by letter 
[ ] 	
by e‐mail 
[ ] 	
Other:________________________________________________________________. 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
277 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
_____________________________________________________________________ 
_____________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
       
       
  
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
     
       
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
  
 
[ ] 	
No Communication. Unless otherwise prohibited by court order, all information and 
communication 
regarding 
the 
child(ren) 
shall 
be 
exchanged 
via 
or 
through 
______________________________________________________________________. 
2. 
Between Parent and Child(ren) 
The [ ] Mother [ ] Father (Choose all that apply) 
[ ] 	
Shall not telephone, write, or e‐mail the child(ren) unless the contact is agreed to in 
advance by the other parent. 
[ ] 	
May write or e‐mail the child(ren) at any time. Each parent shall provide a contact 
address (and e‐mail address if appropriate) to the other parent, unless other prohibited 
by court order. 
[ ] 	
May call the child(ren) on the telephone ___ times per week. The call shall last no more 
than ____ minutes and shall take place between _____ __m. and _____ __ m.. Long 
distance telephone calls made by the child(ren) shall be paid for by the parent receiving 
the call. 
Each parent shall provide a telephone number to the other parent, unless 
otherwise prohibited by court order. 
[ ] 	
Other: ____________________________________________________________. 
3. 
Costs of Electronic Communication 
“Electronic communication” includes telephones, electronic mail or e‐mail, webcams, video­
conferencing equipment and software or other wired or wireless technologies or other 
means of communication to supplement face‐to face contact. 
The costs of electronic communication shall be addressed as follows: 
_____________________________________________________________________. 
XI. ACCESS TO ACTIVITIES AND EVENTS 
The [ ] Mother [ ] Father 
[ ] 
Shall not attend the child(ren)’s activities and events, including but not limited to, school, 
athletic, and extra‐curricular activities and events. 
[ ] 	
May attend the child(ren)’s school, athletic, and extra‐curricular activities and events. 
[ ] 	
The [ ] Mother [ ] Father must stay ___ feet from the other parent and ___ feet from 
the child. 
[ ] 
Other 
___________________________________________________________________. 
XII. CHILD(REN)’S SAFETY 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
278 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
       
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
     
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
_________________________________________________________________________ 
 
 
 
The [ ] Mother [ ] Father shall follow the safety rules checked below. (Choose all that apply) 
[ ] 
There shall be no firearms in the home, car, or in the child(ren)’s presence during time­
sharing. 
[ ] 
No alcoholic beverages shall be consumed from twenty‐four (24) hours before the 
child(ren) arrive until they are returned to the other parent. 
[ ] 
The child(ren) shall not be disciplined by corporal punishment. 
[ ] 
The following person(s) present a danger to the child(ren) and shall not be present 
during time‐sharing: ____________________________________________________. 
[ ] 
Other: _____________________________________________________________. 
XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN 
All changes to the Supervised/Safety‐Focused Parenting Plan must be pursuant to a court order. 
XIV. OTHER PROVISIONS 
________________________________________________________________________. 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
279 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                    
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
 
 
  
 
 
  
 
 
  
 
 
SIGNATURE OF PARENTS 
I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this 
Plan and intend to be bound by it. 
Dated: 
_____________________________________________ 
Signature of Mother 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
STATE OF FLORIDA 
COUNTY OF ___________________________ 
Sworn to or affirmed and signed before me on 
by 
. 
NOTARY PUBLIC or DEPUTY CLERK 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
Personally known 
Produced identification 
Type of identification produced _________________________________ 
I certify that I have been open and honest in entering into this settlement agreement. I am 
satisfied with this agreement and intend to be bound by it. 
Dated: ________________________ 
_____________________________________________ 
Signature of Father 
Printed Name: 
Address: 
City, State, Zip: 
Telephone Number: 
Fax Number: 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
280 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                         
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
  
 
 
 
   
  
 
   
   
 
       
 
       
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
__________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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] 
I, {full legal name and trade name of nonlawyer} 
a nonlawyer, located at {street} 
{state} 
, {phone} 
who is the [ one only] 
petitioner or 
, {city} ___ 
, helped { name} 
respondent, fill out this form. 
, 
, 
, 
ORDER OF THE COURT 
IT IS ORDERED AND ADJUDGED THAT THE PARENTING PLAN SET FORTH ABOVE IS ADOPTED 
AND ESTABLISHED AS AN ORDER OF THIS COURT. 
ORDERED ON ___________________________. 
CIRCUIT JUDGE 
COPIES TO: 
Father (or his Attorney) 
Mother (or her Attorney) 
Other 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety‐Focused Parenting Plan (03/09) 
281 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
  
   
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
   
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
FAMILY LAW FORMS, COMMENTARY, AND INSTRUCTIONS
GENERAL INFORMATION FOR SELF­REPRESENTED LITIGANTS (03/09) 
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. 
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. 
General Information for Self‐Represented Litigants (03/09)
282 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
     
 
 
 
 
 
   
    
     
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
    
 
   
 
 
 
 
 
   
  
 
 
 
 
 
 
   
 
   
    
 
   
 
  
 
   
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
  
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
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 regular U.S. mail or hand delivery. However, service 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 initial original or supplemental petitions, anytime 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. 
General Information for Self‐Represented Litigants (03/09)
283 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
  
   
 
   
 
 
 
   
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
    
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
      
 
   
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
   
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
  
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
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. For more information on 
constructive service, see Notice of Action for Dissolution of Marriage, Florida Supreme Court Approved 
Family Law Form 12.913(a), and Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of 
Procedure Form 12.913(b). 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 service 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, 
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) or Supervised/Safety‐Focused Parenting Plan, Florida Supreme Court Approved Family Law 
Form 12.995(b). The Parenting Plan shall be developed and agreed to by the parents and approved by a 
court or, if the parents cannot agree, established by the court. 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 
General Information for Self‐Represented Litigants (03/09)
284 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
 
 
 
 
 
 
   
 
 
 
        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                
                                       
 
 
 
 
                               
                        
 
 
 
 
                      
                                    
                         
                                  
                             
                                            
 
 
 
                            
                                             
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
 
 
 
 
   
  
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
   
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
   
 
 
 
   
 
 
 
 
 
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). 
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) 	
, 
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. 
General Information for Self‐Represented Litigants (03/09)
285 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
                      
                              
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
    
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
   
 
 
   
 
   
 
 
 
   
  
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
 
 
 
 
 
 
 
                                
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
        
 
 
        
 
  
 
 
 
 
   
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
   
 
 
 
 
  
 
 
   
 
 
  
 
 
 
 
                     
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
   
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)
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 & 3–7) 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. 
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] 
I, {full legal name and trade name of nonlawyer} 
a nonlawyer, located at {street} 
(2) 
, {city} 
{state} 
(4) 
, {phone} 
(5) 
, helped {name} 
(6) 
, 
who is the petitioner, fill out this form. 
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 2–5 
The nonlawyer’s address and telephone number should be typed or printed on lines 2– 
5. 
Line 6 
Your name should be typed or printed on line 6. 
General Information for Self‐Represented Litigants (03/09)
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In addition, a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900 (a), 
should be completed if a nonlawyer assists you. The disclosure is available as a family law form and 
should be completed before the nonlawyer helps you. This is to be sure that you understand the role 
and limitations of a nonlawyer. You and the nonlawyer should keep a copy of this disclosure for your 
records. 
General Information for Self‐Represented Litigants (03/09)
287 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
   
  
 
   
 
 
 
   
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
   
 
 
   
 
     
 
  
 
 
 
 
 
 
 
 
 
 
 
 
   
 
  
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
   
   
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
  
 
 
 
   
   
 
 
 
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. 
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/courts/supct. 
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. 
Central Governmental 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. 
General Information for Self‐Represented Litigants (03/09)
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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. 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. 
Delinquent ‐ late. 
Dependent Child(ren) ‐ child(ren) who depend on their parent(s) for support either because they are 
under the age of 18, they have a mental or physical disability that prevents them from supporting 
themselves, or they are in high school while between the ages of 18 and 19 and are performing in good 
faith with 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. 
Electronic Communication – Contact, other than face‐to‐face contact, facilitated by tools such as 
telephones, electronic mail or e‐mail, 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. 
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. 
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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). 
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. 
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. 
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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. 
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 parties relating to the 
decisions that must be made regarding the minor child(ren). The Parenting Plan shall 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, physical, social, and emotional well‐being. In creating the Plan, all 
circumstances between the parties, including the parties’ historic relationship, domestic violence, and 
other factors must be taken into consideration. The Parenting Plan shall be developed and agreed to by 
the parents and approved by a court, or if the parents cannot agree, established by the court. 
Parenting Plan Recommendation – a Parenting Plan and time‐sharing schedule developed a 
psychologist licensed under chapter 490 that is not binding on a court. 
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 be paid at a specified, periodic rate until modified by a 
court order, the death of either party, or the remarriage of the Obligee, whichever occurs first. 
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. 
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Pleading ‐ a formal written statement of exactly what a party wants the court to do in a lawsuit or court 
action. 
Pro Se 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. 
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 is the father of a child. 
Service ‐ the delivery of legal documents to a party. This must be accomplished as directed by Florida 
Family Law Rules 12.070 and 12.080. 
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. 
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. 
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. 
If 
developed and agreed to by the parents of a minor child or children, it must be approved by the court. If 
the parents cannot agree, the schedule shall be established 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. 
General Information for Self‐Represented Litigants (03/09)
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