Case Title: In Re: Implementation Of Committee On Privacy And Court Records Recommendations – Amendments To The Florida Rules Of Civil Procedure; The Florida Rules Of Judicial Administration; The Florida Rules Of Criminal Procedure; The Florida Probate Rules; The Florida Small Claims Rules; The Florida Rules Of Appellate Procedure; And The Florida Family Law Rules Of Procedure

Citation: 

Docket Number: 

State: florida

Court: Florida Supreme Court

Date: 2011-07-08T00:00:00Z

Document:
Supreme Court of Florida 
 
 
____________ 
 
No. SC08-2443 
____________ 
 
 
IN RE:  IMPLEMENTATION OF COMMITTEE ON PRIVACY AND 
COURT RECORDS RECOMMENDATIONS—AMENDMENTS TO THE 
FLORIDA RULES OF CIVIL PROCEDURE; THE FLORIDA RULES OF 
JUDICIAL ADMINISTRATION; THE FLORIDA RULES OF CRIMINAL 
PROCEDURE; THE FLORIDA PROBATE RULES; THE FLORIDA 
SMALL CLAIMS RULES; THE FLORIDA RULES OF APPELLATE 
PROCEDURE; AND THE FLORIDA FAMILY LAW RULES OF 
PROCEDURE. 
 
[June 30, 2011] 
CORRECTED OPINION 
 
PER CURIAM. 
 
We have for consideration proposed amendments to the Florida rules of 
court and forms intended to minimize the amount of unnecessary personal 
information included in documents filed with the courts.1  Reducing the amount of 
extraneous personal information in court records is another necessary step in the 
Court’s ongoing effort to provide the public with electronic access to 
                                         
 
1.  We have jurisdiction.  See art. V, § 2(a), Fla. Const.; Fla. R. Jud. Admin. 
2.140(d), (f). 
 
2 
 
nonconfidential court records.2  As part of that effort, we recently adopted 
procedures that allow clerks of court to readily identify and screen from the public 
confidential information filed with the courts and refine the procedures for sealing 
and unsealing court records.  See In re Amends. to Fla. Rule of Jud. Admin. 2.420 
& Fla. Rules of App. Pro., 31 So. 3d 756, 757 (Fla. 2010) (recognizing that 
refinement of rule governing confidential court records was a necessary step in 
providing the public electronic access to court records).              
The amendments at issue here further implement recommendations of the 
Committee on Privacy and Court Records (Privacy Committee) and are the result 
of the combined efforts of the Committee on Access to Court Records (Access 
                                         
 
2.  See In re Revised Interim Policy on Elec. Release of Court Records, Fla. 
Admin. Order No. AOSC07-49 (Fla. Sept. 7, 2007) (providing revised interim 
policy for the electronic release of court records); In re Implementation of Report 
and Recommendations of the Comm. on Privacy and Court Records, Fla. Admin. 
Order No. AOSC06-20 (June 30, 2006) (―Admin. Order No. AOSC06-20‖) 
(recognizing that certain conditions, including rule amendments, must be met 
before goal of providing the public electronic access to court records can be 
achieved); see also In re Statewide Standards for Elec. Access to the Courts, Fla. 
Admin. Order No. AOSC09-30 (July 1, 2009) (adopting the Florida Supreme 
Court Statewide Standards for Electronic Access to the Courts in response to 
chapter 2009-61, section 16, Laws of Florida, which requested that the Court 
establish statewide e-filing standards to be used by the clerks of court to implement 
electronic filing); In re Amends. to Fla. Rules of Civil Pro., Fla. Rules of Jud. 
Admin., Fla. Rules of Crim. Pro., Fla. Probate Rules, Fla. Small Claims Rules, Fla. 
Rules of Juv. Pro., Fla. Rules of App. Pro., & Fla. Family Law Rules of Pro.–
Electronic Filing, No. SC11-399 (Fla. Petition filed Feb. 28, 2011) (Court 
considering proposed rule amendments to implement electronic filing of 
documents with courts).   
3 
 
Committee), its successor, the Florida Court Technology Commission’s 
Subcommittee on Access to Court Records (Access Subcommittee),3 and the 
Florida Bar Rules Committees.  After considering the various proposals and 
comments filed in this case, and hearing oral argument, we amend the rules and 
forms to minimize the personal information filed with the court.  Most notably, we 
adopt new Rule of Judicial Administration 2.425 (Minimization of the Filing of 
Sensitive Information) to govern the filing of sensitive personal information, which 
is the linchpin of the minimization efforts.  We take this opportunity to emphasize 
that in order to avoid the electronic dissemination of sensitive personal information 
unnecessary to court proceedings, both attorneys and pro se litigants must be 
vigilant to file only authorized documents that comply with the requirements 
adopted here.  
The newly enacted rules provide for sanctions for violations of these rules.  
However, continual education and a change in mindset for all those involved in the 
litigation process are necessary for these rules to work as intended.  After all, with 
the benefits of electronic access to documents comes the responsibility to minimize 
unnecessary personal information in court records.  With those beginning cautions, 
                                         
 
3.  See In re Fla. Courts Tech. Comm’n, Subcomm. on Access to Court 
Records, Fla. Admin. Order No. AOSC09-3 (Jan. 27, 2009) (directing commission 
to establish a Subcommittee on Access to Court Records to act as the successor to 
the Access Committee for the purpose of advancing rule proposals) (―Admin. 
Order No. AOSC09-3‖). 
4 
 
we explain the evolution of the amendments and the substance of the major 
amendments.  
BACKGROUND 
The Privacy Committee was created in November 2003 and charged with 
providing recommendations to the Court regarding electronic access to court 
records.  See In re Comm. on Privacy and Court Records, Fla. Admin. Order No. 
AOSC04-04 (Feb. 12, 2004) (substituted for AOSC03-49).  As relevant to the 
amendments at issue here, the Privacy Committee was charged with 
recommending strategies for reducing the amount of unnecessary personal 
information in court records.  Id. at 5.  After the Privacy Committee submitted its 
report and recommendations4 and the Court held public hearings on the 
recommendations, an administrative order was issued partially implementing the 
Privacy Committee’s recommendations.5  That administrative order noted the 
Court’s agreement with the Privacy Committee that the Florida judicial branch 
should have a goal of providing electronic access to nonconfidential court records 
when appropriate conditions are met, one of which is minimizing the amount of 
                                         
 
4.  See Committee on Privacy and Court Records, Privacy, Access and Court 
Records: the Report and Recommendations of the Committee on Privacy and Court 
Records (2005) (―Privacy Committee Report‖). 
 
 
5.  Admin. Order No. AOSC06-20. 
5 
 
unnecessary personal information in court records.6  By separate administrative 
order, the Access Committee was created to assist the Court in implementing a 
number of the Privacy Committee recommendations,7 including the 
―minimization‖ recommendations addressed here.8    
As relevant here, the Privacy Committee reported as follows: 
Florida court files commonly contain information which is not 
required by law or rule and which is not needed by the court for 
purposes of adjudication or case management.  Once entered into a 
court file this information becomes a matter of public record.  Much 
of this information is personal or sensitive in nature.  The Committee 
perceives that there is not a clear understanding on the part of 
attorneys and the general public of the negative effects on personal 
privacy of placing unnecessary information in a court record.   
Privacy Committee Report at 56.  The inclusion of unnecessary personal 
information in court filings is of special concern because providing electronic 
access, which would include internet access, to court records will make 
nonconfidential personal information contained in those records more readily 
accessible to the public.   
                                         
 
6.  See Admin. Order AOSC06-20 at 1, 9.   
 
7.  The Court separately considered implementation recommendations 
concerning electronic access to court records contained in the Access Committee’s 
final report and recommendations submitted in September 2008.  See Committee 
on Access to Court Records, Final Report and Recommendations (2008). 
 
8. See In re Comm. on Access to Court Records, Fla. Admin. Order No. 
AOSC06-27 (Aug. 21, 2006) (―Admin. Order AOSC06-27‖). 
6 
 
To mitigate this concern, the Privacy Committee made four 
recommendations intended to minimize the filing of extraneous personal 
information.  Privacy Committee Recommendation Seven urges the review and 
revision of court rules and forms to avoid the filing of personal information that is 
not necessary for adjudication or case management.9  Recommendation Eight 
recommends the study of a court rule to prohibit the filing of unauthorized 
documents.10  Recommendation Nine suggests clarifying Family Law Rule of 
Procedure 12.285 (Mandatory Disclosure) to avoid the unnecessary filing of 
financial information in family law cases.11  And Recommendation Ten urges the 
adoption of a rule that prohibits the filing of discovery information with the court 
unless the information is filed for good cause and that provides for sanctions if the 
rule is violated.12  These ―minimization‖ recommendations were referred to the 
Florida Bar rules committees to propose rule and form amendments implementing 
the recommendations.13  The rules committees’ proposals were then referred to the 
                                         
 
9.  Privacy Committee Report, Recommendation Seven, at 53. 
 
10.  Privacy Committee Report, Recommendation Eight, at 54. 
 
11.  Privacy Committee Report, Recommendation Nine, at 55.    
 
12.  Privacy Committee Report, Recommendation Ten, at 56. 
 
13.  See Admin. Order AOSC06-20 at 19-20.  Privacy Committee 
Recommendation Eight, addressing unauthorized filings, see Privacy Committee 
Report at 54, was referred to the Access Committee.  The Access Committee was 
7 
 
Access Committee for consideration14 and preparation of an omnibus petition of 
proposed rule amendments.  The Access Committee’s petition of proposed 
amendments, as well as revised and new proposals offered by the rules committees 
are before the Court here.   
In considering the proposals, the Court had the benefit of comments from 
interested persons, as well as responses and input from the Access Subcommittee 
(successor to the Access Committee)15 and the various rules committees on a 
number of issues of concern to the Court.  See In re Implementation of Comm. on 
Privacy & Court Records Recommendations, No. SC08-2443 (Fla. order filed 
April 1, 2010) (seeking input on a number of issues); see also In re Implementation 
of Comm. on Privacy & Court Records Recommendations, No. SC08-2443 (Fla. 
                                                                                                                                   
charged with studying the rules to ―determine whether any sanctions [for 
unauthorized filings] need to be strengthened to further the goal of preventing 
gratuitous publication of extraneous and potentially damaging information.‖  
Admin. Order AOSC06-27 at 3.  However, the Access Committee did not directly 
address Recommendation Eight in its petition or report.  We cannot fully 
implement the Privacy Committee’s minimization recommendations without a 
clear mechanism in place to stop the filing of all unauthorized documents.  
Therefore, we ask the various Florida Bar rules committees to study the issue of 
unauthorized filings, as suggested in Recommendation Eight of the Privacy 
Committee Report, and report back to the Court with recommendations to address 
this issue.  The committees should coordinate their efforts, with the Rules of 
Judicial Administration Committee overseeing the effort.   
 
14.  See, e.g., In re Amends. to Fla. Rules of App. Pro., 2 So. 3d 89, 90 n.1 
(Fla. Nov. 13, 2008) (stating that proposed new rule 9.050 (Maintaining Privacy of 
Personal Data) was referred to Access Committee). 
 
15.  See Admin. Order No. AOSC09-3. 
8 
 
order filed May 19, 2010) (seeking input on suggested new rule 2.425).  In 
response to the Court’s concern about consistency among the various rules 
proposed to govern the filing of sensitive personal information, the committees 
now urge the adoption of new Rule of Judicial Administration 2.425 (Minimization 
of the Filing of Sensitive Information) and conforming amendments to the other 
bodies of rules and forms.   
After considering the various proposals, we amend the Florida Rules of Civil 
Procedure, the Florida Rules of Judicial Administration, the Florida Rules of 
Criminal Procedure, the Florida Probate Rules, the Florida Small Claims Rules, the 
Florida Rules of Appellate Procedure, and the Florida Family Law Rules of 
Procedure and forms, as reflected in the appendix to this opinion.  We discuss the 
more significant amendments below.   
AMENDMENTS  
New Rule of Judicial Administration 2.425 and Other Amendments Limiting 
the Filing of Extraneous Personal Information 
 
 
New rule 2.425 (Minimization of the Filing of Sensitive Information) is the 
centerpiece of the amendments adopted in this case.  The new rule governs the 
filing of sensitive personal information in all types of cases, except traffic and 
criminal proceedings.16  It implements Privacy Committee Recommendation 
                                         
 
16.  Subdivision (b) of the rule, which we adopt on an interim basis, exempts 
filings in criminal and traffic proceedings. 
9 
 
Seven, which urges revision of court rules and forms to avoid the filing of personal 
information that is not necessary for adjudication or case management.17  The new 
rule of judicial administration sets forth the categories of personal information that 
must not be filed or must be truncated or redacted before filing, and provides 
exceptions that allow for the filing of complete information in appropriate 
circumstances.   
The new rule serves as a companion to recently amended Rule of Judicial 
Administration 2.420 (Public Access to Judicial Branch Records).18  New rule 
2.425 provides the procedures for protecting personal information being filed with 
the court; while rule 2.420 governs the procedures for determining the 
confidentiality of information after it has been filed and for providing public access 
to nonconfidential information.  Rule 2.425 is loosely modeled after Federal Rule 
of Civil Procedure 5.2 (Privacy Protection for Filings Made with the Court).  The 
most important provisions of the new rule are discussed below. 
                                         
 
17.  Privacy Committee Report, Recommendation Seven, at 53. 
 
18.  The Court previously adopted a number of amendments to Florida Rule 
of Judicial Administration 2.420 (Public Access to Judicial Branch Records) also 
proposed by the Access Committee to implement other Privacy Committee 
recommendations.  See In re Amends. to Fla. Rule of Jud. Admin. 2.420 & Fla. 
Rules of App. Pro., 31 So. 3d 756 (amending Rule of Judicial Administration 
2.420 to provide comprehensive procedures for identifying and segregating 
confidential information in court records, for sealing and unsealing court records, 
and for reviewing orders issued under the rule.)   
10 
 
First, under subdivision (a) (Limitations for Court Filings) of the new rule, 
unless exempted by subdivision (b) (Exceptions), or authorized by statute, another 
rule, or court order,19 personal information of the type listed either must not be 
filed or must be truncated or redacted before filing.  Under subdivisions (a)(1) and 
(a)(2) only the initials of a minor and the year of birth of a person’s birth date may 
be included in filings, and under subdivision (a)(3), no portion of a social security 
number, bank account number, credit card account number, charge account 
number, or debit account number can be filed,20 unless the number falls within one 
of the subdivision (b) exceptions, or is authorized by statute, another rule, or court 
order.    
Only the last four digits of certain other personal identifying numbers (i.e., 
driver’s license number, passport number, taxpayer identification number, and 
patient or health care number) are allowed under subdivision (a)(4).  Similarly, a 
truncated version of other types of personal information (i.e., email address, 
                                         
 
19.  The phrase ―or authorized by statute, another rule, or court order‖ is 
meant to clarify that conflicting provisions of another rule of court, a statute, or a 
court order will control over the rule 2.425 requirements.   
 
20.  In proposing this prohibition, the Rules of Judicial Administration 
Committee recognized that the standard business and banking practice is to use the 
last four digits of such numbers, but the committee determined it would be best to 
completely preclude the filing of such numbers because of their confidential status 
under rule 2.420(d)(1)(B)(iii).  We agree that these highly sensitive and otherwise 
confidential personal identifying numbers should not be filed, unless exempt from 
the rule 2.425(a) limitations as provided in the rule. 
11 
 
password, and other sensitive information as provided by court order) is allowed 
under subdivisions (a)(5) and (a)(6).    
Next, subdivision (b) (Exceptions) allows for the filing of complete 
information under certain circumstances.  For example, under subdivisions (b)(1), 
(b)(5), and (b)(6) respectively, an account number that identifies the property 
alleged to be the subject of a proceeding, the birth date of a minor whenever the 
birth date is necessary for the court to establish or maintain subject matter 
jurisdiction, and the name of a minor in any document or order affecting the 
minor’s ownership of real property are exempt from the subdivision (a) limitations.  
Under subdivision (b)(10), information that is relevant and material to an issue 
before the court also is exempt.   
Subdivision (b)(8), which we adopt on an interim basis, exempts from the 
requirements of the rule filings in traffic and criminal proceedings.  This exception 
is strongly supported by the Criminal Procedure Rules Committee, prosecutors, 
and defense attorneys, as well as numerous Florida criminal justice organizations.21   
The Rules Committee and criminal justice organizations maintain that much of the 
                                         
 
21.  The composite comments of the Florida criminal justice organizations 
filed in this case include comments or resolutions in support of the exemption from 
the Florida Association of Criminal Defense Lawyers, the Miami-Dade County 
Association of Chiefs of Police, the Florida Prosecuting Attorneys Association, the 
Florida Public Defender Association, Inc., and the Florida Bar Criminal Law 
Section. 
12 
 
information filed in criminal cases that would have to be truncated or redacted 
under the new rule must be available to defense attorneys, law enforcement, and 
others in the criminal justice system.  The proponents of the exception also caution 
that application of the rule would result in substantial workload issues for 
prosecutors’ offices that would be required to truncate or redact massive amounts 
of information routinely contained in arrest affidavits, search warrants, charging 
documents, traffic citations, police reports, and discovery documents filed with the 
court.  We acknowledge the reasons advanced for treating filings in criminal and 
traffic proceedings differently than filings in other cases.  However, filings in 
criminal and traffic cases contain a large portion of the personal information filed 
with our courts and a ―blanket‖ exception for those filings would not be necessary 
if a finely tailored rule can be drafted to govern them.  Therefore, we direct the 
Criminal Procedure Rules Committee, the Traffic Court Rules Committee, and the 
Rules of Judicial Administration Committee to work together to propose a rule or 
rules similar to Federal Rule of Criminal Procedure 49.1 (Privacy Protection for 
Filings Made with the Court) to govern the filing of sensitive personal information 
in criminal and traffic proceedings.22   
                                         
 
22.  The Criminal Procedure Rules Committee should oversee this project, 
and the committees’ joint report should be filed with the Court by December 1, 
2011.   
13 
 
Finally, subdivision (c) (Remedies) provides remedies and sanctions for 
violations of the rule.  And subdivisions (d) (Motions Not Restricted) and (e) 
(Application) clarify the new rule’s interplay with rule 2.420 (Public Access to 
Judicial Branch Records) and explain that the new rule does not affect the 
application of constitutional provisions, statutes, or rules of court governing 
confidential information or access to public records.   
Other rules of procedure and forms are amended to conform to or reference 
new rule 2.425.23  For example, new Rule of Appellate Procedure 9.050 
                                         
 
23.  The Small Claims Rules Committee declined to offer conforming 
amendments to the Small Claims Rules.  Rather, that committee asks the Court to 
postpone amending the Small Claims Rules until the committee has an opportunity 
to consider the version of rule 2.425 the Court adopts.  Therefore, we defer 
adoption of pending amendments to the Small Claim Rules that are impacted by 
the adoption of rule 2.425 and direct the Small Claims Rules Committee to use its 
fast-track procedures to file a report with conforming rule amendments by 
September 1, 2011.  However, we adopt other pending amendments to the Small 
Claims Rules that will limit the filing of unnecessary personal information but are 
not directly affected by the adoption of new rule 2.425.  They are new rule 
7.140(e)(3), which requires the judge to assist an unrepresented party in the 
handling of private information, and forms 7.340 (Final Judgment) and 7.373 (Fact 
Information Sheet), which are amended to instruct that the Fact Information Sheet 
should not be filed with the Court.   
We ask that in the future, when the Court seeks proposed rule amendments 
to address a given topic from a number of rules committees, each committee 
comply with the Court’s request and individual committees not decline to act until 
proposals from other committees are acted upon.  See, e.g., In re Amends. to  Fla. 
Rules of Jud. Admin., Fla. Rules of Civil Pro., Fla. Rules of Crim. Pro., Fla. Rules 
of Civil Pro. for Involuntary Commitment of Sexually Violent Predators, Fla. 
Probate Rules, Fla. Rules of Traffic Court, Fla. Rules of Juv. Pro., Fla. Rules of 
App. Pro., & Fla. Family Law Rules of Pro.—Computation of Time, No. SC10-
2299 (Fla. Petition filed Dec. 13, 2010) (Small Claims Rules Committee declining 
14 
 
(Maintaining Privacy of Personal Data) requires all briefs, petitions, replies, 
appendices, motions, notices, stipulations, and responses filed with the court 
comply with rule 2.425.  Family Law Rules 12.130(c) (Protection of Account and 
Personal Identifying Numbers),12.440(a) (Setting for Trial), 12.540 (Relief from 
Judgment, Decrees, or Orders), and 12.620 (Receivers) are amended to require 
compliance with rule 2.425.  Amendments to the civil and family law discovery 
rules also incorporate the requirements of rule 2.425.  See Appendix, infra, pp. 23-
26, 55-63 (amending Fla. R. Civil P. 1.280; 1.310; 1.340; 1.350; Fla. Fam. L. R. P. 
12.280; 12.285; 12.340; 12.370; 12.410; 12.560).   
To further implement Privacy Committee Recommendation Seven (Revision 
of Rules and Forms Leading to Extraneous Personal Information), the various civil 
judgment forms are amended to require that only the last four digits of the 
judgment debtor’s social security number be included in the judgment.  Probate 
Rules 5.200 (Petition for Administration), 5.210 (Probate of Wills without 
Administration), and 5.530 (Summary Administration) are likewise amended to 
require that only the last four digits of the decedent’s social security number be 
                                                                                                                                   
to propose amendments to Small Claims Rules until proposed Rule of Judicial 
Administration governing computation of time is adopted by the Court).  
Addressing all related proposals at the same time ensures consistency and 
conserves valuable judicial resources. 
15 
 
included in petitions filed under those rules.24  Similarly, to limit the filing of 
personal information in criminal cases, Rule of Criminal Procedure 3.140(c)(4) 
(Personal Statistics) is amended to delete the requirement that the defendant’s 
social security number be included in the charging document.25  
Rule of Civil Procedure 1.280(f) and Other Amendments Limiting the 
Filing of Discovery and Financial Information 
 
New Rule of Civil Procedure 1.280(f) (Court Filing of Documents and 
Discovery) works in conjunction with new rule 2.425, by requiring that all 
discovery documents filed with the court comply with the requirements for the 
filing of personal information.  However, the new discovery rule’s primary purpose 
                                         
 
24.  Although the general provisions of new rule 2.425 prohibit the inclusion 
of any portion of a social security number in a court filing, as noted above, 
requirements in other rules or forms, such as the requirement that the last four 
digits of a social security number be included in certain documents, control over 
conflicting requirements in the new rule.   
 
25.  We decline to adopt amendments to rules 3.211(c) (Competence to 
Proceed: Scope of Examination; Written Findings of Experts), 3.212(d) 
(Competence to Proceed: Hearing and Disposition; Release of Finding of 
Incompetence), 3.218(a) (Commitment of a Defendant Found Not Guilty by 
Reason of Insanity; Commitment; 6-Month Report), and 3.219(a) (Conditional 
Release; Release Plan) suggested by the Criminal Procedure Rules Committee.  
Instead, we amend those rules to provide: ―The procedure for determinations of the 
confidential status of reports is governed by Rule of Judicial Administration 
2.420.‖  Further amendments to rule 2.420(d), which are urged in this case, will be 
considered in In re Amends. to the Fla. Rule of Jud. Admin. 2.420, No. SC10-2242 
(Fla. Petition filed Nov. 19, 2010).  See In re Implementation of Comm. on Privacy 
& Court Records Recommendations, No. SC08-2443 (Fla. order filed November 
19, 2010) (stating that suggested amendments to rule 2.420(d)(1)(B) will be 
considered in case number SC10-2242). 
16 
 
is to implement Privacy Committee Recommendation Ten,26 by prohibiting the 
filing of information obtained during discovery unless the information is filed for 
good cause and giving the court authority to impose sanctions for violation of the 
rule.  The Court revised the language of proposed rule 1.280(f) to clarify that good 
cause is satisfied only where the filing of the information is allowed or required by 
another applicable rule of procedure or by court order.  This requirement is 
intended to stop abuses of personal information obtained during discovery by 
preventing the filing of discovery information unless it is necessary to the 
proceedings.  Other civil discovery rules are amended to require compliance with 
new rule 1.280(f).  See Appendix, infra, pp. 23-26 (amending Fla. R. Civ. P. 1.310; 
1.340; 1.350). 
Family law discovery rules also are amended to limit the filing of discovery 
information.  New subdivision (c) is added to Family Law Rule 12.340 
(Interrogatories to Parties) to require that responses to interrogatories be served but 
not filed with the court, unless they are admitted into evidence and are in 
compliance with rule 2.425.  Rule 12.370 (Requests for Admissions) is amended to 
require that documents attached to a request for admissions be served with the 
request but not filed with the court.  The amendments to rule 12.560 (Discovery in 
                                         
 
26.  Privacy Committee Report, Recommendation Ten, at 56. 
17 
 
Aid of Execution) prohibits the filing of a fact information sheet, civil form 1.977, 
unless ordered by the court for good cause shown.   
 
Similarly, subdivisions (b) and (e) of rule 12.363 (Evaluations of Minor 
Child) are amended to prevent the filing of an evaluation of a minor child unless 
the report is being admitted into evidence.  If the report is filed, the filing must 
comply with rule 2.425.  The Media Organizations27 that commented on these 
amendments urge us to reject the requirement, added to subdivision (e), that the 
court consider whether the report should be sealed under rule 2.420.  The Media 
Organizations maintain that rule 2.420 places the burden of seeking a 
determination of confidentiality of court records on the proponent of closure, not 
the court.  In response, the Family Law Rules Committee points out that the court 
has inherent authority to protect the interests of children whose parents are before 
the court, citing Simms v. State Department of Health & Rehabilitative Services, 
641 So. 2d 957, 961 (Fla. 3d DCA 1994).  The Access Subcommittee explains that 
the recent amendments to rule 2.420 were not intended to affect the power of a 
court to determine, sua sponte, that a particular court record is confidential.  
Therefore, we defer to the committee and adopt the subdivision (e) requirement.     
                                         
 
27.  ―The Media Organizations‖ include: Orlando Sentinel Communications 
Company, publisher of the Orlando Sentinel, and Sun-Sentinel Publishing 
Company, publisher of the South Florida Sun-Sentinel. 
18 
 
Next, to implement Privacy Committee Recommendation Nine, which 
requested that the mandatory disclosure rule be clarified to avoid the unnecessary 
filing of financial information in family law cases,28 as well as Recommendations 
Seven and Ten, we adopt new Family Law Rule of Procedure 12.285(a)(3) 
(Mandatory Disclosure; Documents Not to be Filed with Court; Sanctions), and 
amend rule 12.287 (Financial Affidavits in Enforcement and Contempt 
Proceedings).  New rule 12.285(a)(3)(A) highlights language currently in the rule 
stating that except for financial affidavits and child support guidelines worksheets, 
documents produced under the rule are not to be filed with the court absent a court 
order.  Subdivision (a)(3)(B) requires that account numbers and personal 
identifying information are governed by rule 2.425.  And subdivision (a)(3)(C) 
provides that sanctions are governed by new rule 1.280(f).  New rule 12.285(c) 
(Exemption for Requirement to File and Serve Financial Affidavit) prohibits the 
filing and service of a financial affidavit if the parties are seeking a simplified 
dissolution of marriage under 12.105 and certain conditions are met.  The current 
rule 12.105(c) requirement that the parties to a simplified dissolution proceeding 
file a financial affidavit and marital settlement agreement is deleted, and the family 
law forms are amended accordingly.  Rule 12.287 is amended to delete the 
requirement that a requested financial affidavit be filed with the court in 
                                         
 
28.  Privacy Committee Report, Recommendation Nine, at 55.    
19 
 
enforcement and contempt proceedings and to add a requirement that a notice of 
compliance with the service requirement be filed instead.29     
The family law rules of procedure forms are amended to conform with the 
amendments to the family law rules.  Additionally, the instructions to several of the 
rules forms and approved forms are amended to conform to section 
119.071(2)(j)(1), Florida Statutes (2010), which was enacted to protect the 
confidentiality of victims of domestic violence, sexual battery, aggravated child 
abuse, aggravated stalking, and aggravated battery.   
Amendments to Florida Supreme Court Approved Family Law Forms 
Finally, with input from the Court’s Advisory Workgroup on the Florida 
Supreme Court Approved Family Law Forms,30 we amend the Florida Supreme 
Court Approved Family Law Forms to ensure that the forms do not prompt those 
who use them to provide unnecessary personal information, such as ―place of 
marriage,‖ ―date of separation,‖ ―place of birth of minor children,‖ or ―gender of 
minor children.‖  The requirement to include a statement of the ―best interest of the 
                                         
 
29.  The rules committee felt that the affidavit could be entered into 
evidence if necessary at the hearing and that only at that point is it necessary to 
include the affidavit in the court record.   
 
30.  See Amends. to the Fla. Family Law Rules of Procedure & Family Law 
Forms, 810 So. 2d 1, 14 (Fla. 2000) (providing that Court will seek input from 
advisory workgroup when making more substantial changes to the Supreme Court 
Approved Family Law Forms).  
20 
 
child(ren)‖ is deleted from 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), as unnecessary.  Requests for financial 
information that is required to be provided in the family financial affidavits also is 
removed from form 12.943 (Motion to Deviate from Child Support Guidelines).  
Other more minor changes also are made to the approved forms. 
CONCLUSION 
We thank the Access Committee, the Access Subcommittee, the Florida Bar 
Rules Committees, the Court’s Advisory Workgroup on the Florida Supreme Court 
Approved Family Law Forms, and those who submitted comments for assisting the 
Court in moving closer to our goal of providing the public with electronic access to 
court records.  We also take this opportunity to emphasize that in order to avoid the 
electronic dissemination of sensitive personal information unnecessary to court 
proceedings, both attorneys and pro se litigants must be vigilant to file only 
authorized documents that comply with the requirements adopted here.  
Accordingly, we amend the Florida Rules of Civil Procedure, the Florida 
Rules of Judicial Administration, the Florida Rules of Criminal Procedure, the 
Florida Probate Rules, the Florida Small Claims Rules, the Florida Rules of 
Appellate Procedure, and the Florida Family Law Rules as reflected in the 
21 
 
appendix to this opinion.31  New language is indicated by underscoring; deletions 
are indicated by struck-through type.  The committee notes are offered for 
explanation only and are not adopted as an official part of the rules.  We also 
amend the Family Law Rules of Procedure Forms and the Florida Supreme Court 
Approved Family Law Forms, as set forth in the appendix to this opinion, fully 
engrossed for use on the effective date of the amendments.  The forms can be 
accessed and downloaded from this Court’s website at www. flcourts. org/ gen_ 
public/ family/ forms_ rules/ index. shtml.  By adopting the amended forms, we 
express no opinion as to their correctness or applicability.   
The amendments to the rules and forms shall become effective October 1, 
2011, at 12:01 a.m.  Because the amendments to the Florida Supreme Court 
Approved Family Law Forms were not published for comment prior to their 
adoption, interested persons shall have sixty days from the date of this opinion to 
                                         
 
31.  We recognize that the development and refinement of the numerous rule 
and form amendments adopted here has been an arduous task for all involved.  
Therefore, we ask the rules committees to carefully review the new and amended 
rules and forms for consistency and to ensure that interim amendments to the rules 
and forms amended here have not been inadvertently omitted.  Any needed 
revisions should be brought to the Court’s attention during the rehearing period in 
this case.  We also ask the rules committees, as part of their regular-cycle review, 
to conduct a thorough review of rules and forms not amended here to determine 
whether any of those rules or forms should to be amended to ensure consistency 
with the amendments we adopt here.   
22 
 
file comments with the Court addressing only the amendments to the approved 
forms.32 
 
 
It is so ordered. 
CANADY, C.J., and PARIENTE, LEWIS, POLSTON, LABARGA, and PERRY, 
JJ., concur. 
QUINCE, J., concurs in result. 
 
THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE 
EFFECTIVE DATE OF THESE AMENDMENTS. 
 
 
Original Proceedings – The Civil Procedure Rules Committee, The Rules of 
Judicial Administration Committee, Criminal Procedure Rules Committee, The 
Probate Rules Committee, The Small Claims Rules Committee, The Appellate 
Court Rules Committee, and The Family Law Rules Committee 
 
Judith L. Kreeger, Chair, the Florida Courts Technology Commission, Senior 
Judge, Eleventh Judicial Circuit, Miami, Florida, Paul Regensdorf, Chair, 
Subcommittee on Access to Court Records, and Judge Melanie G. May, Fourth 
District Court of Appeal, West Palm Beach, Florida; Steven Patrick Combs, Chair, 
Family Law Rules Committee, Jacksonville, Florida,  
 
for Petitioners 
 
Frank T. Pilotte, Chair, Florida Probate Rules Committee, and John F. Harkness, 
Jr., Executive Director, The Florida Bar, Tallahassee, Florida; Russell Robert 
Winer, St. Petersburg, Florida; Robyn L. Vines, Past Chair, Fort Lauderdale, 
                                         
 
32.  An original and nine paper copies of all comments addressing the 
approved forms must be filed with the Court on or before August 29, 2011.  
Electronic copies of all comments also must be filed in accordance with the 
Court’s administrative order In re Mandatory Submission of Electronic Copies of 
Documents, Fla. Admin. Order No. AOSC04-84 (Sept. 13, 2004). 
 
 
23 
 
Florida; Carol Jean LoCicero and Deanna K. Shullman of Thomas, LoCicero and 
Bralow, PL, Tampa, Florida; John S. Mills, Past Chair, Appellate Court Rules 
Committee, Jacksonville, Florida; Judge Robert W. Lee, Past Chair Small Claims 
Rules Committee, Seventeenth Judicial Circuit, Fort Lauderdale, Florida; Mark 
Romance, Past Chair, Civil Procedure Rules Committee, Miami, Florida; Jack A. 
Moring, Past Chair, Family Law Rules Committee, Crystal River, Florida; John G. 
Crabtree, Chair, Appellate Court Rules Committee, Key Biscayne, Florida; Fleur J. 
Lobree, Past Chair, Criminal Procedure Rules Committee; Robert T. Strain, Chair, 
Criminal Procedure Rules Committee, Tampa, Florida; Keith H. Park, on behalf of 
the Rules of Judicial Administration Committee, West Palm Beach, Florida, 
 
Responding with comments 
 
Donald E. Christopher, Chair, Civil Procedure Rules Committee, Orlando, Florida, 
and Jeffrey S. Goethe, Chair, Florida Probate Rules Committee, Bradenton, 
Florida, 
 
Also attended oral arguments 
24 
 
APPENDIX 
 
FLORIDA RULES OF CIVIL PROCEDURE 
 
RULE 1.280. 
GENERAL PROVISIONS GOVERNING DISCOVERY 
 
(a) - (e) [No change] 
 
 
(f) Court Filing of Documents and Discovery. Information obtained during 
discovery shall not be filed with the court until such time as it is filed for good 
cause. The requirement of good cause is satisfied only where the filing of the 
information is allowed or required by another applicable rule of procedure or by 
court order. All filings of discovery documents shall comply with Florida Rule of 
Judicial Administration 2.425. The court shall have authority to impose sanctions 
for violation of this rule.  
 
Committee Notes 
 
1972 Amendment - 1996 Amendment.  [No change] 
 
 
2011 Amendment.  Subdivision (f) is added to ensure that information 
obtained during discovery is not filed with the court unless there is good cause for 
the documents to be filed, and that information obtained during discovery that 
includes certain private information shall not be filed with the court unless the 
private information is redacted as required by Florida Rule of Judicial 
Administration 2.425. 
 
 
Court Commentary 
[No change] 
 
 
RULE 1.310. 
DEPOSITIONS UPON ORAL EXAMINATION 
 
 
(a) - (e) [No change] 
 
 
 
(f) 
Filing; Exhibits. 
 
 
 
(1) - (2) [No change]  
 
25 
 
(3) 
A copy of a deposition may be filed only under the following 
circumstances: 
 
 
 
 
(A) 
It may be filed in compliance with Florida Rule of 
Judicial Administration 2.425 and rule 1.280(f) by a party or the witness when the 
contents of the deposition must be considered by the court on any matter pending 
before the court. Prompt notice of the filing of the deposition shall be given to all 
parties unless notice is waived. A party filing the deposition shall furnish a copy of 
the deposition or the part being filed to other parties unless the party already has a 
copy. 
 
 
 
 
(B) 
If the court determines that a deposition previously taken 
is necessary for the decision of a matter pending before the court, the court may 
order that a copy be filed by any party at the initial cost of the party, and the filing 
party shall comply with rules 2.425 and 1.280(f).  
 
 
(g) - (h) [No change] 
 
 
Committee Notes 
 
1972 Amendment - 2010 Amendment.  [No change] 
 
2011 Amendment. A reference to Florida Rule of Judicial Administration 
2.425 and rule 1.280(f) is added to require persons filing discovery materials with 
the court to make sure that good cause exists prior to filing discovery materials and 
that certain specific personal information is redacted. 
 
Court Commentary 
[No change] 
 
 
 
RULE 1.340. 
INTERROGATORIES TO PARTIES 
 
 
(a) - (d) [No change] 
 
 
 
(e) 
Service and Filing. Interrogatories shall be arranged so that a blank 
space is provided after each separately numbered interrogatory. The space shall be 
reasonably sufficient to enable the answering party to insert the answer within the 
space. If sufficient space is not provided, the answering party may attach additional 
papers with answers and refer to them in the space provided in the interrogatories. 
26 
 
The interrogatories shall be served on the party to whom the interrogatories are 
directed and copies shall be served on all other parties. A certificate of service of 
the interrogatories shall be filed, giving the date of service and the name of the 
party to whom they were directed. The answers to the interrogatories shall be 
served upon the party originally propounding the interrogatories and a copy shall 
be served on all other parties by the answering party. The original or any copy of 
the answers to interrogatories may be filed in compliance with Florida Rule of 
Judicial Administration 2.425 and rule 1.280(f) by any party when the court should 
consider the answers to interrogatories in determining any matter pending before 
the court. The court may order a copy of the answers to interrogatories filed at any 
time when the court determines that examination of the answers to interrogatories 
is necessary to determine any matter pending before the court. 
 
Committee Notes 
 
 
1992 Amendment – 1988 Amendment.  [No change] 
 
2011 Amendment. A reference to Florida Rule of Judicial Administration 
2.425 and rule 1.280(f) is added to require persons filing discovery materials with 
the court to make sure that good cause exists prior to filing discovery materials and 
that certain specific personal information is redacted. 
 
Court Commentary 
[No change] 
 
 
RULE 1.350. 
PRODUCTION OF DOCUMENTS AND THINGS AND 
ENTRY UPON LAND FOR INSPECTION AND OTHER 
PURPOSES 
 
 
(a) - (c) [No change] 
 
 
 
(d) 
Filing of Documents. Unless required by the court, a party shall not 
file any of the documents or things produced with the response. Documents or 
things may be filed in compliance with Florida Rule of Judicial Administration 
2.425 and rule 1.280(f) when they should be considered by the court in 
determining a matter pending before the court. 
 
Committee Notes 
 
27 
 
 
1972 Amendment – 1980 Amendment.  [No change] 
 
 
2011 Amendment. A reference to Florida Rule of Judicial Administration 
2.425 and rule 1.280(f) is added to require persons filing discovery materials with 
the court to make sure that good cause exists prior to filing discovery materials and 
that certain specific personal information is redacted. 
 
 
 
28 
 
FORM 1.988.  JUDGMENT AFTER DEFAULT 
 
 
(a) 
General Form. This form is the general form for a judgment after default, not 
including recovery for prejudgment interest and attorneys’ fees: 
 
FINAL JUDGMENT 
 
 
This action was heard after entry of default against defendant and 
 
 
IT IS ADJUDGED that plaintiff, .....(name and address)....., recover from defendant, 
.....(name and address, and last 4 digits of social security number if known)....., the sum of 
$.......... with costs in the sum of $.........., that shall bear interest at the rate of .....% a year, for 
which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
 
Judge 
 
 
(b) 
Form with Interest and Fees. This form is for judgment after default including 
prejudgment interest and attorneys’ fees recovered: 
 
FINAL JUDGMENT 
 
 
This action was heard after entry of default against defendant and 
 
 
IT IS ADJUDGED that plaintiff, .....(name and address)....., recover from defendant, 
.....(name and address, and last 4 digits of social security number if known)....., the sum of 
$.......... on principal, $.......... for attorneys’ fees with costs in the sum of $.........., and 
prejudgment interest in the sum of $.........., making a total of $.......... that shall bear interest at 
the rate of .....% a year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: The address of the person who claims a lien as a result of the judgment must be 
included in the judgment in order for the judgment to become a lien on real estate when a 
certified copy of the judgment is recorded. Alternatively, an affidavit with this information may 
be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; 
Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social 
security number (if known) of each person against whom the judgment is rendered must be 
included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy 
reasons, only the last 4 digits of the social security number should be shown. 
 
29 
 
Committee Notes 
 
 
1980 Adoption. This form is new. 
 
 
2003 Amendment. Subdivision (b) is amended to include prejudgment interest in the 
total judgment pursuant to Quality Engineered Installation, Inc. v. Higley South, Inc., 670 So. 2d 
929 (Fla. 1996). 
30 
 
FORM 1.990. FINAL JUDGMENT FOR PLAINTIFF.  JURY ACTION FOR DAMAGES 
 
FINAL JUDGMENT 
 
 
Pursuant to the verdict rendered in this action 
 
 
IT IS ADJUDGED that plaintiff, .....(name and address)....., recover from defendant, 
.....(name and address, and last 4 digits of social security number if known)....., the sum of 
$.......... with costs in the sum of $.........., making a total of $.........., that shall bear interest at the 
rate of .....% a year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: The address of the person who claims a lien as a result of the judgment must be 
included in the judgment in order for the judgment to become a lien on real estate when a 
certified copy of the judgment is recorded. Alternatively, an affidavit with this information may 
be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; 
Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social 
security number (if known) of each person against whom the judgment is rendered must be 
included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy 
reasons, only the last 4 digits of the social security number should be shown. 
 
31 
 
FORM 1.991. FINAL JUDGMENT FOR DEFENDANT. JURY ACTION FOR                                              
DAMAGES 
 
FINAL JUDGMENT 
 
 
Pursuant to the verdict rendered in this action 
 
 
IT IS ADJUDGED that plaintiff, .....(name and address, and last 4 digits of social security 
number if known)....., take nothing by this action and that defendant, .....(name and address)....., 
shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear 
interest at the rate of .....% a year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: The address of the person who claims a lien as a result of the judgment must be 
included in the judgment in order for the judgment to become a lien on real estate when a 
certified copy of the judgment is recorded. Alternatively, an affidavit with this information may 
be simultaneously recorded. For the specific requirements, see section 55.10(1), Florida Statutes; 
Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social 
security number (if known) of each person against whom the judgment is rendered must be 
included in the judgment, pursuant to section 55.01(2), Florida Statutes. However, for privacy 
reasons, only the last 4 digits of the social security number should be shown. 
 
32 
 
FORM 1.993. FINAL JUDGMENT FOR PLAINTIFF. GENERAL FORM.  NON-JURY 
 
FINAL JUDGMENT 
 
 
This action was tried before the court. On the evidence presented 
 
 
IT IS ADJUDGED that: 
 
 
1. 
(list adjudications in numbered paragraphs) 
 
 
2. 
.................................................. 
 
(See note below on name, address, and 
social security number requirements.) 
 
 
ORDERED at ....................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: Findings of fact can be inserted after ―presented‖ if desired. The address of the 
person who claims a lien as a result of the judgment must be included in the judgment in order 
for the judgment to become a lien on real estate when a certified copy of the judgment is 
recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For 
the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 
721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of 
each person against whom the judgment is rendered must be included in the judgment, pursuant 
to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the 
social security number should be shown. 
 
33 
 
FORM 1.994. FINAL JUDGMENT FOR DEFENDANT. GENERAL FORM.  NON-JURY 
 
FINAL JUDGMENT 
 
 
This action was tried before the court. On the evidence presented 
 
 
IT IS ADJUDGED that plaintiff, .....(name and address, and last 4 digits of social security 
number if known)....., take nothing by this action and that defendant, .....(name and address)....., 
shall go hence without day and recover costs from plaintiff in the sum of $.......... that shall bear 
interest at the rate of .....% a year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: Findings of fact can be inserted after ―presented‖ if desired. The address of the 
person who claims a lien as a result of the judgment must be included in the judgment in order 
for the judgment to become a lien on real estate when a certified copy of the judgment is 
recorded. Alternatively, an affidavit with this information may be simultaneously recorded. For 
the specific requirements, see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 
721 So. 2d 1236 (Fla. 4th DCA 1998). The address and social security number (if known) of 
each person against whom the judgment is rendered must be included in the judgment, pursuant 
to section 55.01(2), Florida sStatutes. However, for privacy reasons, only the last 4 digits of the 
social security number should be shown. 
 
34 
 
FORM 1.995. FINAL JUDGMENT OF REPLEVIN 
 
 
NOTE APPLICABLE TO FORMS (a)–(d): The address of the person who claims a 
lien as a result of the judgment must be included in the judgment in order for the judgment to 
become a lien on real estate when a certified copy of the judgment is recorded. Alternatively, an 
affidavit with this information may be simultaneously recorded. For the specific requirements, 
see section 55.10(1), Florida Statutes; Hott Interiors, Inc. v. Fostock, 721 So. 2d 1236 (Fla. 4th 
DCA 1998). The address and social security number (if known) of each person against whom the 
judgment is rendered must be included in the judgment, pursuant to section 55.01(2), Florida 
Statutes. However, for privacy reasons, only the last 4 digits of the social security number should 
be shown. 
 
 
(a) 
Judgment in Favor of Plaintiff when Plaintiff Has Possession. 
 
FINAL JUDGMENT OF REPLEVIN 
 
 
This matter was heard on plaintiff’s complaint. On the evidence presented 
 
 
IT IS ADJUDGED that: 
 
 
1. 
Plaintiff, .....(name and address)....., has the right against defendant, .....(name and 
address, and last 4 digits of social security if known)....., to retain possession of the following 
described property: 
 
(list the property and include a value for each item) 
 
 
2. 
Plaintiff shall recover from defendant the sum of $.......... as damages for the 
detention of the property and the sum of $.......... as costs, making a total of $.........., which shall 
bear interest at the rate of .....% per year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: This form applies when the plaintiff has recovered possession under a writ of 
replevin and prevailed on the merits. Pursuant to section 78.18, Florida Statutes (1995), 
paragraph 2 of the form provides that the plaintiff can also recover damages for the wrongful 
taking and detention of the property, together with costs. Generally these damages are awarded 
in the form of interest unless loss of use can be proven. Ocala Foundry & Machine Works v. 
Lester, 49 Fla. 199, 38 So. 51 (1905). 
 
 
If the defendant has possession of part of the property, see form 1.995(b). 
 
 
(b) 
Judgment in Favor of Plaintiff when Defendant Has Possession. 
 
35 
 
FINAL JUDGMENT OF REPLEVIN 
 
 
This matter was heard on plaintiff’s complaint. On the evidence presented 
 
 
IT IS ADJUDGED that: 
 
 
1. 
Plaintiff, .....(name and address)....., has the right against defendant, .....(name and 
address, and last 4 digits of social security number if known)....., to possession of the following 
described property: 
 
(list the property and include a value for each item) 
 
for which the clerk of the court shall issue a writ of possession; or 
 
 
2. 
Plaintiff shall recover from defendant [if applicable add ―and surety on the 
forthcoming bond‖] the sum of $.......... for the value of the property, which shall bear interest at 
the rate of .....% per year, for which let execution issue. 
 
 
3. 
Plaintiff shall recover from defendant the sum of $.......... as damages for the 
detention of the property and the sum of $.......... as costs, making a total of $.........., which shall 
bear interest at the rate of .....% per year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: This form applies when the plaintiff prevails on the merits and the defendant 
retains possession of the property. Section 78.19, Florida Statutes (1995), allows the plaintiff to 
recover the property or its value or the value of the plaintiff’s lien or special interest. The value 
for purposes of paragraph 2 is either the value of the property or the value of the plaintiff’s lien 
or special interest. 
 
 
Paragraph 3 of the form provides for damages for detention only against the defendant 
because the defendant’s surety obligates itself only to ensure forthcoming of the property, not 
damages for its detention. 
 
 
Pursuant to section 78.19(2), Florida Statutes, paragraphs 1 and 2 of the form provide the 
plaintiff the option of obtaining either a writ of possession or execution against the defendant and 
defendant’s surety on a money judgment for property not recovered. Demetree v. Stramondo, 
621 So. 2d 740 (Fla. 5th DCA 1993). If the plaintiff elects the writ of possession for the property 
and the sheriff is unable to find it or part of it, the plaintiff may immediately have execution 
against the defendant for the whole amount recovered or the amount less the value of the 
property found by the sheriff. If the plaintiff elects execution for the whole amount, the officer 
shall release all property taken under the writ. 
 
36 
 
 
If the plaintiff has possession of part of the property, see form 1.995(a). 
 
 
(c) 
Judgment in Favor of Defendant when Defendant Has Possession under 
Forthcoming Bond. 
 
FINAL JUDGMENT OF REPLEVIN 
 
 
This matter was heard on plaintiff’s complaint. On the evidence presented 
 
 
IT IS ADJUDGED that: 
 
 
1. 
Defendant, .....(name and address)....., has the right against plaintiff, .....(name and 
address, and last 4 digits of social security number if known)....., to possession of the following 
described property: 
 
(list the property and include a value for each item) 
 
 
2. 
Defendant retook possession of all or part of the property under a forthcoming 
bond, and defendant’s attorney has reasonably expended ..... hours in representing defendant in 
this action and $.......... is a reasonable hourly rate for the services. 
 
 
3. 
Defendant shall recover from plaintiff the sum of $.......... for the wrongful taking 
of the property, costs in the sum of $.........., and attorneys’ fees in the sum of $.........., making a 
total of $.........., which shall bear interest at the rate of .....% per year, for which let execution 
issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: This form applies when the defendant prevails and the property was retained by 
or redelivered to the defendant. Section 78.20, Florida Statutes (1995), provides for an award of 
attorneys’ fees. The prevailing defendant may be awarded possession, damages, if any, for the 
taking of the property, costs, and attorneys’ fees. 
 
 
If the plaintiff has possession of part of the property, see form 1.995(d). 
 
 
(d) 
Judgment in Favor of Defendant when Plaintiff Has Possession. 
 
FINAL JUDGMENT OF REPLEVIN 
 
 
This matter was heard on plaintiff’s complaint. On the evidence presented 
 
 
IT IS ADJUDGED that: 
 
37 
 
 
1. 
Defendant, .....(name and address)....., has the right against plaintiff, .....(name and 
address, and last four digits of social security number if known)....., to recover possession of the 
following described property: 
 
(list the property and include a value for each item) 
 
for which the clerk of the court shall issue a writ of possession; or 
 
 
2. 
Defendant shall recover from plaintiff [if applicable add ―and surety on plaintiff’s 
bond‖] the sum of $.......... for the value of the property, which shall bear interest at the rate of 
.....% per year, for which let execution issue. 
 
 
3. 
Defendant shall recover from plaintiff the sum of $.......... as damages for 
detention of the property and the sum of $.......... as costs, making a total of $.........., which shall 
bear interest at the rate of .....% per year, for which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
 
 
 
 
 
 
Judge 
 
 
NOTE: This form should be used when the defendant prevails but the plaintiff has 
possession of the property. Section 78.21, Florida Statutes (1995), does not provide for an award 
of attorneys’ fees when the defendant prevails and possession had been temporarily retaken by 
the plaintiff. Sections 78.21 and 78.19 allow the defendant to recover the property or its value or 
the value of the defendant’s special interest. 
 
 
Paragraphs 1 and 2 of the form provide to the defendant the option of obtaining either a 
writ of possession or execution against the plaintiff and plaintiff’s surety on a money judgment 
for property not recovered and costs. Demetree v. Stramondo, 621 So. 2d 740 (Fla. 5th DCA 
1993). If the defendant elects the writ of possession for the property and the sheriff is unable to 
find it or part of it, the defendant may immediately have execution against the plaintiff and 
surety for the whole amount recovered or the amount less the value of the property found by the 
sheriff. If the defendant elects execution for the whole amount, the officer shall release all 
property taken under the writ. 
 
 
If the defendant has possession of part of the property, see form 1.995(c). 
38 
 
FLORIDA RULES OF JUDICIAL ADMINISTRATION 
 
RULE 2.425 
MINIMIZATION OF THE FILING OF SENSITIVE 
INFORMATION       
 
 
(a)   Limitations for Court Filings.  Unless authorized by subdivision (b), 
statute, another rule of court, or the court orders otherwise, designated sensitive 
information filed with the court must be limited to the following format: 
 
 
 
(1) 
The initials of a person known to be a minor; 
 
 
 
(2) 
The year of birth of a person’s birth date; 
 
 
 
(3) 
No portion of any 
 
 
 
 
(A) 
social security number, 
 
 
 
 
(B)  bank account number, 
 
 
 
 
(C)  credit card account number, 
 
 
 
 
(D) 
charge account number, or 
 
 
 
 
(E) 
debit account number;  
 
 
 
(4) 
The last four digits of any 
 
(A) 
taxpayer identification number (TIN), 
 
(B) 
employee identification number, 
 
(C) 
driver’s license number, 
 
(D) 
passport number, 
 
(E) 
telephone number, 
 
 
 
 
(F) 
financial account number, except as set forth in 
subdivision (a)(3), 
 
39 
 
(G) 
brokerage account number, 
 
(H) 
insurance policy account number, 
  
(I) 
loan account number,  
 
(J) 
customer account number, or 
 
(K) 
patient or health care number;  
 
(5) 
A truncated version of any 
 
(A) 
email address, 
 
(B) 
computer user name, 
 
(C) 
password, or  
 
(D) 
personal identification number (PIN); and 
 
 
 
(6) 
A truncated version of any other sensitive information as 
provided by court order. 
 
(b) 
Exceptions.  Subdivision (a) does not apply to the following: 
 
 
 
(1) 
An account number which identifies the property alleged to be 
the subject of a proceeding; 
 
(2) 
The record of an administrative or agency proceeding; 
 
(3) 
The record in appellate or review proceedings; 
 
 
 
(4) 
The birth date of a minor whenever the birth date is necessary 
for the court to establish or maintain subject matter jurisdiction; 
 
 
 
(5) 
The name of a minor in any order relating to parental 
responsibility, time-sharing, or child support; 
 
 
 
(6) 
The name of a minor in any document or order affecting the 
minor's ownership of real property; 
40 
 
 
(7)  
The birth date of a party in a writ of attachment or notice to 
payor; 
 
(8) 
Traffic and criminal proceedings; 
 
 
 
(9) 
Information used by the clerk for case maintenance purposes or 
the courts for case management purposes; and  
 
 
 
(10) Information which is relevant and material to an issue before 
the court. 
 
(c) 
Remedies. Upon motion by a party or interested person or sua 
sponte by the court, the court may order remedies, sanctions or both for a violation 
of subdivision (a). Following notice and an opportunity to respond, the court may 
impose sanctions if such filing was not made in good faith. 
 
(d) 
Motions Not Restricted.  This rule does not restrict a party’s right to 
move for protective order, to move to file documents under seal, or to request a 
determination of the confidentiality of records. 
 
(e) 
Application.  This rule does not affect the application of 
constitutional provisions, statutes, or rules of court regarding confidential 
information or access to public information. 
 
 
FLORIDA RULES OF CRIMINAL PROCEDURE 
 
RULE 3.140. 
INDICTMENTS; INFORMATIONS 
 
 
(a) - (b) [No change] 
 
 
 
(c) 
Caption, Commencement, Date, and Personal Statistics. 
 
 
 
(1)- (3) [No change] 
 
 
 
 
(4) 
Personal Statistics. Every indictment or information shall 
include the defendant’s race, gender, and date of birth, and social security number 
when any of these facts are known. Failure to include these facts shall not 
invalidate an otherwise sufficient indictment or information. 
41 
 
 
 
(d) - (o) [No change] 
 
 
 
Committee Notes 
[No change] 
 
 
 
RULE 3.211. 
COMPETENCE TO PROCEED: SCOPE OF 
EXAMINATION AND REPORT 
 
 
(a) - (b) [No change] 
 
 
 
(c) 
Written Findings of Experts. Any written report submitted by the 
experts shall: 
 
 
 
(1) 
identify the specific matters referred for evaluation; 
 
 
 
(2) 
describe the evaluative procedures, techniques, and tests used in 
the examination and the purpose or purposes for each; 
 
 
 
(3) 
state the expert’s clinical observations, findings, and opinions 
on each issue referred for evaluation by the court, and indicate specifically those 
issues, if any, on which the expert could not give an opinion; and 
 
 
 
(4) 
identify the sources of information used by the expert and 
present the factual basis for the expert’s clinical findings and opinions. 
 
The procedure for determinations of the confidential status of reports is governed 
by Rule of Judicial Administration 2.420. 
 
 
(d) 
[No change] 
 
Committee Notes 
[No change] 
 
 
 
RULE 3.212. 
COMPETENCE TO PROCEED: HEARING AND  
 
 
 
 
DISPOSITION 
 
42 
 
 
(a) - (c) [No change] 
 
 
 
(d) 
Release on Finding of Incompetence. If the court decides that a 
defendant is not mentally competent to proceed but does not meet the criteria for 
commitment, the defendant may be released on appropriate release conditions for a 
period not to exceed 1 year. The court may order that the defendant receive 
outpatient treatment at an appropriate local facility and that the defendant report 
for further evaluation at specified times during the release period as conditions of 
release. A report shall be filed with the court after each evaluation by the persons 
appointed by the court to make such evaluations, with copies to all parties.  The 
procedure for determinations of the confidential status of reports is governed by 
Rule of Judicial Administration 2.420. 
 
 
Committee Notes 
[No change] 
 
 
 
RULE 3.218. 
COMMITMENT OF A DEFENDANT FOUND NOT 
GUILTY BY REASON OF INSANITY 
 
 
(a) 
Commitment; 6-Month Report. The Department of Children and 
Family Services shall admit to an appropriate facility a defendant found not guilty 
by reason of insanity under rule 3.217 and found to meet the criteria for 
commitment for hospitalization and treatment and may retain and treat the 
defendant. No later than 6 months from the date of admission, the administrator of 
the facility shall file with the court a report, and provide copies to all parties, which 
shall address the issues of further commitment of the defendant. If at any time 
during the 6-month period, or during any period of extended hospitalization that 
may be ordered under this rule, the administrator of the facility shall determine that 
the defendant no longer meets the criteria for commitment, the administrator shall 
notify the court by such a report and provide copies to all parties. The procedure 
for determinations of the confidential status of reports is governed by Rule of 
Judicial Administration 2.420. 
 
 
 
(b) - (c) [No change] 
 
Committee Notes 
[No change] 
 
43 
 
 
 
RULE 3.219. 
CONDITIONAL RELEASE 
 
 
(a) 
Release Plan. The committing court may order a conditional release of 
any defendant who has been committed according to a finding of incompetency to 
proceed or an adjudication of not guilty by reason of insanity based on an approved 
plan for providing appropriate outpatient care and treatment. When the administrator 
shall determine outpatient treatment of the defendant to be appropriate, the 
administrator may file with the court, and provide copies to all parties, a written 
plan for outpatient treatment, including recommendations from qualified profes-
sionals. The plan may be submitted by the defendant. The plan shall include: 
 
 
 
(1) 
special provisions for residential care, adequate supervision of 
the defendant, or both; 
 
 
 
(2) 
provisions for outpatient mental health services; and 
 
 
 
(3) 
if appropriate, recommendations for auxiliary services such as 
vocational training, educational services, or special medical care. 
 
In its order of conditional release, the court shall specify the conditions of release 
based on the release plan and shall direct the appropriate agencies or persons to 
submit periodic reports to the court regarding the defendant’s compliance with the 
conditions of the release, and progress in treatment, and provide copies to all 
parties. The procedure for determinations of the confidential status of reports is 
governed by Rule of Judicial Administration 2.420. 
 
 
 
(b) - (c) [No change] 
 
 
Committee Notes 
[No change] 
 
 
PROBATE RULES  
 
RULE 5.200.  
PETITION FOR ADMINISTRATION 
 
The petition for administration shall be verified by the petitioner and shall 
contain: 
44 
 
 
(a) 
 [No change] 
 
(b) 
 the name, and last known address of the decedent, last 4 digits of the 
decedent’s social security number, date and place of death of the decedent, and 
state and county of the decedent’s domicile; 
 
(c) - (j) [No change] 
 
Committee Notes 
 
Rule History 
 
1977 Revision - 2010 Revision: [No change] 
 
2011 Revision: Subdivision (b) amended to limit listing of decedent’s social 
security number to last four digits. 
 
Statutory References 
  [No change] 
 
Rule References 
  [No change] 
 
 
RULE 5.210.  
PROBATE OF WILLS WITHOUT ADMINISTRATION 
 
(a)  Petition and Contents.  A petition to admit a decedent’s will to probate 
without administration shall be verified by the petitioner and shall contain: 
 
(1) 
[No change] 
 
(2) 
the name, and last known address of the decedent, last 4 digits of the 
decedent’s social security number, date and place of death of the decedent, and 
state and county of the decedent’s domicile; 
 
(3) - (8) [No change] 
 
 
(b) - (d) [No change]    
 
45 
 
Committee Notes 
[No change] 
 
 
Rule History 
 
1975 Revision - 2010 Revision: [No change] 
 
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent’s social 
security number to last four digits. 
 
Statutory References 
  [No change] 
 
Rule References 
  [No change] 
 
RULE 5.530. 
SUMMARY ADMINISTRATION 
 
(a) 
 Petition. The petition shall be verified as required by law and shall contain: 
 
(1) [No change] 
 
(2)  the name, and last known address of the decedent, last 4 digits of the 
decedent’s social security number, and date and place of death of the decedent, and 
the state and county of the decedent’s domicile; 
 
(3) - (12) [No change]  
 
(b) - (d) [No change] 
 
 
Committee Notes 
[No change] 
 
Rule History 
 
   1977 Revision - 2007 Revision: [No change] 
 
2011 Revision: Subdivision (a)(2) amended to limit listing of decedent’s social 
security number to last four digits. 
46 
 
 
Statutory References 
[No change] 
 
Rule References 
[No change] 
 
 
FLORIDA SMALL CLAIMS RULES 
 
RULE 7.140. 
TRIAL 
 
 
(a) - (d) [No change] 
 
 
 
(e) 
Unrepresented Parties. In an effort to further the proceedings and in 
the interest of securing substantial justice, the court shall assist any party not 
represented by an attorney on: 
 
 
 
(1) 
courtroom decorum; and 
 
 
 
(2) 
order of presentation of material evidence; and 
 
 
 
(3) 
handling private information. 
 
The court may not instruct any party not represented by an attorney on accepted 
rules of law. The court shall not act as an advocate for a party. 
 
 
(f)  [No change] 
 
Committee Notes 
 
 
1984 Amendment - 1996 Amendment.  [No change] 
 
 
2011 Amendment. Subdivision (e)(3) was added so that a judge can assist 
an unrepresented party in the handling of private information that might otherwise 
inadvertently become public by placement in the court file. 
47 
 
FORM 7.340. FINAL JUDGMENT 
 
(CAPTION) 
 
FINAL JUDGMENT 
AGAINST (DEFENDANT(S)’S NAME) 
 
 
It is adjudged that the plaintiff(s), ...................., recover from the defendant(s), 
...................., the  sum of $.......... on principal, $.......... as prejudgment interest, $.......... for 
attorneys’ fees, with costs of $.........., all of which shall bear interest at the rate of .....% per year 
as provided for by Florida Statute, for all of which let execution issue. 
 
 
ORDERED at ...................., Florida, on .....(date)...... 
 
_________________________ 
County Court Judge 
 
Copies furnished to: 
PLAINTIFF(S) 
DEFENDANT(S) 
 
Plaintiff(s)’s address: 
.................... 
.................... 
Defendant(s)’s last known address and 
last four digits of defendant(s)’s Social Security Number (if known): 
.................... 
.................... 
.................... 
 
(OPTIONAL ENFORCEMENT PARAGRAPH — 
TO BE INCLUDED UPON REQUEST 
PURSUANT TO RULE 7.221) 
 
 
It is further ordered and adjudged that the defendant(s) shall complete Florida Small 
Claims Rules Form 7.343 (Fact Information Sheet) and return it to the plaintiff’s attorney, or to 
the plaintiff if the plaintiff is not represented by an attorney, within 45 days from the date of this 
final judgment, unless the final judgment is satisfied or a motion for new trial or notice of appeal 
is filed. The defendant should NOT file the completed form 7.343 with the court. 
 
 
Jurisdiction of this case is retained to enter further orders that are proper to compel the 
defendant(s) to complete form 7.343 and return it to the plaintiff’s attorney, or the plaintiff if the 
plaintiff is not represented by an attorney. 
 
Committee Notes 
 
48 
 
 
1992 Amendment. The optional enforcement paragraph was added to facilitate 
discovery. 
49 
 
FORM 7.343. FACT INFORMATION SHEET 
 
 
(a) 
For Individuals 
 
(CAPTION) 
 
FACT INFORMATION SHEET — INDIVIDUAL 
 
Full Legal Name:  
 
 
 
 
 
 
 
 
 
 
 
Nicknames or Aliases:  
 
 
 
 
 
 
 
 
 
 
Residence Address:   
 
 
 
 
 
 
 
 
 
 
Mailing Address (if different):  
 
 
 
 
 
 
 
 
 
Telephone Numbers: (Home)  
 
 (Business)  
 
 
 
 
 
 
Name of Employer:   
 
 
 
 
 
 
 
 
 
 
Address of Employer:  
 
 
 
 
 
 
 
 
 
 
Position or Job Description:   
 
 
 
 
 
 
 
 
 
Rate of Pay: $  
 per  
 
. Average Paycheck: $ 
 per  
 
 
 
 
Average Commissions or Bonuses: $  
 per  
 
. Commissions or bonuses are based 
on  
 
 
 
Other Personal Income: $ 
 
 from   
 
 
 
 
 
 
 
(Explain details on the back of this sheet or an additional sheet if necessary.) 
Social Security Number:  
 
 
 
 Birthdate:  
 
 
 
 
 
Driver’s License Number:  
 
 
 
 
 
 
 
 
 
 
Marital Status:  
 
 Spouse’s Name:  
 
 
 
 
 
 
 
Spouse’s Address (if different):  
 
 
 
 
 
 
 
 
 
Spouse’s Social Security Number:   
 
 
 Birthdate:  
 
 
 
 
Spouse’s Employer:   
 
 
 
 
 
 
 
 
 
 
Spouse’s Average Paycheck or Income: $ 
 
 per  
 
 
 
 
 
 
Other Family Income: $ 
 per  
 
 (Explain details on back of this sheet or an 
additional sheet if necessary.) 
Names and Ages of All Your Children (and addresses if not living with you):  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Child Support or Alimony Paid: $ 
 
 per  
 
 
 
 
 
 
 
Names of Others You Live With:  
 
 
 
 
 
 
 
 
 
Who is Head of Your Household?  
 
You   
 Spouse  
Other Person 
Checking Account at:  
 
 
 
 Account # 
 
 
 
 
 
 
Savings Account at:   
 
 
 Account # 
 
 
 
 
 
 
(Describe all other accounts or investments you may have, including stocks, mutual funds, 
savings bonds, or annuities, on the back of this sheet or an additional sheet if necessary.) 
 
For Real Estate (land) You Own or Are Buying: 
Address:  
 
 
 
 
 
 
 
 
 
 
 
 
All Names on Title:   
 
 
 
 
 
 
 
 
 
 
Mortgage Owed to:   
 
 
 
 
 
 
 
 
 
 
Balance Owed:  
 
 
 
 
 
 
 
 
 
 
 
Monthly Payment: $  
 
 
 
 
 
 
 
 
 
 
50 
 
(Attach a copy of the deed or mortgage, or list the legal description of the property on the back of 
this sheet or an additional sheet if necessary. Also provide the same information on any other 
property you own or are buying.) 
 
For All Motor Vehicles You Own or Are Buying: 
Year/Make/Model:  
 
 
 
 
 
 Color:  
 
 
 
 
Vehicle ID #:   
 
 Tag No:  
 
 
 Mileage:  
 
 
 
 
Names on Title:  
 
 
 
 
 Present Value: $ 
 
 
 
 
Loan Owed to:  
 
 
 
 
 
 
 
 
 
 
 
Balance on Loan: $ 
 
 
 
 
 
 
 
 
 
 
 
Monthly Payment: $  
 
 
 (List all other automobiles, as well as other 
vehicles, such as boats, motorcycles, bicycles, or aircraft, on the back of this sheet or an 
additional sheet if necessary.) 
Have you given, sold, loaned, or transferred any real or personal property worth more than $100 
to any person in the last year? If your answer is ―yes,‖ describe the property and sale price, and 
give the name and address of the person who received the property. 
 
Does anyone owe you money? Amount Owed: $ 
 
 
 
 
 
 
 
Name and Address of Person Owing Money:  
 
 
 
 
 
 
 
Reason money is owed:  
 
 
 
 
 
 
 
 
 
 
 
Please attach copies of the following: 
 
1. 
Your last pay stub. 
 
2. 
Your last 3 statements for each bank, savings, credit union, or other financial 
account. 
 
3. 
Your motor vehicle registrations and titles. 
 
4. 
Any deeds or titles to any real or personal property you own or are buying, or 
leases to property you are renting. 
 
UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING 
ANSWERS ARE TRUE AND COMPLETE. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Judgment Debtor 
 
STATE OF FLORIDA 
COUNTY OF .................... 
 
 
The foregoing instrument was acknowledged before me on .....(date)....., by ...................., 
who is personally known to me or has produced .................... as identification and who 
.....did/did not..... take an oath. 
 
 
WITNESS my hand and official seal, on .....(date)...... 
 
 
 
 
 
Notary Public 
 
State of Florida 
51 
 
 
My Commission expires: .................... 
 
MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE 
JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT. 
 
 
(b) 
For Corporate Entities 
 
(CAPTION) 
 
FACT INFORMATION SHEET — BUSINESS ENTITY 
 
Name/Title of person filling out this form:   
 
 
 
 
 
 
 
Address:  
 
 
 
 
 
 
 
 
 
 
 
 
Telephone Number: Home:   
 
 
 Business:  
 
 
 
 
 
Address of Business Entity:   
 
 
 
 
 
 
 
 
 
Type of Entity: (Check One)  Corporation   Partnership   Limited Partnership  Sole 
Proprietorship  Limited Liability Corporation (LLC)   Professional Association (PA)   
Other: (Please Explain) 
Does Business Entity own/have interest in any other business entity? If so please explain. 
Gross/Taxable income reported for Federal Income Tax purposes last three years: 
$ 
 
 
 
$ 
 
 
 
 
$ 
 
 
 
 
Taxpayer Identification Number:  
 
 
 
 
 
 
 
 
 
List Partners (General or Limited and Designate Percentage of Ownership):  
 
 
 
Average No. of Employees/Month:   
 
 
 
 
 
 
 
 
Names of Officers and Directors:  
 
 
 
 
 
 
 
 
 
Checking Account at:  
 
 
 
  Account No:   
 
 
 
 
 
Savings Account At:   
 
 
 Account No:   
 
 
 
 
 
Does the Business Entity own any vehicles:   
 
 
 
 
 
 
 
Years/Makes/Models:  
 
 
 
 
 
 
 
 
 
 
Vehicle I.D. Nos.:  
 
 
 
 
 
 
 
 
 
 
 
Tag Nos.:  
 
 
 
 
 
 
 
 
 
 
 
 
Loans Outstanding:   
 
 
 
 
 
 
 
 
 
 
Does the Business Entity own any real property: YES  
 
  NO 
 
 
If Yes: Address:  
 
 
 
 
 
 
 
 
 
 
 
Please check if the business entity owns the following: 
 
 
 
 Boat  
 
 
 
 
 Camper 
 
 
 Stocks/Bonds  
 
 
 
 Other Real Property 
 
 
 Other Personal Property 
 
 
 Intangible Property 
 
Please attach copies of the following: 
 
1. 
All tax returns for the past 3 years, including but not limited to state and federal income 
tax returns and tangible personal property tax returns.  
 
52 
 
2. 
All bank, savings and loan, and other account books or statements for accounts in 
institutions in which the defendant had any legal or equitable interest for the past 3 years. 
 
3. 
All canceled checks for the 12 months immediately preceding the date of this judgment 
for accounts in which the defendant held any legal or equitable interest. 
 
4. 
All deeds, leases, mortgages, or other written instruments evidencing any interest in or 
ownership of real property at any time within the 12 months immediately preceding the date of 
this judgment. 
 
5. 
Bills of sale or other written evidence of the gift, sale, purchase, or other transfer of any 
personal or real property to or from the defendant within the 12 months immediately preceding 
the date of filing this lawsuit. Any transfer of property within the last year other than ordinary 
course of business transactions. 
 
6. 
Motor vehicle documents, including titles and registrations relating to any motor vehicles 
owned by the defendant alone or with others. 
 
7. 
Financial statements and any other business records, including but not limited to accounts 
payable and accounts receivable ledgers, as to the defendant’s assets and liabilities prepared 
within the 12 months immediately preceding the date of this judgment. 
 
8. 
Copies of articles, by-laws, partnership agreement, operating agreement, and any other 
governing documents, and minutes of all meetings of the defendant’s shareholders, board of 
directors, or members held within 2 years of the date of this judgment. 
 
9. 
Resolutions of the shareholders, board of directors, or members passed within 2 years of 
the date of this judgment. 
 
10. 
A list or schedule of all inventory and equipment. 
 
UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM THAT THE FOREGOING 
ANSWERS ARE TRUE AND COMPLETE. 
 
________________________________ 
Defendant’s Designated Representative 
Title: .................... 
 
STATE OF FLORIDA 
COUNTY OF .................... 
 
The foregoing instrument was acknowledged before me on .....(date)....., by ...................., 
as the defendant’s duly authorized representative, who is personally known to me or has 
produced .............................. as identification and who .....did/did not..... take an oath. 
 
 
53 
 
 
WITNESS my hand and official seal, on .....(date)...... 
 
 
 
 
 
 
Notary Public 
State of Florida 
 
My Commission expires: .................... 
 
MAIL OR DELIVER THE COMPLETED FORM TO THE JUDGMENT CREDITOR OR THE 
JUDGMENT CREDITOR’S ATTORNEY. DO NOT FILE THIS FORM WITH THE COURT. 
 
 
54 
 
FLORIDA RULES OF APPELLATE PROCEDURE 
 
RULE 9.050.  
MAINTAINING PRIVACY OF PERSONAL DATA 
 
(a) 
 Application. Unless otherwise required by another rule of court or 
permitted by leave of court, all briefs, petitions, replies, appendices, motions, 
notices, stipulations, and responses and any attachment thereto filed with the court 
shall comply with the requirements of Florida Rule of Judicial Administration 
2.425.  
 
(b) 
Limitation. This rule does not require redaction of personal data from 
the record. 
 
(c) 
Motions Not Restricted.  This rule does not restrict a party’s right to 
move to file documents under seal. 
 
 
FLORIDA FAMILY LAW RULES OF PROCEDURE 
 
RULE 12.105. 
SIMPLIFIED DISSOLUTION PROCEDURE 
 
 
(a)   Requirements for Use. The parties to the dissolution may file a 
petition for simplified dissolution if they certify under oath that 
 
 
(1)  there are no minor or dependent children of the parties and the 
wife is not now pregnantthe parties do not have any minor or dependent children 
together, the wife does not have any minor or dependent children who were born 
during the marriage, and the wife is not now pregnant; 
 
 
(2)  the parties have made a satisfactory division of their property and 
have agreed as to payment of their joint obligations; and 
 
 
(3)  the other facts set forth in Florida Family Law Rules of Procedure 
Form 12.901(a) (Petition for Simplified Dissolution of Marriage) are true. 
 
 
(b)  [No change] 
 
 
(c)  Financial Affidavit and Settlement Agreement. The parties must each 
file a financial affidavit (Florida Family Law Rules of Procedure Form 12.902(b) 
55 
 
or 12.902(c)), and a marital settlement agreement (Florida Family Law Rules of 
Procedure Form 12.902(f)(3)). 
 
 
(dc)  Final Judgment. Upon the entry of the judgment, the clerk shall 
furnish to each party a certified copy of the final judgment of dissolution, which 
shall be in substantially the form provided in Florida Family Law Rules of 
Procedure Form 12.990(a). 
 
 
(ed) Forms. The clerk or family law intake personnel shall provide forms 
for the parties whose circumstances meet the requirements of this rule and shall 
assist in the preparation of the petition for dissolution and other papers to be filed 
in the action. 
 
Commentary 
[No change] 
 
RULE 12.130. 
     DOCUMENTS SUPPORTING ACTION OR DEFENSE 
 
 
Attachment of documents supporting an action or defense shall be governed 
by Florida Rule of Civil Procedure 1.130.  
  
 
(a) 
Documents Attached.  If it is essential to state a cause of action, a 
copy of the bonds, notes, bills of exchange, contracts, accounts, or other documents 
or the relevant portions of the documents shall be incorporated in or attached to the 
pleadings.  
  
 
(b) 
Part for All Purposes.  Any exhibit attached to a pleading shall be 
considered part of the pleading. Statements in a pleading may be adopted by 
reference in a different part of the same pleading, in another pleading, or in any 
motion.  
  
 
(c) 
Protection of Account and Personal Identifying Numbers.  Any 
reference in any pleading or exhibit filed with the court to account numbers, social 
security numbers, employee identification numbers, driver’s license numbers, 
passport numbers, or other personal identifying information shall be presented as 
provided in Florida Rule of Judicial Administration 2.425.  
 
 
 
 
56 
 
RULE 12.280. 
GENERAL PROVISIONS GOVERNING DISCOVERY 
 
 
Florida Rule of Civil Procedure 1.280 shall govern general provisions 
concerning discovery in family law matters with the following exceptions: 
 
 
(a) 
Redaction of Personal Information. All filings of discovery 
information shall comply with Florida Rule of Judicial Administration 2.425. The 
court shall have authority to impose sanctions for violation of this rule. 
 
 
(ab) Supplementing of Responses.  A party is under a duty to amend a 
prior response or disclosure if the party: 
 
 
 
(1) - (2) [No change] 
 
 
(bc) Time for Serving Supplemental Responses.  Any supplemental 
response served pursuant to this rule shall be served as soon as possible after 
discovery of the incorrect information or change, but in no case shall the 
supplemental response be served later than 24 hours before any applicable hearing 
absent a showing of good cause. 
 
 
(cd) Documents Considered Confidential. A determination as to the 
confidentiality of a court record shall be made in accordance with Florida Rule of 
Judicial Administration 2.420. 
 
 
(de) Sealing of Records. Records found to be confidential under Florida 
Rule of Judicial Administration 2.420 shall be sealed on request of a party. 
 
Commentary 
[No change] 
 
 
 
RULE 12.285. 
MANDATORY DISCLOSURE 
 
(a) 
Application. 
 
 
(1) – (2) [No change] 
 
 
 
(3) 
Documents Not to be Filed with Court; Sanctions.  
  
57 
 
 
 
 
(A) 
Except for the financial affidavit and child support 
guidelines worksheet, no documents produced under this rule shall be filed in the 
court file without first obtaining a court order.  
  
 
 
 
(B) 
References to account numbers and personal identifying 
information to be filed in the court file shall be governed by Florida Rule of 
Judicial Administration 2.425. 
  
 
 
 
(C) 
Sanctions shall be governed by Florida Rule of Civil 
Procedure 1.280(f).  
 
 
(b)  [No change] 
 
 
(c) 
Exemption from Requirement to File and Serve Financial 
Affidavit.  The parties shall not be required to file and serve a financial affidavit 
under subdivisions (d) and (e) if they are seeking a simplified dissolution of 
marriage under rule 12.105, they have no minor children, have no support issues, 
and have filed a written settlement agreement disposing of all financial issues, or if 
the court lacks jurisdiction to determine any financial issues. 
 
 
(cd) Disclosure Requirements for Temporary Financial Relief. In any 
proceeding for temporary financial relief heard within 45 days of the service of the 
initial pleading or within any extension of the time for complying with mandatory 
disclosure granted by the court or agreed to by the parties, the following 
documents shall be served on the other party: 
 
                   (1) - (4) [No change] 
 
 
(de) Parties’ Disclosure Requirements for Initial or Supplemental 
Proceedings. A party shall serve the following documents in any proceeding for an 
initial or supplemental request for permanent financial relief, including, but not 
limited to, a request for child support, alimony, equitable distribution of assets or 
debts, or attorneys’ fees, suit money, or costs: 
 
                    (1) - (16) [No change] 
 
 
(ef) 
Duty to Supplement Disclosure; Amended Financial Affidavit. 
 
                    (1) - (2) [No change] 
 
58 
 
 
(fg) 
Sanctions. Any document to be produced under this rule that is served 
on the opposing party fewer than 24 hours before a nonfinal hearing or in violation 
of the court’s pretrial order shall not be admissible in evidence at that hearing 
unless the court finds good cause for the delay. In addition, the court may impose 
other sanctions authorized by rule 12.380 as may be equitable under the 
circumstances. The court may also impose sanctions upon the offending lawyer in 
lieu of imposing sanctions on a party. 
 
 
(gh) Extensions of Time for Complying with Mandatory Disclosure. By 
agreement of the parties, the time for complying with mandatory disclosure may be 
extended. Either party may also file, at least 5 days before the due date, a motion to 
enlarge the time for complying with mandatory disclosure. The court shall grant 
the request for good cause shown. 
 
 
(hi) 
Objections to Mandatory Automatic Disclosure. Objections to the 
mandatory automatic disclosure required by this rule shall be served in writing at 
least 5 days prior to the due date for the disclosure or the objections shall be 
deemed waived. The filing of a timely objection, with a notice of hearing on the 
objection, automatically stays mandatory disclosure for those matters within the 
scope of the objection. For good cause shown, the court may extend the time for 
the filing of an objection or permit the filing of an otherwise untimely objection. 
The court shall impose sanctions for the filing of meritless or frivolous objections. 
 
 
(ij) 
Certificate of Compliance. All parties subject to automatic 
mandatory disclosure shall file with the court a certificate of compliance, Florida 
Family Law Rules of Procedure Form 12.932, identifying with particularity the 
documents which have been delivered and certifying the date of service of the 
financial affidavit and documents by that party. The party shall swear or affirm 
under oath that the disclosure is complete, accurate, and in compliance with this 
rule, unless the party indicates otherwise, with specificity, in the certificate of 
compliance. Except for the financial affidavit and child support guidelines 
worksheet, no documents produced under this rule shall be filed in the court file 
without a court order. 
 
 
(jk) Child Support Guidelines Worksheet. If the case involves child 
support, the parties shall file with the court at or prior to a hearing to establish or 
modify child support a Child Support Guidelines Worksheet in substantial 
conformity with Florida Family Law Rules of Procedure Form 12.902(e). This 
requirement cannot be waived by the parties. 
 
59 
 
 
(kl) 
Place of Production. 
 
                     (1) - (2) [No change] 
 
 
(lm) Failure of Defaulted Party to Comply. Nothing in this rule shall be 
deemed to preclude the entry of a final judgment when a party in default has failed 
to comply with this rule. 
 
Commentary 
[No change] 
 
      
 
Committee Notes 
[No change] 
 
      
RULE 12.287. 
FINANCIAL AFFIDAVITS IN ENFORCEMENT  
 
 
AND CONTEMPT PROCEEDINGS 
 
     Any party in an enforcement or contempt proceeding may serve upon any other 
party a written request to file and serve a financial affidavit if the other party’s 
financial circumstances are relevant in the proceeding. The party to whom the 
request is made shall file and serve the requested financial affidavit and file a 
notice of compliance within 10 days after the service of the written request. The 
court may allow a shorter or longer time. The financial affidavit shall be in 
substantial conformity with Florida Family Law Rules of Procedure Form 
12.902(b) (Short Form), all sections of which shall be completed.  
 
RULE 12.340. 
INTERROGATORIES TO PARTIES 
 
     Interrogatories to parties shall be governed generally by Florida Rule of Civil 
Procedure 1.340, with the following exceptions. 
 
(a) – (b)  [No change] 
 
(c) Serving of Responses.  Parties shall serve responses to interrogatories on 
the requesting party. Responses shall not be filed with the court unless they are 
admitted into evidence by the court and are in compliance with Florida Rule of 
Judicial Administration 2.425. The responding party shall file with the court 
60 
 
Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of 
Answers to Standard Family Law Interrogatories.  
 
Commentary 
[No change] 
 
Committee Note 
[No change] 
 
 
RULE 12.363. 
EVALUATION OF MINOR CHILD 
 
 
(a) 
[No change] 
 
 
(b) 
Providing of Reports. 
 
 
 
(1) 
Unless otherwise ordered, the expert shall prepare and provide a 
written report to the attorney for each party or the party, if unrepresented, and the 
guardian ad litem, if appointed, a reasonable time before any evidentiary hearing 
on the matter at issue. The expert also shall send written notice to the court that the 
report has been completed and that a copy of the written report has been provided 
to the attorney for each party or the party, if unrepresented, and the guardian ad 
litem, if appointed. In any event, the written report shall be prepared and provided 
no later than 30 days before trial or 75 days from the order of appointment, unless 
the time is extended by order of the court. The expert shall not send a copy of the 
report to the court unless the parties and their attorneys have agreed in writing that 
the report will be considered by the court and filed in the court file as provided in 
subdivision (e).  
  
 
 
(2) 
[No change] 
 
 
(c) – (d) [No change] 
 
 
(e) 
Use of Evidence. An expert appointed by the court shall be subject to 
the same examination as a privately retained expert and the court shall not entertain 
any presumption in favor of the appointed expert’s findings. Any finding or report 
by an expert appointed by the court may be entered into evidence on the court’s 
own motion or the motion of any party in a manner consistent with the rules of 
evidence, subject to cross-examination by the parties. Any report filed in the court 
file shall be in compliance with Florida Rule of Judicial Administration 2.425. The 
61 
 
report shall not be considered by the court before it is properly admitted into 
evidence. The report shall not be filed in the court file unless or until it is properly 
admitted into evidence and considered by the court. The court shall consider 
whether the report should be sealed as provided by Florida Rule of Judicial 
Administration 2.420.  
 
Committee Note 
[No change] 
 
 
RULE 12.370. 
REQUESTS FOR ADMISSION 
 
 
Requests for admission shall be governed by Florida Rule of Civil Procedure 
1.370, except that 
 
 
(a) 
the request and any response to it must comply with Florida Rule of 
Judicial Administration 2.425; and  
  
 
(b) 
documents attached to the request for admission shall not be filed with 
the court and shall only be attached to the copy served on the party to whom the 
request for admissions is directed.  
 
 
RULE 12.410. 
SUBPOENA 
 
  Subpoenas shall be governed by Florida Rule of Civil Procedure 1.410, except 
as follows: 
 
 
(a) 
Subpoenas. No subpoena issued under Florida Rule of Civil 
Procedure 1.410, even if for the purpose of proof of service or nonservice of the 
subpoena, shall be filed with the court unless in compliance with Florida Rule of 
Judicial Administration 2.425.  
  
 
(b) 
Notice of Issuance of Subpoena. A party issuing a subpoena through 
an attorney of record or clerk of the court under Florida Rule of Civil Procedure 
1.410 shall, on the same day as the subpoena is issued, serve each party to the 
proceeding with a notice of issuance of subpoena and file this notice with the court. 
The notice of issuance of subpoena shall identify the person or entity subject to the 
subpoena, the date the subpoena was issued, and the date and time for appearance 
or production, and shall recite that all references to account numbers or personal 
62 
 
identifying numbers are in compliance with Florida Rule of Judicial 
Administration 2.425.  
  
 
(c) 
Notice to Produce. Any notice to produce issued under Florida Rule 
of Civil Procedure 1.410 shall comply with Florida Rule of Judicial Administration 
2.425.  
  
Committee Note 
 
2008 Amendment. The provisions of Fla. R. Civ. P.Fla. R. Civ. P. 1.410(h) 
do not alter the requirements of Rulerule 12.407 that a court order must be obtained 
before a minor child may be subpoenaed to appear at a hearing. 
 
  
RULE 12.440. 
SETTING ACTION FOR TRIAL 
 
 
Florida Rule of Civil Procedure 1.440 shall govern general provisions 
concerning setting an action for trial in family law matters, with the following 
exceptions and additions. 
 
 
(a) 
Setting for Trial. If the court finds the action ready to be set for trial, 
it shall enter an order setting the action for trial, fixing a date for trial, and setting a 
pretrial conference, if necessary. In the event a default has been entered, reasonable 
notice of not less than 10 days shall be given unless otherwise required by law. 
Trial shall be set within a reasonable time from the service of the notice for trial. 
At the pretrial conference, the parties should be prepared, consistent with Florida 
Family Law Rule of Procedure 12.200, to present any matter that will prepare the 
parties for trial and that can expedite the resolution of the case. The trial court may 
also direct the parties to reciprocally exchange and file with the court all 
documents relative to the outcome of the case; a list of all witnesses, all issues to 
be tried, and all undisposed motions; an estimate of the time needed to try the case; 
and any other information the court deems appropriate. Any court filings shall be 
in conformity with Florida Rule of Judicial Administration 2.425. This information 
should be served and filed no later than 72 hours before the pretrial conference or 
30 days before the trial.  
  
 
(b) 
[No change] 
 
Commentary 
[No change] 
63 
 
 
 
RULE 12.540. 
RELIEF FROM JUDGMENT, DECREES, OR ORDERS 
 
 
Florida Rule of Civil Procedure 1.540 shall govern general provision 
concerning relief from judgment, decrees, or orders, except: 
 
 
(a)  
that there shall be no time limit for motions based on fraudulent 
financial affidavits in marital or paternity cases; and 
 
 
(b) 
the motion and any attachment or exhibit to it shall be in compliance 
with Florida Rule of Judicial Administration 2.425. 
  
 
Commentary 
[No change] 
 
 
RULE 12.560. 
DISCOVERY IN AID OF EXECUTION 
 
(a) – (d) 
[No change] 
  
 
(e) 
Notice of Compliance.  The judgment debtor shall file with the clerk 
of court a notice of compliance with the order to complete form 1.977, and serve a 
copy of the notice of compliance on the judgment creditor or the judgment 
creditor’s attorney.  Form 1.977 shall not be filed with the clerk of the court or in 
any other public record, except by order of the court after a notice and hearing and 
for good cause shown. If the court permits the filing of form 1.977, it shall be in 
compliance with the requirements of Florida Rule of Judicial Administration 
2.425.  
  
Committee Notes 
 
2000 Amendment. Subdivisions (b) - (e) were added to the Florida Rules of 
Civil Procedure and adopted with amendments into the Family Law Rules of 
Procedure. The amendments to the Civil Rules were patterned after Florida Small 
Claims Rule 7.221(a) and Form 7.343. Although the judgment creditor is entitled 
to broad discovery into the judgment debtor’s finances (Fla. R. Civ. P. 1.280(b); 
Jim Appley’s Tru-Arc, Inc. v. Liquid Extraction Systems, 526 So. 2d 177, 179 (Fla. 
2d DCA 1988)), in family law cases inquiry into the individual assets of the 
judgment debtor’s spouse must be precluded until a proper predicate has been 
64 
 
shown. Tru-Arc, Inc., 526 So. 2d at 179; Rose Printing Co. v. D’Amato, 338 So. 2d 
212 (Fla. 3d DCA 1976). 
     
RULE 12.620. 
RECEIVERS 
 
    Receivers shall be governed by Florida Rule of Civil Procedure 1.620, except 
that any inventory filed with the court shall be in compliance with Florida Rule of 
Judicial Administration 2.425. 
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of 
Marriage (10/11) 
65 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 
12.901(a), PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE  
(10/11) 
When should this form be used? 
This form should be used when a husband and wife are filing for a simplified dissolution of 
marriage.  You and/or your spouse must have lived in Florida for at least 6 months before filing 
for a dissolution in Florida.  You may file a simplified dissolution of marriage in Florida if all of 
the following are true: 
 You and your spouse agree that the marriage cannot be saved. 
 You and your spouse have no minor or dependent child(ren) together, the wife does not 
have any minor or dependent children born during the marriage, and the wife is not 
now pregnant. 
 You and your spouse have worked out how the two of you will divide the things that you 
both own (your assets) and who will pay what part of the money you both owe (your 
liabilities), and you are both satisfied with this division. 
 You are not seeking support (alimony) from your spouse, and vice versa. 
 You and your spouse have filed financial affidavits with the court or you have waived the 
filing of financial affidavits and you are satisfied with the financial disclosure received 
from the other spouse. 
 You are willing to give up your right to trial and appeal. 
 You and your spouse are both willing to go into the clerk’s office to sign the petition (not 
necessarily together). 
 You and your spouse are both willing to go to the final hearing (at the same time). 
 
If you do not meet the criteria above, you must file a regular petition for dissolution of 
marriage. 
This petition should be typed or printed in black ink.  Each of you must sign the petition in the 
presence of a deputy clerk (in the clerk’s office), although you do not have to go into the clerk’s 
office at the same time. You will need to provide picture identification (valid driver’s license or 
official identification card) for the clerk to witness your signatures. 
 
What should I do next? 
1. After completing this form, 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.   
 
If you did not waive the filing of a financial affidavit in the petition, each of you must file a 
Financial Affidavit. Florida Family Law Rules of Procedure Form 12.902(b) or (c). You may 
document your agreement by signing a Marital Settlement Agreement, Florida Family Law 
Rules of Procedure Form 12.902(f)(3) and filing it with the clerk of the circuit court or you 
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of 
Marriage (10/11) 
66 
may agree that all of your assets (what you own) and liabilities (what you owe) have been 
disposed of by oral agreement. 
 
2. You must prove to the court that the husband and/or wife has (have) lived in Florida for 
more than 6 months before filing the petition for dissolution of marriage.  Residence can be 
proved by: 
 
 a valid Florida driver’s license, Florida identification card, or voter registration card 
issued to one of you at least 6 months prior to filing for dissolution of marriage; or 
 the testimony of another person who knows that either you or your spouse has resided 
in Florida for more than 6 months and is available to testify in court; or 
 an affidavit. To prove residence by affidavit, use an Affidavit of Corroborating Witness, 
Florida Supreme Court Approved Family Law Form 12.902(i).  This form must be signed 
by a person who knows that either you or your spouse has lived in Florida for more than 
6 months before the date that you filed the petition for dissolution of marriage.  This 
affidavit may be signed in the presence of the clerk of the court or in the presence of a 
notary public, who must affix his or her seal at the proper place on the affidavit. 
 
3. You must pay the appropriate filing fees to the clerk of the circuit court.  If you and your 
spouse cannot afford to pay the filing fees, you may fill out an Application for 
Determination of Civil Indigent Status, and file it with your petition for dissolution of 
marriage.  You may obtain this form from the clerk and he or she will determine whether 
you are eligible to have filing fees waived. 
 
4. Either you or the clerk of court will need to complete a Family Court Cover Sheet, Florida 
Family Law Rules of Procedure Form 12.928 .  The clerk’s office can provide this form. 
 
5. You must obtain a date and time for a court appearance from the clerk of court.  On that 
date, you and your spouse must appear together before a judge.  You should complete a 
Final Judgment of Simplified Dissolution of Marriage, Florida Family Law Rules of 
Procedure Form 12.990(a), and bring it with you to the hearing. At that time, if all of the 
papers are in order, the judge may grant a final judgment dissolving your marriage under 
simplified dissolution of marriage procedures by signing the final judgment which you have 
provided. 
 
6. If you fail to complete this procedure, the court may dismiss the case to clear its records. 
 
Where can I look for more information? 
 
Before proceeding, you should read “General Information for Self-Represented Litigants” 
found at the beginning of these forms.  The words that are in “bold underline” in these 
instructions are defined there.  For further information, see chapter 61, Florida Statutes, and 
Rule 12.105, Florida Family Law Rules of Procedure. 
Instructions for Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of 
Marriage (10/11) 
67 
 
Special notes... 
 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill 
out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number 
on the bottom of the last page of every form he or she helps you complete.
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (10/11) 
68 
 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
Case No.:  
 
Division:  
 
 
 
 
 
 
, 
Husband, 
and 
 
 
 
 
 
, 
      Wife. 
 
PETITION FOR SIMPLIFIED DISSOLUTION OF MARRIAGE 
 
We, {full legal name}  
, Husband, 
and {full legal name}  
, Wife, 
being sworn, certify that the following information is true: 
[fill in all blanks] 
 
1. We are both asking the Court for a dissolution of our marriage. 
2. Husband lives in {name}   
 
 County, {state}  
 
 
, and has lived 
there since {date}  
 
.  Wife lives in {name}  
 
                   
 
   
County, {state}  
 
 
, and has lived there since {date}  
 
         
. 
3. We were married to each other on {date} 
       in the city of {city} _________________  
in state of {state}   
, or country of {country} _________________________________. 
4. Our marriage is irretrievably broken. 
5. We do not have any minor or dependent children together, the wife does not have any 
minor or dependent children born during the marriage, and the wife is not pregnant. 
6. We have divided our assets (what we own) and our liabilities (what we owe) by agreement.  
We are satisfied with this agreement.  
[Check one only] 
(    ) Our marital settlement agreement, Florida Family Law Rules of Procedure Form 
12.902(f)(3), is attached.  This agreement was signed freely and voluntarily by each of us 
and we intend to be bound by it. 
(    ) Our marital settlement agreement is not in writing. We prefer to keep our financial 
agreements private. 
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (10/11) 
69 
 
7. [check one only] 
(    )We have each completed and signed financial affidavits, Florida Family Law Rules of  
Procedure Forms 12.902(b) or (c), which are attached to this petition. 
(   ) Each of us is satisfied with the financial disclosure we received from the other spouse 
and we waive the filing of financial affidavits.  
8. [ Check one only ]  (    ) yes (    ) no Wife wants to be known by her former name, which was 
{full legal name}                                                                                               . 
9. We each certify that we have not been threatened or pressured into signing this petition. 
We each understand that the result of signing this petition may be a final judgment ending 
our marriage and allowing no further relief. 
10. We each understand that we both must come to the hearing to testify about the things we 
are asking for in this petition. 
11. We understand that we each may have legal rights as a result of our marriage and that by 
signing this petition we may be giving up those rights. 
12. We ask the Court to end our marriage and approve our marital settlement agreement. 
 
 
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 HUSBAND 
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  
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.901(a), Petition for Simplified Dissolution of Marriage (10/11) 
70 
 
 
 
[Print, type, or stamp commissioned name of 
notary or deputy clerk.] 
        
Personally known 
        
Produced identification 
 
Type of identification produced                                                
 
 
 
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 WIFE 
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}  
, 
[Choose only one] (    ) Husband (    ) Wife or (    ) both, fill out this form. 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage  with Dependent  or Minor Child(ren) (10/11) 
71 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.901(b)(1), PETITION FOR DISSOLUTION OF MARRIAGE WITH 
DEPENDENT OR MINOR CHILD(REN) (10/11) 
 
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. 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage  with Dependent  or Minor Child(ren) (10/11) 
72 
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 
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 you want to keep your address confidential because you are the victim of sexual battery, aggravated 
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence do not enter the 
address, telephone, and fax information at the bottom of this form.  Instead, file 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.) 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage  with Dependent  or Minor Child(ren) (10/11) 
73 
 
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. 
 
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 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage  with Dependent  or Minor Child(ren) (10/11) 
74 
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. 
 
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. 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of 
Marriage  with Dependent  or Minor Child(ren) (10/11) 
75 
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. 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
76 
 
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 
 [Choose only one] (    ) 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 [Choose only one] (    ) is (    ) is not a member of the military service. 
The wife [Choose only one]  (    ) is (    ) is not a member of the military service. 
3. MARRIAGE HISTORY 
Date of marriage: {month, day, year} ___________________________________________________ 
Date of separation: {month, day, year}______________ (Please indicate if approximate) 
4. DEPENDENT OR MINOR CHILD(REN) 
[Choose 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 
Birth date 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
77 
 
 
c. ___The minor child(ren) born or conceived during the marriage who are not common to both 
parties are: 
 
Name 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
   
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 
Birth date 
________________________________________________________________________ 
________________________________________________________________________ 
 
5. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c)  (   ) is filed or (   ) will be timely filed. 
 
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.  (You must complete 
and attach this form in a dissolution of marriage with minor child(ren)). 
 
7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), is filed with this petition. 
 
8. This petition for dissolution of marriage should be granted because: 
[Choose only one] 
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[] 
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  
2.902(b) or (c), to be filed in this case. 
[Choose 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:  
 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
78 
 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION II.  SPOUSAL SUPPORT (ALIMONY) 
[Choose only one] 
1. ___  Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. 
 
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): ___________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
[Choose if applicable] (    ) 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: 
 [Choose only one] 
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 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
79 
 
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: 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
4. Explain why this request is in the best interests of the child(ren): __________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
SECTION IV.  CHILD SUPPORT 
[Choose 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. 
 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
80 
 
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: 
[Choose only one] 
a. ___ Father. 
b. ___ Mother. 
 
5.  ___Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: 
[Choose only one] 
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} 
__________________________________________________________________________________ 
 
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: 
[Choose 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; 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(1), Petition for Dissolution of Marriage with 
Dependent  or Minor Child(ren) (10/11) 
81 
 
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) (10/11) 
82 
 
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,  whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} ______,  
helped {name} _______________________________, who is the petitioner, fill out this form.
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of 
Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
83 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 
12.901(b)(2), PETITION FOR DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO 
DEPENDENT OR MINOR CHILD(REN)(10/11) 
 
When should this form be used? 
 
This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband 
and wife have marital assets and/or marital liabilities but they do not have any dependent children nor 
is the wife is now pregnant.  You and/or your spouse must have lived in Florida for at least 6 months 
before filing for a dissolution in Florida.  If you and your spouse agree on all issues and both can attend 
the hearing, you may want to file a simplified dissolution of marriage petition, Florida Family Law Rules 
of Procedure Form 12.901(a). However, you cannot file for a simplified dissolution of marriage if any of 
the following are true: 
 
 
You disagree about property, debts, or other matters and wish to have a judge settle them for you. 
 
Either you or your spouse is seeking support (alimony). 
 
You would like to ask questions and get documents concerning your spouse’s income, expenses, 
assets, debts, or other matters before having a trial or settlement. 
 
You would like to reserve your rights to have any matters reconsidered or appeal the judge’s 
decision. 
 
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 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of 
Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
84 
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 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 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 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.  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. 
 
If  you want to keep your address confidential because you are the victim of sexual battery, aggravated 
child abuse, aggravated stalking, harassment, aggravated battery or domestic violence do not enter the 
address, telephone, and fax information at the bottom of this form.  Instead, file a Request for 
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h). 
 
With this form, you must also file the following: 
 
 
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 No Dependent or Minor 
Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2), 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). 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of 
Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
85 
 
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 the respondent, if not filed at the 
time of the petition.) 
 
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.) 
 
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 
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. 
 
Temporary Relief...  If you need temporary relief regarding temporary use of assets, temporary 
responsibility for liabilities, or temporary alimony, 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 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 Property 
But No Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2).  
Both husband and wife 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 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 a 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).  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 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of 
Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
86 
out these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete.
 
Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of Marriage with Property 
but No Dependent or Minor Child(ren) (10/11) 
87 
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 PROPERTY BUT NO DEPENDENT OR MINOR CHILD(REN) 
 
 
I, {full legal name} ______________________________________________________, the 
[Choose 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 [Choose one only] (    ) is (    ) is not a member of the military service. 
The wife [Choose one only] (    ) is (    ) is not a member of the military service. 
 
3. MARRIAGE HISTORY 
Date of marriage: {month, day, year} ________________________________________________ 
 
Date of separation: {month, day, year} ___________ _________[Please indicate if approximate] 
 
4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND 
THE WIFE IS NOT PREGNANT. 
 
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this petition. 
 
6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: 
[ Choose one only] 
a. ____ The marriage is irretrievably broken. 
b. ____ One of the parties has been adjudged mentally incapacitated for a period of 3 years 
before the filing of this petition.  A copy of the Judgment of Incapacity is attached. 
 
Florida Supreme Court Approved Family Law Form 12.901(b)(2), Petition for Dissolution of Marriage with Property 
but No Dependent or Minor Child(ren) (10/11) 
88 
SECTION I.  MARITAL ASSETS AND LIABILITIES 
[Choose 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. 
[Choose all that apply] 
a. ____ All marital assets and debts 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 Simplified Dissolution of Marriage, 
Florida Family Law Rules of Procedure Form 12.902(f)(3) 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). 
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) 
[Choose one only] 
1. ____ Petitioner forever gives up his/her right to spousal support (alimony) from Respondent. 
 
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): 
_________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
[ Indicate if applicable] (    ) Petitioner requests life insurance on Respondent’s life, provided by 
Respondent, to secure such support. 
 
SECTION III.  OTHER 
1.  [If Petitioner is also the Wife,  choose one only]  (    ) yes (    ) no Petitioner/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 12.901(b)(2), Petition for Dissolution of Marriage with Property 
but No Dependent or Minor Child(ren) (10/11) 
89 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
SECTION IV.  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: 
[ Choose 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. ____ restoring Wife’s former name as requested in Section III of this petition; 
4. ____ awarding other relief as requested in Section III 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:  __________________________________ 
 
 
 
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 12.901(b)(2), Petition for Dissolution of Marriage with Property 
but No Dependent or Minor Child(ren) (10/11) 
90 
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,  whose address is {street} ____________________________________________,  
{city} ______________________________________,{state} ______________,{phone} ______________, 
 helped {name} ___________________________________, who is the petitioner, fill out this form.
 
Instructions for Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with 
No Dependent or Minor Child(ren) or Property (10/11) 
91 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.901(b)(3), PETITION FOR DISSOLUTION OF MARRIAGE WITH 
NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY(10/11) 
 
When should this form be used? 
 
This form may be used when a husband or wife is filing for a dissolution of marriage, and the husband 
and wife have no marital assets and/or marital liabilities and they do not have any dependent children 
nor is the wife is now pregnant.  You and/or your spouse must have lived in Florida for at least 6 months 
before filing for a dissolution in Florida.  If you and your spouse agree on all issues and both can attend 
the hearing, you may want to file a petition for simplified dissolution of marriage, Florida Family Law 
Rules of Procedure Form 12.901(a).  However, you may file this form if all of the following are true: 
 
 
You have no marital assets or marital debts. 
 
Neither you nor your spouse is seeking support (alimony). 
 
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 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 
 
Instructions for Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with 
No Dependent or Minor Child(ren) or Property (10/11) 
92 
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 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.  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. 
 
If you want to keep your address confidential because you are the victim of sexual battery, aggravated 
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence  do not enter the 
address, telephone, and fax information at the bottom of this form.  Instead, file a Request for 
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h). 
 
With this form, you must also file the following: 
 
 
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). 
 
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 the respondent, if not filed at the 
time of the petition.) 
 
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.) 
 
 
Instructions for Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with 
No Dependent or Minor Child(ren) or Property (10/11) 
93 
Final Judgment Form...  These family law forms contain a Final Judgment of Dissolution of Marriage 
with No Property or Minor Child(ren) (Uncontested), 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. 
 
 
 
Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent 
or Minor Child(ren) or Property (10/11) 
94 
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 NO DEPENDENT OR MINOR CHILD(REN) OR PROPERTY 
 
 
I, {full legal name} ______________________________________________________, the 
[ Choose only one] (    ) 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 [Choose only one] (    ) is (    ) is not a member of the military service. 
The wife [Choose only one]         (    ) is (    ) is not a member of the military service. 
 
3. MARRIAGE HISTORY 
Date of marriage: {month, day, year} ________________________________________________  
 
4. THERE ARE NO MINOR (under 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND 
THE WIFE IS NOT PREGNANT. 
 
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), is filed with this petition. 
 
6. THIS PETITION FOR DISSOLUTION OF MARRIAGE SHOULD BE GRANTED BECAUSE: 
[Choose only one] 
a. _____ The marriage is irretrievably broken. 
b. _____ One of the parties has been adjudged mentally incapacitated for a period of 3 years 
before the filing of this petition.  A copy of the Judgment of Incapacity is attached. 
 
7. THERE ARE NO MARITAL ASSETS OR LIABILITIES. 
 
8. PETITIONER FOREVER GIVES UP HIS/HER RIGHTS TO SPOUSAL SUPPORT (ALIMONY) FROM 
RESPONDENT. 
 
 
Florida Supreme Court Approved Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent 
or Minor Child(ren) or Property (10/11) 
95 
9. [If Petitioner is also the Wife, Choose only one] (    ) yes (    ) no Petitioner/Wife wants to be known 
by her former name, which was {full legal name} _________________________________. 
 
10. Other relief {specify}: ________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
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: 
[ Choose all that apply] 
1. ____ restoring Wife’s former name as specified in paragraph 9 of this petition; 
2. ____ awarding other relief as specified in paragraph 10 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 
motion 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 Law Form 12.901(b)(3), Petition for Dissolution of Marriage with No Dependent 
or Minor Child(ren) or Property (10/11) 
96 
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, whose address is {street} _________________________, {city} ______________________, 
{state} ______________,{phone} ______, helped {name} _______________________________, who is 
the petitioner, fill out this form.
 
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) 
 (10/11) 
97 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 
12.902(b), FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)(10/11) 
 
When should this form be used? 
 
This form should be used when you are involved in a family law case which requires a financial 
affidavit and your individual gross income is UNDER $50,000 per year unless. 
 
(1) you are filing a simplified dissolution of marriage under rule 12.105 and both parties 
have waived the filing of a financial affidavit. 
(2) you have no minor children, no support issues, and have filed a written settlement 
agreement disposing of all financial issues, or 
(3) the court lacks jurisdiction to determine any financial issues. 
 
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? 
 
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.  This must be accomplished within 45 days of 
service of the petition. 
 
Where can I look for more information? 
 
Before proceeding, you should read “General Information for Self-Represented Litigants” 
found at the beginning of these forms.  The words that are in “bold underline” in these 
instructions are defined there.  For further information, see rule 12.285, Florida Family Law 
Rules of Procedure. 
 
Special notes... 
 
If you want to keep your address confidential because you are the victim of sexual battery, 
aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic 
violence, do not enter the address, telephone, and fax information at the bottom of this form.  
Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family 
 
Instructions to Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) 
 (10/11) 
98 
Law Form 12.980(h). 
 
The affidavit must be completed using monthly income and expense amounts.  If you are paid 
or your bills are due on a schedule which is not monthly, you must convert those amounts.  
Hints are provided below for making these conversions. 
 
Hourly - If you are paid by the hour, you may convert your income to monthly as 
follows: 
Hourly amount 
x 
Hours worked per week 
= 
Weekly amount 
Weekly amount 
x 
52 Weeks per year 
 
= 
Yearly amount 
Yearly amount  
÷ 
12 Months per year  
= 
Monthly Amount 
Daily - If you are paid by the day, you may convert your income to monthly as follows: 
Daily amount  
x 
Days worked per week 
= 
Weekly amount 
Weekly amount 
x 
52 Weeks per year 
 
= 
Yearly amount 
Yearly amount  
÷ 
12 Months per year  
=  
Monthly Amount 
Weekly - If you are paid by the week, you may convert your income to monthly as 
follows: 
Weekly amount 
x 
52 Weeks per year 
 
=  
Yearly amount 
Yearly amount  
÷ 
12 Months per year  
=  
Monthly Amount 
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly 
as follows: 
Bi-weekly amount 
x 
 
26 
 
 
= 
Yearly amount 
Yearly amount  
÷ 
12 Months per year   
= 
Monthly Amount 
Semi-monthly - If you are paid twice per month, you may convert your income to 
monthly as follows: 
Semi-monthly amount x 
 
2 
 
 
=  
Monthly Amount 
 
Expenses may be converted in the same manner. 
 
 
 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill 
out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida 
Family Law Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer 
helping you fill out these forms also must put his or her name, address, and telephone number 
on the bottom of the last page of every form he or she helps you complete. 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial Affidavit (Short Form) (10/11) 
99 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                        COUNTY, FLORIDA 
 
Case No.:  
 
Division:  
 
 
                                                                      , 
Petitioner, 
and 
 
                                                                       , 
Respondent. 
 
 
FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) 
(Under $50,000 Individual Gross Annual Income) 
 
I, {full legal name}   
 
 
 
, being sworn, certify that the 
following information is true: 
My Occupation:  
   
  Employed by:  
 
Business Address:   
 
 
 
Pay rate: $                    (    ) every week (    ) every other week (    ) twice a month (    ) monthly 
(    ) other:  
 
___ Check here if unemployed and explain on a separate sheet your efforts to find 
employment. 
 
SECTION I.  PRESENT MONTHLY GROSS INCOME: 
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 “other” should be listed separately with separate dollar amounts. 
1. _______ Monthly gross salary or wages 
2. _______Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 
3. _______Monthly business income from sources such as self-employment, partnerships, 
close corporations, and/or independent contracts (gross receipts minus ordinary and 
necessary expenses required to produce income)  ( Attach sheet itemizing such income and 
expenses.) 
4. _______Monthly disability benefits/SSI 
5. _______Monthly Workers’ Compensation 
6. _______Monthly Unemployment Compensation 
7. _______Monthly pension, retirement, or annuity payments 
8. _______Monthly Social Security benefits 
9. ______Monthly alimony actually received (Add 9a and 9b) 
a. 
From this case:  $ _______ 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial   Affidavit (Short Form) (10/11) 
100 
 
b. From other case(s): _______ 
10. _______ Monthly interest and dividends 
11. _______Monthly rental income (gross receipts minus ordinary and necessary expenses 
 required to produce income) (□ Attach sheet itemizing such income and expense items.) 
12. _______ Monthly income from royalties, trusts, or estates 
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they  
reduce personal living expenses 
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains) 
15. _______ Any other income of a recurring nature (list source) ________________________ 
16. __________________________________________________________________________ 
17. $ _______ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1–16) 
 
PRESENT MONTHLY DEDUCTIONS: 
18. _______ Monthly federal, state, and local income tax (corrected for filing status and 
allowable dependents and income tax liabilities) 
a. 
Filing Status ____________ 
b. 
Number of dependents claimed _______ 
19. _______ Monthly FICA or self-employment taxes 
20. _______ Monthly Medicare payments 
21. _______ Monthly mandatory union dues 
22. _______ Monthly mandatory retirement payments 
23. _______ Monthly health insurance payments (including dental insurance), excluding portion 
paid for any minor children of this relationship 
24. _______ Monthly court-ordered child support actually paid for children from another 
relationship 
25. Monthly court-ordered alimony actually paid (Add 25a and 25b) 
a. from this case:  $ _______ 
b. from other case(s):  _______ 
26. $_______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES 
(Add lines 18 through 25). 
27. $_______ PRESENT NET MONTHLY INCOME  (Subtract line 26 from line 17) 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial   Affidavit (Short Form) (10/11) 
101 
 
 
SECTION II.  AVERAGE MONTHLY EXPENSES 
A. 
HOUSEHOLD: 
Mortgage or rent   
$ _______ 
Property taxes  
 
$_______ 
Utilities  
 
 
$_______ 
Telephone  
 
$ _______ 
Food  
 
 
$ _______ 
Meals outside home  
$_______     
Maintenance/Repairs  
$ _______   
 Other: __________ 
$_______ 
 
B. 
AUTOMOBILE 
Gasoline   
 
$ _______       
Repairs  
 
 
$_______       
Insurance   
 
$_______ 
 
C. 
CHILD(REN)’S EXPENSES 
Day care   
 
$ _______ 
Lunch money  
 
$_______ 
Clothing   
 
$ _______ 
Grooming   
 
$_______ 
      
Gifts for holidays   
$ _______ 
 
Medical/Dental (uninsured) $ _______        
Other:                             
 $_______ 
D. 
INSURANCE 
Medical/Dental 
  
$ _______ 
Child(ren)’s medical/dental $ _______  
Life 
  
 
  
$ _______ 
 
Other:                                 $ _______ 
 
 
OTHER EXPENSES NOT LISTED ABOVE 
Clothing 
 
 
$ _______      
Medical/Dental (uninsured) $_______      
Grooming  
 
$ _______ 
Entertainment 
 
$_______ 
Gifts 
 
 
$_______     
Religious organizations 
$_______      
Miscellaneous 
 
$_______ 
Other: ______________ $ _______ 
____________________ $_______   
____________________ $_______  
____________________ $_______  
____________________ $_______  
____________________ $_______  
 
 
F.  CREDITORS  
   
MONTHLY 
 
 
 
 
 
   
PAYMENT 
____________________ $_______                                    
____________________ $_______                                    
____________________ $_______ 
____________________ $_______                                    
____________________ $_______   
____________________ $_______                                    
____________________ $_______                                    
____________________ $_______     
____________________ $_______                                    
____________________ $_______   
____________________ $_______  
 
28. $_______ TOTAL MONTHLY EXPENSES (add ALL monthly amounts in A through F above) 
 
 
SUMMARY 
29. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I.  INCOME) 
30. $_______ TOTAL MONTHLY EXPENSES  (from line 28 above)  
 
31. $_______ SURPLUS  (If line 29 is more than line 30, subtract line 30 from line 29. This is the 
amount of your surplus.  Enter that amount here.) 
32. $_______ (DEFICIT)  (If line 30 is more than line 29, subtract line 29 from line 30. This is the 
amount of your deficit.  Enter that amount here.) 
 
SECTION III.  ASSETS AND LIABILITIES 
Use the nonmarital column only if this is a petition for dissolution of marriage and you 
believe an item is “nonmarital,” meaning it belongs to only one of you and should not be 
divided.  You should indicate to whom you believe the item(s) or debt belongs.  (Typically, you 
will only use this column if property/debt was owned/owed by one spouse before the marriage.  
See the “General Information for Self-Represented Litigants” found at the beginning of these 
forms and section 61.075(1), Florida Statutes, for definitions of “marital” and “nonmarital” 
assets and liabilities.) 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial   Affidavit (Short Form) (10/11) 
102 
 
 
 
A. ASSETS: 
 
DESCRIPTION OF ITEM(S).  List a description of each separate item 
owned by you (and/or your spouse, if this is a petition for dissolution 
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check 
the box next to any asset(s) which you are requesting the judge 
award to you. 
 
 
 
 
Current 
Fair 
Market 
Value 
 Nonmarital 
(Check correct 
column) 
 
husband 
 
wife 
 
 
Cash (on hand) 
 
$ 
 
 
 
 
 
 
Cash (in banks or credit unions) 
 
 
 
 
 
 
 
 
Stocks, Bonds, Notes 
 
 
 
 
 
 
 
 
Real estate: (Home) 
 
 
 
 
 
 
 
 
(Other) 
 
 
 
 
 
 
 
 
Automobiles 
 
 
 
 
 
 
 
 
Other personal property 
 
 
 
 
 
 
 
 
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
 
 
 
 
 
 
 
 
Other 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check here if additional pages are attached. 
 
 
 
 
 
 
 
Total Assets  (add next column) 
 
$   
 
 
 
 
 
B. LIABILITIES: 
 
DESCRIPTION OF ITEM(S).  List a description of each separate debt 
owed by you (and/or your spouse, if this is a petition for dissolution 
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check 
the box next to any debt(s) for which you believe you should be 
responsible. 
 
 
 
 
Current 
Amount 
Owed 
 Nonmarital 
(check correct 
column) 
 
husband wife 
 
 
Mortgages on real estate: First mortgage on home 
 
$ 
 
 
 
 
 
 
Second mortgage on home 
 
 
 
 
 
 
 
 
Other mortgages 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Auto loans 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Charge/credit card accounts 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial   Affidavit (Short Form) (10/11) 
103 
 
 
 
DESCRIPTION OF ITEM(S).  List a description of each separate debt 
owed by you (and/or your spouse, if this is a petition for dissolution 
of marriage). LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. Check 
the box next to any debt(s) for which you believe you should be 
responsible. 
 
 
 
 
Current 
Amount 
Owed 
 Nonmarital 
(check correct 
column) 
 
husband wife 
 
 
 
 
 
 
 
 
 
 
 
Other   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check here if additional pages are attached. 
 
 
 
 
 
 
 
Total Debts   (add next column) 
 
$                 
 
 
 
 
 
C. CONTINGENT ASSETS AND LIABILITIES: 
INSTRUCTIONS:  If you have any POSSIBLE assets (income potential, accrued vacation or sick 
leave, bonus, inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid 
taxes, contingent tax liabilities, debts assumed by another), you must list them here. 
  
Contingent Assets 
 
Check the box next to any contingent asset(s) which you are 
requesting the judge award to you. 
 
 
 
 
Possible 
Value 
 Nonmarital 
(check correct 
column) 
 
husband  
wife 
 
 
 
 
$ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Contingent Assets 
 
$                  
 
 
 
 
  
Contingent Liabilities 
 
Check the box next to any contingent debt(s) for which you believe 
you should be responsible. 
 
 
 
 
Possible 
Amount 
Owed 
 
 Nonmarital 
(check correct 
column) 
 
husband 
 
wife 
 
 
 
 
$ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Contingent Liabilities 
 
$                
 
 
 
 
 
 
SECTION IV.  CHILD SUPPORT GUIDELINES WORKSHEET 
(Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet, 
MUST be filed with the court at or prior to a hearing to establish or modify child support. This 
requirement cannot be waived by the parties.) 
 
[Check one only] 
____ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case 
involves the establishment or modification of child support. 
 
 
Florida Family Law Rules of Procedure Form 12.902(b), Family Law Financial   Affidavit (Short Form) (10/11) 
104 
 
 
____ A Child Support Guidelines Worksheet IS NOT being filed in this case.  The 
establishment or modification of child support is not an issue in this case. 
 
I certify that a copy of this document was [choose only one] (    ) 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:  
 
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 [choose only one]       petitioner or       respondent, fill out this form.
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
105 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 
12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (10/11) 
 
 
When should this form be used? 
This form should be used when you are involved in a family law case which requires a financial affidavit 
and your individual gross income is $50,000 OR MORE per year unless: 
 
(1) You are filing a simplified dissolution of marriage under rule 12.105 and both parties have 
waived the filing of financial affidavits; 
(2) you have no minor children, no support issues, and have filed a written settlement agreement 
disposing of all financial issues, or 
(3) the court lacks jurisdiction to determine any financial issues. 
 
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.  This must be accomplished within 45 days of service of the 
petition. 
Where can I look for more information? 
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the 
beginning of these forms.  The words that are in “bold underline” in these instructions are defined 
there.  For further information, see rule 12.285, Florida Family Law Rules of Procedure. 
 
Special notes... 
If you want to keep your address confidential because you are the victim of sexual battery, aggravated 
child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, do not enter the 
address, telephone, and fax information at the bottom of this form.  Instead, file Request for 
Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h). 
 
The affidavit must be completed using monthly income and expense amounts.  If you are paid or your 
bills are due on a schedule which is not monthly, you must convert those amounts.  Hints are provided 
below for making these conversions. 
 
Hourly - If you are paid by the hour, you may convert your income to monthly as follows: 
Hourly amount   
x 
Hours worked per week  
 = 
 Weekly amount 
Weekly amount  
x  
52 Weeks per year  
 
 
 =  
 Yearly amount 
Yearly amount   
÷ 
12 Months per year  
 
 =  
 Monthly Amount 
Daily - If you are paid by the day, you may convert your income to monthly as follows: 
Daily amount 
 
x 
Days worked per week   
 =  
Weekly amount 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
106 
Weekly amount  
x 
52 Weeks per year  
 
 
 = 
Yearly amount 
Yearly amount   
÷ 
12 Months per year 
  
 = 
Monthly Amount 
Weekly - If you are paid by the week, you may convert your income to monthly as follows: 
Weekly amount  
x 
52 Weeks per year 
 
 
 = 
Yearly amount 
Yearly amount  
÷ 
12 Months per year 
 
 = 
Monthly Amount 
Bi-weekly - If you are paid every two weeks, you may convert your income to monthly as 
follows: 
Bi-weekly amount  
x  
 
26 
 
 
 
 
 = 
Yearly 
amount 
Yearly amount  
÷ 
12 Months per year 
 
 = 
Monthly Amount 
Semi-monthly - If you are paid twice per month, you may convert your income to monthly as 
follows: 
Semi-monthly amount x 
 
2 
 
 
  
= 
Monthly 
Amount 
 
Expenses may be converted in the same manner. 
 
Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete. 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
107 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
 
Case No.:  
 
Division:  
 
 
, 
              Petitioner, 
 
and 
 
 
, 
           Respondent. 
 
FAMILY LAW FINANCIAL AFFIDAVIT 
($50,000 or more Individual Gross Annual Income) 
 
I, {full legal name}                               
                                                                           , being  sworn, 
certify that the following information is true: 
 
SECTION I.  INCOME 
 
1. My age is: ___________________                                   
2. My occupation is: ________________________________________________________________ 
3. I am currently 
[Check all that apply] 
a. ____ Unemployed 
Describe your efforts to find employment, how soon you expect to be employed, and the pay 
you expect to receive: __________________________________________________________ 
____________________________________________________________________________ 
b. ____ Employed by: ____________________________________________________________ 
Address: ____________________________________________________________________ 
City, State, Zip code: ________________________________ Telephone Number: _________ 
Pay rate: $ ______ (    ) every week (    ) every other week (    ) twice a month  
(    ) monthly (    ) other: ________________________________________________________ 
 
If you are expecting to become unemployed or change jobs soon, describe the change you 
expect and why and how it will affect your income: _________________________________ 
 
___________________________________________________________________________ 
 
___ Check here if you currently have more than one job.  List the information above for the 
second job(s) on a separate sheet and attach it to this affidavit.
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
108 
 
c. _____ Retired.  Date of retirement: _______________________________________________ 
                             
Employer from whom retired:  ___________________________________________________ 
 
Address: _____________________________________________________________________ 
 
City, State, Zip code: _______________________________ Telephone Number: __________ 
 
LAST YEAR’S GROSS INCOME:  
 
Your Income 
 
Other Party’s Income (if known) 
YEAR_____  
 
$ _______ 
 
$ _______ 
 
 
 
PRESENT MONTHLY GROSS INCOME: 
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 “other” should 
be listed separately with separate dollar amounts. 
 
1. _______ Monthly gross salary or wages 
2. _______ Monthly bonuses, commissions, allowances, overtime, tips, and similar payments 
3. _______ Monthly business income from sources such as self-employment, partnerships, close 
corporations, and/or independent contracts (Gross receipts minus ordinary and necessary expenses 
required to produce income.)( Attach sheet itemizing such income and expenses.) 
4. _______ Monthly disability benefits/SSI 
5. _______ Monthly Workers’ Compensation 
6. _______ Monthly Unemployment Compensation 
7. _______ Monthly pension, retirement, or annuity payments 
8. _______ Monthly Social Security benefits 
9. _______ Monthly alimony actually received (Add 9a and 9b) 
a. From this case:  $________                 
b. From other case(s): ________     
10. _______ Monthly interest and dividends 
11. _______ Monthly rental income (gross receipts minus ordinary and necessary expenses required to 
produce income) (____ Attach sheet itemizing such income and expense items.) 
12. _______ Monthly income from royalties, trusts, or estates 
13. _______ Monthly reimbursed expenses and in-kind payments to the extent that they reduce 
personal living expenses (____ Attach sheet itemizing each item and amount.) 
14. _______ Monthly gains derived from dealing in property (not including nonrecurring gains) 
Any other income of a recurring nature (identify source) 
15. _______________________________________________________________________________ 
16. _______________________________________________________________________________ 
17. $_________ TOTAL PRESENT MONTHLY GROSS INCOME (Add lines 1-16).    
 
PRESENT MONTHLY DEDUCTIONS: 
All amounts must be MONTHLY.  See the instructions with this form to figure out money amounts for 
anything that is NOT paid monthly. 
18. $_________ Monthly federal, state, and local income tax (corrected for filing status and allowable 
dependents and income tax liabilities) 
a. Filing Status   
 
  
b. Number of dependents claimed  
 
 
19. _______ Monthly FICA or self-employment taxes 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
109 
20. _______ Monthly Medicare payments 
21. _______ Monthly mandatory union dues 
22. _______ Monthly mandatory retirement payments 
23. _______ Monthly health insurance payments (including dental insurance), excluding portion paid for 
any minor children of this relationship 
24. _______ Monthly court-ordered child support actually paid for children from another relationship 
25. _______ Monthly court-ordered alimony actually paid (Add 25a and 25b). 
a. from this case: 
$ _________           
b. from other case(s): _________ 
26. $______ TOTAL DEDUCTIONS ALLOWABLE UNDER SECTION 61.30, FLORIDA STATUTES  
(Add lines 18 through 25).     
 
27. $_______  PRESENT NET MONTHLY INCOME (Subtract line 26 from line 17). 
 
 
SECTION II.  AVERAGE MONTHLY EXPENSES 
Proposed/Estimated Expenses.  If this is a dissolution of marriage case and your expenses as listed 
below do not reflect what you actually pay currently, you should write “estimate” next to each amount 
that is estimated. 
HOUSEHOLD: 
1. $______ Monthly mortgage or rent payments 
2. _______ Monthly property taxes (if not included in mortgage) 
3. _______ Monthly insurance on residence (if not included in mortgage) 
4. _______ Monthly condominium maintenance fees and homeowner’s association fees 
5. _______ Monthly electricity 
6. _______ Monthly water, garbage, and sewer 
7. _______ Monthly telephone 
8. _______ Monthly fuel oil or natural gas 
9. _______ Monthly repairs and maintenance 
10. _______ Monthly lawn care 
11. _______ Monthly pool maintenance 
12. _______ Monthly pest control 
13. _______ Monthly misc. household 
14. _______ Monthly food and home supplies 
15. _______ Monthly meals outside home 
16. _______ Monthly cable t.v. 
17. _______ Monthly alarm service contract 
18. _______ Monthly service contracts on appliances 
19. _______ Monthly maid service 
Other: 
20. __________________________________________________________________________________
21. __________________________________________________________________________________
22. __________________________________________________________________________________
23. __________________________________________________________________________________
24. __________________________________________________________________________________
25. $_______ SUBTOTAL (add lines 1 through 24).
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
110 
AUTOMOBILE: 
26. $_______ Monthly gasoline and oil  
27. _______ Monthly repairs 
28. _______ Monthly auto tags and emission testing 
29. _______ Monthly insurance 
30. _______ Monthly payments (lease or financing)           
31. _______ Monthly rental/replacements 
32. _______ Monthly alternative transportation (bus, rail, car pool, etc.) 
33. _______ Monthly tolls and parking 
34. _______ Other: _________________________________________________  
35. _______ SUBTOTAL (add lines 26 through 34) 
 
MONTHLY EXPENSES FOR CHILDREN COMMON TO BOTH PARTIES: 
36. $______ Monthly nursery, babysitting, or day care 
37. _______ Monthly school tuition 
38. _______ Monthly school supplies, books, and fees 
39. _______ Monthly after school activities 
40. _______ Monthly lunch money 
41. _______ Monthly private lessons or tutoring 
42. _______ Monthly allowances 
43. _______ Monthly clothing and uniforms 
44. _______ Monthly entertainment (movies, parties, etc.) 
45. _______ Monthly health insurance 
46. _______ Monthly medical, dental, prescriptions (nonreimbursed only) 
47. _______ Monthly psychiatric/psychological/counselor 
48. _______ Monthly orthodontic 
49. _______ Monthly vitamins 
50. _______ Monthly beauty parlor/barber shop 
51. _______ Monthly nonprescription medication 
52. _______ Monthly cosmetics, toiletries, and sundries 
53. _______ Monthly gifts from child(ren) to others (other children, relatives, teachers, etc.) 
54. _______ Monthly camp or summer activities 
55. _______ Monthly clubs (Boy/Girl Scouts, etc.) 
56. _______ Monthly time-sharing expenses  
57. _______ Monthly miscellaneous 
58. $_______ SUBTOTAL (add lines 36 through 57) 
 
MONTHLY EXPENSES FOR CHILD(REN) FROM ANOTHER RELATIONSHIP: (other than court-ordered child 
support) 
59. __________________________________________________________________________________ 
60. __________________________________________________________________________________ 
61. __________________________________________________________________________________ 
62. __________________________________________________________________________________ 
63. $_______ SUBTOTAL (add lines 59 through 62)
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
111 
MONTHLY INSURANCE: 
64. $_______ Health insurance, excluding portion paid for any minor child(ren) of this relationship 
65. _______ Life insurance 
66. _______ Dental insurance 
Other: 
 
67. __________________________________________________________________________________ 
68. __________________________________________________________________________________
69. $_______ SUBTOTAL (add lines 64 through 68)
OTHER MONTHLY EXPENSES NOT LISTED ABOVE: 
70. $_______ Monthly dry cleaning and laundry 
71. _______ Monthly clothing 
72. _______ Monthly medical, dental, and prescription (unreimbursed only) 
73. _______ Monthly psychiatric, psychological, or counselor (unreimbursed only) 
74. _______ Monthly non-prescription medications, cosmetics, toiletries, and sundries 
75. _______ Monthly grooming 
76. _______ Monthly gifts 
77. _______ Monthly pet expenses 
78. _______ Monthly club dues and membership 
79. _______ Monthly sports and hobbies 
80. _______ Monthly entertainment 
81. _______ Monthly periodicals/books/tapes/CDs 
82. _______ Monthly vacations 
83. _______ Monthly religious organizations 
84. _______ Monthly bank charges/credit card fees 
85. _______ Monthly education expenses 
Other: (include any usual and customary expenses not otherwise mentioned in the items listed above) 
86. __________________________________________________________________________________ 
87. __________________________________________________________________________________ 
88. __________________________________________________________________________________ 
89. __________________________________________________________________________________ 
90. $_______ SUBTOTAL (add lines 70 through 89)
 
MONTHLY PAYMENTS TO CREDITORS:  (only when payments are currently made by you on outstanding 
balances) List only last 4 digits of account numbers. 
NAME OF CREDITOR(s):   
91. $_________________________________________________________________________________ 
92. __________________________________________________________________________________ 
93. __________________________________________________________________________________ 
94. __________________________________________________________________________________ 
95. __________________________________________________________________________________ 
96. __________________________________________________________________________________ 
97. __________________________________________________________________________________ 
98. __________________________________________________________________________________ 
99. __________________________________________________________________________________ 
100. _________________________________________________________________________________ 
101. _________________________________________________________________________________ 
102. _________________________________________________________________________________ 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
112 
103. _________________________________________________________________________________ 
104. $_______ SUBTOTAL (add lines 91 through 103)
105. $_______TOTAL MONTHLY EXPENSES:(add lines 25, 35, 58, 63, 69, 90, and 104 of Section II, 
Expenses)    
 
SUMMARY 
106. $_______ TOTAL PRESENT MONTHLY NET INCOME (from line 27 of SECTION I.  INCOME) 
107. $_______ TOTAL MONTHLY EXPENSES (from line 105 above) 
 
108. $_______ SURPLUS (If line 106 is more than line 107, subtract line 107 from line 106.  This is the 
amount of your surplus.  Enter that amount here.) 
109. ($_______) (DEFICIT) (If line 107 is more than line 106, subtract line 106 from line 107.  This is the 
amount of your deficit.  Enter that amount here.) 
SECTION III.  ASSETS AND LIABILITIES 
A. ASSETS  (This is where you list what you OWN.) 
INSTRUCTIONS: 
STEP 1:  In column A, list a description of each separate item owned by you (and/or your spouse, if 
this is a petition for dissolution of marriage).  Blank spaces are provided if you need to list more than 
one of an item.  
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any item 
that you are requesting the judge award to you. 
STEP 3:  In column B, write what you believe to be the current fair market value of all items listed.   
STEP 4:  Use column C only if this is a petition for dissolution of marriage and you believe an item 
is “nonmarital,” meaning it belongs to only one of you and should not be divided.  You should 
indicate to whom you believe the item belongs.  (Typically, you will only use Column C if property 
was owned by one spouse before the marriage.  See the “General Information for Self-Represented 
Litigants” found at the beginning of these forms and section 61.075(1), Florida Statutes, for 
definitions of “marital” and “nonmarital” assets and liabilities.) 
 
A 
ASSETS:  DESCRIPTION OF ITEM(S) 
 
LIST ONLY LAST 4 DIGITS OF ACCOUNT NUMBERS. 
Check the box next to any asset(s) which you are requesting the judge award 
to you. 
 
 
B 
Current 
Fair 
Market 
Value 
 
C 
Nonmarital 
(Check correct 
column) 
 
husband 
 
wife 
 
 
Cash (on hand) 
 
$ 
 
 
 
 
 
 
Cash (in banks or credit unions) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stocks/Bonds 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Notes (money owed to you in writing) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Money owed to you (not evidenced by a note) 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
113 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Real estate: (Home) 
 
 
 
 
 
 
 
 
(Other) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Business interests 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Automobiles 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Boats 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other vehicles 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retirement plans (Profit Sharing, Pension, IRA, 401(k)s, etc.) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Furniture & furnishings in home 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Furniture & furnishings elsewhere 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Collectibles 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Jewelry 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Life insurance (cash surrender value) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
114 
 
 
B. LIABILITIES/DEBTS  (This is where you list what you OWE.) 
INSTRUCTIONS: 
STEP 1:  In column A, list a description of each separate debt owed by you (and/or your spouse, if 
this is a petition for dissolution of marriage).  Blank spaces are provided if you need to list more than 
one of an item. 
STEP 2: If this is a petition for dissolution of marriage, check the box in Column A next to any debt(s) 
for which you believe you should be responsible. 
STEP 3:  In column B, write what you believe to be the current amount owed for all items listed. 
STEP 4:  Use column C only if this is a petition for dissolution of marriage and you believe an item 
is “nonmarital,” meaning the debt belongs to only one of you and should not be divided.  You 
should indicate to whom you believe the debt belongs. (Typically, you will only use Column C if the 
debt was owed by one spouse before the marriage.  See the “General Information for Self-
Represented Litigants” found at the beginning of these forms and section 61.075(1), Florida 
Statutes, for definitions of “marital” and “nonmarital” assets and liabilities.) 
 
 
 
 
 
 
 
 
 
 
 
Sporting and entertainment (T.V., stereo, etc.) equipment 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other assets 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Assets  (add column B) 
 
$ 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
115 
 
 
A 
LIABILITIES:  DESCRIPTION OF ITEM(S) 
 
LIST ONLY LAST FOUR DIGITS OF ACCOUNT NUMBERS. 
Check the box next to any debt(s) for which you believe you should be 
responsible. 
 
 
B 
Current 
Amount 
Owed 
 
C 
Nonmarital 
(Check correct 
column) 
 
husband 
 
wife 
 
 
Mortgages on real estate: First mortgage on home 
 
$ 
 
 
 
 
 
 
Second mortgage on home 
 
 
 
 
 
 
 
 
Other mortgages 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Charge/credit card accounts 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Auto loan 
 
 
 
 
 
 
 
 
Auto loan 
 
 
 
 
 
 
 
 
Bank/Credit Union loans 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Money you owe (not evidenced by a note) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Judgments 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Debts  (add column B)  
 
$    
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
116 
 
C. NET WORTH  (excluding contingent assets and liabilities) 
 
$_______Total Assets  (enter total of Column B in Asset Table; Section A) 
   
$_______Total Liabilities (enter total of Column B in Liabilities Table; Section B)   
$_______TOTAL NET WORTH  (Total Assets minus Total Liabilities)  
(excluding contingent assets and liabilities)  
 
 
  
 
 
D. CONTINGENT ASSETS AND LIABILITIES 
INSTRUCTIONS: 
If you have any POSSIBLE assets (income potential, accrued vacation or sick leave, bonus, 
inheritance, etc.) or POSSIBLE liabilities (possible lawsuits, future unpaid taxes, contingent tax 
liabilities, debts assumed by another), you must list them here. 
  
A 
Contingent Assets 
 
Check the box next to any contingent asset(s) which you are requesting the 
judge award to you. 
 
B 
 
Possible 
Value 
 
C 
Nonmarital 
(Check correct 
column) 
 
husband 
wife 
 
 
 
 
$ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Contingent Assets 
 
$ 
 
 
 
 
 
  
A 
Contingent Liabilities 
 
Check the box next to any contingent debt(s) for which you believe you 
should be responsible. 
 
 
 
B 
 
Possible 
Amount 
Owed 
 
 
C 
Nonmarital 
(Check correct 
column) 
 husband 
wife 
 
 
 
 
$ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Total Contingent Liabilities 
 
$  
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
117 
 
 
 
E. CHILD SUPPORT GUIDELINES WORKSHEET.  Florida Family Law Rules of Procedure Form 12.902(e), 
Child Support Guidelines Worksheet, MUST be filed with the court at or prior to a hearing to 
establish or modify child support. This requirement cannot be waived by the parties. 
[Check one only] 
_____ A Child Support Guidelines Worksheet IS or WILL BE filed in this case. This case involves the 
establishment or modification of child support. 
_____ A Child Support Guidelines Worksheet IS NOT being filed in this case. The establishment or 
modification of child support is not an issue in this case. 
 
I certify that a copy of this financial affidavit was: (    ) mailed, (    ) faxed and mailed, or (    ) 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:  
 
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 Family Law Rules of Procedure Form 12.902(c), Family Law Financial Affidavit (10/11) 
118 
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 [check only one]       petitioner or       respondent, fill out this form.
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet  
(10/11) 
119 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE 
FORM 12.902(e), CHILD SUPPORT GUIDELINES WORKSHEET (10/11) 
 
When should this form be used? 
 
You should complete this worksheet if child support is being requested in your case.  If you know 
the income of the other party, this worksheet should accompany your financial affidavit.  If you do 
not know the other party’s income, this form must be completed after the other party files his or 
her financial affidavit, and serves a copy on you. 
 
This form should be typed or printed in black ink.  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, 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 section 61.30, Florida Statutes. 
 
Special notes... 
 
If  you want to keep your address confidential because you are the victim of sexual battery, 
aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, , 
do not enter the address, telephone, and fax information at the bottom of this form.  Instead, file a 
Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 
12.980(h). 
 
The chart below contains the guideline amounts that you should use when calculating child support.  
This amount is based on the number of children and the combined income of the parents, and it is 
divided between the parents in direct proportion to their income or earning capacity.  From time to 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet  
(10/11) 
120 
time, some of the amounts in the child support guidelines chart will change.  Be sure you have the 
most recent version of the chart before using it. 
Because the guidelines are based on monthly amounts, it may be necessary to convert some income 
and expense figures from other frequencies to monthly.  You should do this as follows: 
 
If payment is twice per month 
Payment amount x 
2 
= 
Monthly amount 
 
If payment is every two weeks 
Payment amount x 
26 = 
Yearly amount due 
Yearly amount 
÷ 
12 = 
Monthly amount 
 
If payment is weekly 
Weekly amount 
x 
52 = 
Yearly amount due 
Yearly amount 
÷ 
12 = 
Monthly amount 
 
If you or the other parent request that the court award an amount that is different than the 
guideline amount, you must also complete and attach a Motion to Deviate from Child Support 
Guidelines, Florida Supreme Court Approved Family Law Form 12.943. 
 
Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out 
these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
121 
CHILD SUPPORT GUIDELINES CHART 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
 
 
 
 
 
 
 
800.00 
850.00 
190 
202 
211 
257 
212 
259 
216 
262 
218 
265 
220 
268 
900.00 
213 
302 
305 
309 
312 
315 
950.00 
224 
347 
351 
355 
359 
363 
1000.00 
235 
365 
397 
402 
406 
410 
1050.00 
246 
382 
443 
448 
453 
458 
1100.00 
258 
400 
489 
495 
500 
505 
1150.00 
269 
417 
522 
541 
547 
553 
1200.00 
280 
435 
544 
588 
594 
600 
1250.00 
290 
451 
565 
634 
641 
648 
1300.00 
300 
467 
584 
659 
688 
695 
1350.00 
310 
482 
603 
681 
735 
743 
1400.00 
320 
498 
623 
702 
765 
790 
1450.00 
330 
513 
642 
724 
789 
838 
1500.00 
340 
529 
662 
746 
813 
869 
1550.00 
350 
544 
681 
768 
836 
895 
1600.00 
360 
560 
701 
790 
860 
920 
1650.00 
370 
575 
720 
812 
884 
945 
1700.00 
380 
591 
740 
833 
907 
971 
1750.00 
390 
606 
759 
855 
931 
996 
1800.00 
400 
622 
779 
877 
955 
1022 
1850.00 
410 
638 
798 
900 
979 
1048 
1900.00 
421 
654 
818 
923 
1004 
1074 
1950.00 
431 
670 
839 
946 
1029 
1101 
2000.00 
442 
686 
859 
968 
1054 
1128 
2050.00 
452 
702 
879 
991 
1079 
1154 
2100.00 
463 
718 
899 
1014 
1104 
1181 
2150.00 
473 
734 
919 
1037 
1129 
1207 
2200.00 
484 
751 
940 
1060 
1154 
1234 
2250.00 
494 
767 
960 
1082 
1179 
1261 
2300.00 
505 
783 
980 
1105 
1204 
1287 
2350.00 
515 
799 
1000 
1128 
1229 
1314 
2400.00 
526 
815 
1020 
1151 
1254 
1340 
2450.00 
536 
831 
1041 
1174 
1279 
1367 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
122 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
2500.00 
547 
847 
1061 
1196 
1304 
1394 
2550.00 
557 
864 
1081 
1219 
1329 
1420 
2850.00 
616 
956 
1197 
1349 
1471 
1573 
2900.00 
626 
971 
1215 
1370 
1494 
1598 
2950.00 
635 
986 
1234 
1391 
1517 
1622 
3000.00 
644 
1001 
1252 
1412 
1540 
1647 
3050.00 
654 
1016 
1271 
1433 
1563 
1671 
3100.00 
663 
1031 
1289 
1453 
1586 
1695 
3150.00 
673 
1045 
1308 
1474 
1608 
1720 
3200.00 
682 
1060 
1327 
1495 
1631 
1744 
3250.00 
691 
1075 
1345 
1516 
1654 
1769 
3300.00 
701 
1090 
1364 
1537 
1677 
1793 
3350.00 
710 
1105 
1382 
1558 
1700 
1818 
3400.00 
720 
1120 
1401 
1579 
1723 
1842 
3450.00 
729 
1135 
1419 
1599 
1745 
1867 
3500.00 
738 
1149 
1438 
1620 
1768 
1891 
3550.00 
748 
1164 
1456 
1641 
1791 
1915 
3600.00 
757 
1179 
1475 
1662 
1814 
1940 
3650.00 
767 
1194 
1493 
1683 
1837 
1964 
3700.00 
776 
1208 
1503 
1702 
1857 
1987 
3750.00 
784 
1221 
1520 
1721 
1878 
2009 
3800.00 
793 
1234 
1536 
1740 
1899 
2031 
3850.00 
802 
1248 
1553 
1759 
1920 
2053 
3900.00 
811 
1261 
1570 
1778 
1940 
2075 
3950.00 
819 
1275 
1587 
1797 
1961 
2097 
4000.00 
828 
1288 
1603 
1816 
1982 
2119 
4050.00 
837 
1302 
1620 
1835 
2002 
2141 
4100.00 
846 
1315 
1637 
1854 
2023 
2163 
4150.00 
854 
1329 
1654 
1873 
2044 
2185 
4200.00 
863 
1342 
1670 
1892 
2064 
2207 
4250.00 
872 
1355 
1687 
1911 
2085 
2229 
4300.00 
881 
1369 
1704 
1930 
2106 
2251 
4350.00 
889 
1382 
1721 
1949 
2127 
2273 
4400.00 
898 
1396 
1737 
1968 
2147 
2295 
4450.00 
907 
1409 
1754 
1987 
2168 
2317 
4500.00 
916 
1423 
1771 
2006 
2189 
2339 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
123 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
4550.00 
924 
1436 
1788 
2024 
2209 
2361 
4600.00 
933 
1450 
1804 
2043 
2230 
2384 
4650.00 
942 
1463 
1821 
2062 
2251 
2406 
4700.00 
951 
1477 
1838 
2081 
2271 
2428 
4750.00 
959 
1490 
1855 
2100 
2292 
2450 
4800.00 
968 
1503 
1871 
2119 
2313 
2472 
4850.00 
977 
1517 
1888 
2138 
2334 
2494 
4900.00 
986 
1530 
1905 
2157 
2354 
2516 
4950.00 
993 
1542 
1927 
2174 
2372 
2535 
5000.00 
1000 
1551 
1939 
2188 
2387 
2551 
5050.00 
1006 
1561 
1952 
2202 
2402 
2567 
5100.00 
1013 
1571 
1964 
2215 
2417 
2583 
5150.00 
1019 
1580 
1976 
2229 
2432 
2599 
5200.00 
1025 
1590 
1988 
2243 
2447 
2615 
5250.00 
1032 
1599 
2000 
2256 
2462 
2631 
5300.00 
1038 
1609 
2012 
2270 
2477 
2647 
5350.00 
1045 
1619 
2024 
2283 
2492 
2663 
5400.00 
1051 
1628 
2037 
2297 
2507 
2679 
5450.00 
1057 
1638 
2049 
2311 
2522 
2695 
5500.00 
1064 
1647 
2061 
2324 
2537 
2711 
5550.00 
1070 
1657 
2073 
2338 
2552 
2727 
5600.00 
1077 
1667 
2085 
2352 
2567 
2743 
5650.00 
1083 
1676 
2097 
2365 
2582 
2759 
5700.00 
1089 
1686 
2109 
2379 
2597 
2775 
5750.00 
1096 
1695 
2122 
2393 
2612 
2791 
5800.00 
1102 
1705 
2134 
2406 
2627 
2807 
5850.00 
1107 
1713 
2144 
2418 
2639 
2820 
5900.00 
1111 
1721 
2155 
2429 
2651 
2833 
5950.00 
1116 
1729 
2165 
2440 
2663 
2847 
6000.00 
1121 
1737 
2175 
2451 
2676 
2860 
6050.00 
1126 
1746 
2185 
2462 
2688 
2874 
6100.00 
1131 
1754 
2196 
2473 
2700 
2887 
6150.00 
1136 
1762 
2206 
2484 
2712 
2900 
6200.00 
1141 
1770 
2216 
2495 
2724 
2914 
6250.00 
1145 
1778 
2227 
2506 
2737 
2927 
6300.00 
1150 
1786 
2237 
2517 
2749 
2941 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
124 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
6350.00 
1155 
1795 
2247 
2529 
2761 
2954 
6400.00 
1160 
1803 
2258 
2540 
2773 
2967 
6450.00 
1165 
1811 
2268 
2551 
2785 
2981 
6500.00 
1170 
1819 
2278 
2562 
2798 
2994 
6550.00 
1175 
1827 
2288 
2573 
2810 
3008 
6600.00 
1179 
1835 
2299 
2584 
2822 
3021 
6650.00 
1184 
1843 
2309 
2595 
2834 
3034 
6700.00 
1189 
1850 
2317 
2604 
2845 
3045 
6750.00 
1193 
1856 
2325 
2613 
2854 
3055 
6800.00 
1196 
1862 
2332 
2621 
2863 
3064 
6850.00 
1200 
1868 
2340 
2630 
2872 
3074 
6900.00 
1204 
1873 
2347 
2639 
2882 
3084 
6950.00 
1208 
1879 
2355 
2647 
2891 
3094 
7000.00 
1212 
1885 
2362 
2656 
2900 
3103 
7050.00 
1216 
1891 
2370 
2664 
2909 
3113 
7100.00 
1220 
1897 
2378 
2673 
2919 
3123 
7150.00 
1224 
1903 
2385 
2681 
2928 
3133 
7200.00 
1228 
1909 
2393 
2690 
2937 
3142 
7250.00 
1232 
1915 
2400 
2698 
2946 
3152 
7300.00 
1235 
1921 
2408 
2707 
2956 
3162 
7350.00 
1239 
1927 
2415 
2716 
2965 
3172 
7400.00 
1243 
1933 
2423 
2724 
2974 
3181 
7450.00 
1247 
1939 
2430 
2733 
2983 
3191 
7500.00 
1251 
1945 
2438 
2741 
2993 
3201 
7550.00 
1255 
1951 
2446 
2750 
3002 
3211 
7600.00 
1259 
1957 
2453 
2758 
3011 
3220 
7650.00 
1263 
1963 
2461 
2767 
3020 
3230 
7700.00 
1267 
1969 
2468 
2775 
3030 
3240 
7750.00 
1271 
1975 
2476 
2784 
3039 
3250 
7800.00 
1274 
1981 
2483 
2792 
3048 
3259 
7850.00 
1278 
1987 
2491 
2801 
3057 
3269 
7900.00 
1282 
1992 
2498 
2810 
3067 
3279 
7950.00 
1286 
1998 
2506 
2818 
3076 
3289 
8000.00 
1290 
2004 
2513 
2827 
3085 
3298 
8050.00 
1294 
2010 
2521 
2835 
3094 
3308 
8100.00 
1298 
2016 
2529 
2844 
3104 
3318 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
125 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
8150.00 
1302 
2022 
2536 
2852 
3113 
3328 
8200.00 
1306 
2028 
2544 
2861 
3122 
3337 
8250.00 
1310 
2034 
2551 
2869 
3131 
3347 
8300.00 
1313 
2040 
2559 
2878 
3141 
3357 
8350.00 
1317 
2046 
2566 
2887 
3150 
3367 
8400.00 
1321 
2052 
2574 
2895 
3159 
3376 
8450.00 
1325 
2058 
2581 
2904 
3168 
3386 
8500.00 
1329 
2064 
2589 
2912 
3178 
3396 
8550.00 
1333 
2070 
2597 
2921 
3187 
3406 
8600.00 
1337 
2076 
2604 
2929 
3196 
3415 
8650.00 
1341 
2082 
2612 
2938 
3205 
3425 
8700.00 
1345 
2088 
2619 
2946 
3215 
3435 
8750.00 
1349 
2094 
2627 
2955 
3224 
3445 
8800.00 
1352 
2100 
2634 
2963 
3233 
3454 
8850.00 
1356 
2106 
2642 
2972 
3242 
3464 
8900.00 
1360 
2111 
2649 
2981 
3252 
3474 
8950.00 
1364 
2117 
2657 
2989 
3261 
3484 
9000.00 
1368 
2123 
2664 
2998 
3270 
3493 
9050.00 
1372 
2129 
2672 
3006 
3279 
3503 
9100.00 
1376 
2135 
2680 
3015 
3289 
3513 
9150.00 
1380 
2141 
2687 
3023 
3298 
3523 
9200.00 
1384 
2147 
2695 
3032 
3307 
3532 
9250.00 
1388 
2153 
2702 
3040 
3316 
3542 
9300.00 
1391 
2159 
2710 
3049 
3326 
3552 
9350.00 
1395 
2165 
2717 
3058 
3335 
3562 
9400.00 
1399 
2171 
2725 
3066 
3344 
3571 
9450.00 
1403 
2177 
2732 
3075 
3353 
3581 
9500.00 
1407 
2183 
2740 
3083 
3363 
3591 
9550.00 
1411 
2189 
2748 
3092 
3372 
3601 
9600.00 
1415 
2195 
2755 
3100 
3381 
3610 
9650.00 
1419 
2201 
2763 
3109 
3390 
3620 
9700.00 
1422 
2206 
2767 
3115 
3396 
3628 
9750.00 
1425 
2210 
2772 
3121 
3402 
3634 
9800.00 
1427 
2213 
2776 
3126 
3408 
3641 
9850.00 
1430 
2217 
2781 
3132 
3414 
3647 
9900.00 
1432 
2221 
2786 
3137 
3420 
3653 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines 
Worksheet  
(10/11) 
126 
Combined 
Monthly 
Available 
Income 
 
One 
Child 
 
Two 
Children 
 
Three 
Children 
 
Four 
Children 
 
Five 
Children 
 
Six 
Children 
 
9950.00 
1435 
2225 
2791 
3143 
3426 
3659 
10000.00 
1437 
2228 
2795 
3148 
3432 
3666 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
127 
IN THE CIRCUIT COURT OF THE                                               JUDICIAL CIRCUIT, 
IN AND FOR                                                  COUNTY, FLORIDA 
 
Case No.:  
 
Division:  
 
 
 
 
 
, 
                        Petitioner, 
                               and 
 
 
 
 
 
, 
                     Respondent. 
 
 
NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET 
 
PLEASE TAKE NOTICE, that {name}                                                           , is filing his/her Child 
Support Guidelines Worksheet attached and labeled Exhibit 1. 
CERTIFICATE OF SERVICE 
I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was 
[check 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:  
 
 
 
 
Date:   
 
 
 
 
 
 
 
 
Signature of Party 
Printed Name:  
 
Address:  
 
City, State, Zip:  
 
Telephone Number:  
 
Fax Number:  
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
128 
 
CHILD SUPPORT GUIDELINES WORKSHEET 
 
A. FATHER 
B. MOTHER 
TOTAL 
1. Present Net Monthly Income 
Enter the amount from line number 
27, Section I of Florida Family Law 
Rules of Procedure Form 12.902(b) 
or (c), Financial Affidavit. 
 
 
 
2.  Basic Monthly Obligation  
There is (are) {number} ____  minor 
child(ren) common to the parties.  
Using the total amount from line 1, 
enter the appropriate amount from 
the child support  guidelines chart. 
 
 
 
3. Percent of Financial Responsibility 
Divide the amount on line 1A by the 
total amount on line 1 to get 
Father’s percentage financial 
responsibility.  Enter answer on line 
3A.  Divide the amount on line 1B by 
the total amount on line 1 to get 
Mother’s percentage financial 
responsibility.  Enter answer on line 
3B. 
% 
% 
 
4. Share of Basic Monthly Obligation 
Multiply the number on line 2 by the 
percentage on line 3A to get 
Father’s share of basic obligation.  
Enter answer on line 4A. 
Multiply the number on line 2 by the 
percentage on line 3B to get 
Mother’s share of basic obligation.  
Enter answer on line 4B. 
 
 
 
Additional Support — Health Insurance, Child Care & Other 
5.  
a. 100% of Monthly Child Care 
Costs 
[Child care costs should not 
exceed the level required to 
provide quality care from a 
licensed source.  See section 
61.30(7), Fla. Stat. for more 
information.] 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
129 
CHILD SUPPORT GUIDELINES WORKSHEET 
 
A. FATHER 
B. MOTHER 
TOTAL 
b. Total Monthly Child(ren)’s 
Health Insurance Cost 
[This is only amounts actually 
paid for health insurance on the 
child(ren).] 
 
 
 
c. Total Monthly Child(ren)’s 
Noncovered Medical, Dental and 
Prescription Medication Costs 
 
 
 
d. Total Monthly Child Care & 
Health Costs [Add lines 
5a+5b+5c] 
 
 
 
6. Additional Support Payments 
Multiply the number on line 5d by 
the percentage on line 3A to 
determine the Father’s share. 
Enter answer on line 6A. 
Multiply the number on line 5d by 
the percentage on line 3B to 
determine the Mother’s share. 
Enter answer on line 6B. 
 
 
 
Statutory Adjustments/Credits 
7.  
a. Monthly child care payments 
actually made 
 
 
 
b. Monthly health insurance 
payments actually made  
 
 
 
c. Other payments/credits actually 
made for any noncovered 
medical, dental and prescription 
medication expenses of the 
child(ren) not ordered to be 
separately paid on a percentage 
basis. [See § 61.30 (8), Florida 
Statutes] 
 
 
 
8. Total Support Payments actually made 
[Add 7a through 7c] 
 
 
 
9. MINIMUM CHILD SUPPORT 
OBLIGATION FOR EACH PARENT 
[Line 4 plus line 6; minus line 8] 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
130 
CHILD SUPPORT GUIDELINES WORKSHEET 
 
A. FATHER 
B. MOTHER 
TOTAL 
Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20 
percent of the overnights in the year (73 overnights in the year), complete Nos. 10 through 21 
10. Basic Monthly Obligation x 150%  
[ Multiply line 2 by 1.5] 
 
 
 
11. Increased Basic Obligation for each 
parent  
Multiply the number on line 10 by 
the percentage on line 3A to 
determine the Father’s share. 
Enter answer on line 11A. 
Multiply the number on line 10 by 
the percentage on line 3B to 
determine the Mother’s share. 
Enter answer on line 11B. 
 
 
 
12. Percentage of overnight stays with 
each parent 
The child(ren) spend(s)  ______        
overnight stays with the father each 
year.  Using the number on the 
above line, multiply it by 100 and 
divide by 365.  Enter this number on 
line 12A. 
The child(ren) spend(s)   ______         
overnight stays with the mother 
each year.  Using the number on the 
above line, multiply it by 100 and 
divide by 365.  Enter this number on 
line 12B. 
% 
%  
13. Parent’s support multiplied by other 
Parent’s percentage of overnights 
[Multiply line 11A by line 12B.  Enter 
this number in 13A.  Multiply line 
11B by line 12A.  Enter this number 
in 13B.] 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
131 
 
Additional Support — Health Insurance, Child Care & Other 
14.  
a. Total Monthly Child Care Costs  
[Child care costs should not 
exceed the level required to 
provide quality care from a 
licensed source.  See section 
61.30(7), Fla. Stat. for more 
information.] 
 
 
 
b. Total Monthly Child(ren)’s 
Health Insurance Cost.  [This is 
only amounts actually paid for 
health insurance on the 
child(ren).] 
 
 
 
c. Total Monthly Child(ren)’s 
Noncovered Medical, Dental and 
Prescription Costs. 
 
 
 
d. Total Monthly Child Care & 
Health Costs [Add lines 
14a+14b+14c] 
 
 
 
 
15. Additional Support Payments 
Multiply the number on line 14d by 
the percentage on line 3A to 
determine the Father’s share. 
Enter answer on line 15A. 
Multiply the number on line 14d by 
the percentage on line 3B to 
determine the Mother’s share. 
Enter answer on line 15B. 
 
 
 
Statutory Adjustments/Credits 
16.  
a. Monthly child care payments 
actually made 
 
 
 
b. Monthly health insurance 
payments actually made 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (10/11) 
132 
c. Other payments/credits actually 
made for any noncovered 
medical, dental and prescription 
medication expenses of the 
child(ren) not ordered to be 
separately paid on a percentage 
basis. [See § 61.30 (8), Florida 
Statutes] 
 
 
 
 
17. Total Support Payments actually 
made [Add 16a through 16c] 
 
 
 
18. Total Additional Support Transfer 
Amount [Line 15 minus line 17; Enter 
any negative number as zero] 
 
 
 
 
19. Total Child Support Owed from 
Father to Mother [Add line 13A+18A] 
 
 
 
20. Total Child Support Owed from 
Mother to Father [Add line 13B+18B] 
 
 
 
21. Actual Child Support to Be Paid. 
[Comparing lines 19 and 20, Subtract 
the smaller amount owed from the 
larger amount owed and enter the 
result in the column for the parent 
that owes the larger amount of 
support] 
  $ 
$ 
 
 
ADJUSTMENTS TO GUIDELINES AMOUNT.  If you or the other parent is requesting the Court to award a 
child support amount that is more or less than the child support guidelines, you must complete and file 
Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 
12.943. 
[check one only] 
a. __ Deviation from the guidelines amount is requested.  The Motion to Deviate from Child 
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached. 
b. __ Deviation from the guidelines amount is NOT requested.  The Motion to Deviate from Child 
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached. 
 
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 [check one only]       petitioner or       respondent, fill out this form.
 
 
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)(10/11)  
133 
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)(10/11) 
 
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 
 
 
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)(10/11)  
134 
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... 
 
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 12.9.995(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 
 
 
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)(10/11)  
135 
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 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.  Equitable 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 
 
 
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)(10/11)  
136 
file a Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(a),   12.995(b), or 
12.995(c) 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. 
 
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.
 
 
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)(10/11)  
137 
 
 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
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. 
 
 
 
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)(10/11)  
138 
 
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 
Date of marriage: {month, day, year} ___________________________________________________ 
Date of separation: {month, day, year} _____________________ (indicate if approximate) 
 
4. DEPENDENT OR MINOR CHILD(REN) 
[Choose 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 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
c. ___The minor child(ren) born or conceived during the marriage who are not common to both 
parties are: 
Name 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
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 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
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 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. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or 
(c) (   ) is filed or (   ) will be timely filed. 
 
 
 
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)(10/11)  
139 
 
8. This counterpetition for dissolution of marriage should be granted because: 
[Choose only one] 
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. 
 
SECTION I.  MARITAL ASSETS AND LIABILITIES 
[Choose only one] 
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. 
[Choose 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) 
[Choose only one] 
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 that 
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): __________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
 
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)(10/11)  
140 
 
__________________________________________________________________________________ 
[Please indicate if applicable] (    ) Respondent requests life insurance on Petitioner’s life, provided 
by Petitioner, 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: 
[Choose only one] 
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 ___ 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 as follows:  ______________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
Explain why this request is in the best interests of the child(ren): __________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
SECTION IV.  CHILD SUPPORT [Choose 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 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)(10/11)  
141 
 
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. ___ 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: 
[Choose only one] 
a. ___ Father. 
b. ___ Mother. 
 
5. ___Respondent requests that uninsured medical/dental expenses for the child(ren) be paid: 
[Choose only one] 
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. 
 
 
 
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)(10/11)  
142 
 
SECTION V.  OTHER 
1. If Respondent is also the Wife,  please indicate  by either  (    ) yes  OR   (    ) no   whether 
Respondent/Wife wants to be known by her former name, which was {full legal name} : 
__________________________________________________________________________________ 
 
2. Other relief {specify}: ________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
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: 
[Choose 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 [Choose only one] (    ) mailed (    ) faxed and mailed 
(    ) hand delivered to the person(s) listed below on {date} ______________. 
 
Petitioner or his/her attorney: 
Printed 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 
 
 
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)(10/11)  
143 
 
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)(10/11)  
144 
 
 
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, whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} ____________________,  
helped {name} _______________________________, who is the petitioner, fill out this form.
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(2), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
145 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.903(c)(2), ANSWER TO PETITION AND COUNTERPETITION FOR 
DISSOLUTION OF MARRIAGE WITH PROPERTY BUT NO DEPENDENT OR 
MINOR CHILD(REN)(10/11) 
 
When should this form be used? 
 
This form should be used when you are responding to a petition for dissolution of marriage with 
property but no 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). 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(2), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
146 
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.  
For further information, see chapter 61, Florida Statutes. 
 
Special notes... 
 
With this form, you must also file the following: 
 
 
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 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.) 
 
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. Equitable does not necessarily mean equal. Many factors, including 
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. 
 
Temporary Relief...  If you need temporary relief regarding temporary use of assets, temporary 
responsibility for liabilities, or temporary alimony, 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 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.903(c)(2), Answer to Petition and 
Counterpetition for Dissolution of Marriage with Property but No Dependent or Minor Child(ren) (10/11) 
147 
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 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. Any issues on which you are unable to agree 
will be considered contested and settled by the judge at the final hearing. 
 
Final Judgment Forms...  These family law forms contain a 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 a 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). 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. 
 
 
Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for 
Dissolution of Marriage with Property but No Dependent or Minor Children (10/11) 
148 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
ANSWER TO PETITION AND COUNTERPETITION FOR DISSOLUTION OF MARRIAGE 
WITH PROPERTY BUT NO 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 PROPERTY BUT NO 
DEPENDENT OR 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 [ Choose only one] (    ) is (    ) is not a member of the military service. 
Respondent [Choose only one] (    ) is (    ) is not a member of the military service. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for 
Dissolution of Marriage with Property but No Dependent or Minor Children (10/11) 
149 
3. MARRIAGE HISTORY 
Date of marriage: {month, day, year} ___________________________________________________ 
4. THERE ARE NO MINOR (UNDER 18) OR DEPENDENT CHILD(REN) COMMON TO BOTH PARTIES AND 
THE WIFE IS NOT PREGNANT. 
 
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), is filed with this counterpetition. 
 
6. This counterpetition for dissolution of marriage should be granted because: 
[Choose only one] 
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. 
 
SECTION I.  MARITAL ASSETS AND LIABILITIES 
[Choose only one] 
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. 
[Choose 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 No 
Dependent or Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.902(f)(2). 
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) 
[Choose only one] 
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): __________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for 
Dissolution of Marriage with Property but No Dependent or Minor Children (10/11) 
150 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
[ Choose if applies] (    ) Respondent requests life insurance on Petitioner’s life, provided by 
Petitioner, to secure such support. 
 
SECTION III.  OTHER 
1. [If Respondent is also the Wife, Choose one only]  (    ) yes (    ) no   Respondent/Wife wants to be 
known by her former name, which was {full legal name} _________________________. 
 
2. Other relief {specify}: ________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
SECTION IV.  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: 
[Choose 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. ____ restoring Wife=s former name as requested in Section III of this petition; 
4. ____ awarding other relief as requested in Section III of this petition; and any other terms the Court 
deems necessary. 
 
I certify that a copy of this document was [ Choose one only] (    ) mailed  
(    ) faxed and mailed (    ) hand delivered to the person(s) listed below on {date}           . 
 
Petitioner or his/her attorney: 
Printed Name: ________________________________ 
Address: _____________________________________ 
City, State, Zip: ________________________________ 
Fax Number: __________________________________ 
 
 
 
Florida Supreme Court Approved Family Law Form 12.903(c)(2) Answer to Petition and Counterpetition for 
Dissolution of Marriage with Property but No Dependent or Minor Children (10/11) 
151 
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 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 
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,  whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} ______,  
helped {name} _______________________________, who is the petitioner, fill out this 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) (10/11) 
152 
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) (10/11) 
 
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: 
 
 
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) (10/11) 
153 
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 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 
 
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) (10/11) 
154 
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) 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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (10/11) 
155 
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 
(    ) 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 [Choose only one]     (    ) is (    ) is not a member of the military service. 
Respondent [Choose only one] (    ) is (    ) is not a member of the military service. 
 
3. MARRIAGE HISTORY 
a. Date of marriage: {month, day, year} _________________________ 
b. Date of separation: {month, day, year} ___________________(___Please indicate if 
approximate) 
 
4. MINOR CHILD(REN) 
[Choose 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 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (10/11) 
156 
c. ____ The minor child(ren) born or conceived during the marriage who are not common to both 
parties  are: 
Name 
Birth date 
______________________________________________________________________________ 
______________________________________________________________________________ 
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 
Birth date 
______________________________________________________________________________ 
_____________________________________________________________________________ 
 
5. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), if required, 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) 
[Choose only one] 
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): __________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________
[Choose if applies] (    )  Petitioner requests life insurance on Respondent’s life, provided by 
Respondent, to secure such support. 
 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (10/11) 
157 
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-sharing schedule, the Petitioner is entitled to child support. 
[Choose 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. 
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: [Choose only one] 
a. ___ Father. 
b. ___ Mother. 
 
4. ___ Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid: 
[Choose only one] 
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.)
 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (10/11) 
158 
Petitioner requests that the Court enter an order establishing support and: 
[Choose 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. 
 
 
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 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,  whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} ______,  
 
Florida Supreme Court Approved Family Law Form 12.904(a), Petition for Support Unconnected with Dissolution of 
Marriage with Dependent or Minor Child(ren) (10/11) 
159 
helped {name} _______________________________, who is the petitioner, fill out this form.
 
Instructions for Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected 
with Dissolution of Marriage with No Dependent or Minor Child(ren) (10/11) 
160 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.904(b), PETITION FOR SUPPORT UNCONNECTED WITH 
DISSOLUTION OF MARRIAGE WITH NO DEPENDENT OR MINOR 
CHILD(REN)(10/11) 
 
When should this form be used? 
 
This form may be used if you and your spouse are separated, but a dissolution of marriage has not been 
filed, and you are requesting alimony.  If a petition for dissolution has been filed, you should file a 
Motion for Temporary Support with No Dependent or Minor Child(ren), Florida Supreme Court 
Approved Family Law Form 12.947(c), 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 does not address the issues of property or debts.  It only deals with alimony. 
 
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 for Marriage with No 
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(b), Petition for Support Unconnected 
with Dissolution of Marriage with No Dependent or Minor Child(ren) (10/11) 
161 
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). 
 
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 the respondent, if not filed at the time of 
the petition.) 
 
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.) 
 
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.  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. 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected 
with Dissolution of Marriage with No Dependent or Minor Child(ren) (10/11) 
162 
Temporary Relief...  If you need temporary relief regarding alimony, 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 that form. 
Final Judgment Form...  These family law forms contain a Final Judgment of Support Unconnected with 
Dissolution of Marriage with No Dependent or Minor Child(ren), Florida Supreme Court Approved 
Family Law Form 12.994(b), 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.
 
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of 
Marriage with No Dependent or Minor Child(ren) (10/11) 
163 
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 NO DEPENDENT OR MINOR CHILD(REN) 
 
 
I, {full legal name} ______________________________________________________, the 
[ Choose only one] (    ) 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 [Choose only one] (    ) is (    ) is not a member of the military service. 
Respondent [Choose only one] (    ) is (    ) is not a member of the military service. 
 
3. MARRIAGE HISTORY 
Date of marriage: {month, day, year} ______________ 
Date of separation: {month, day, year} (Choose if approximate) ______________________________ 
 
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), if required, is, or will be filed. 
 
SECTION I.  SPOUSAL SUPPORT (ALIMONY) 
 
1. ____ 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} ______________  
__________________________________________________________________________________ 
 
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of 
Marriage with No Dependent or Minor Child(ren) (10/11) 
164 
 
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): ___________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
[indicate if applicable] (    ) Petitioner requests life insurance on Respondent’s life, provided by 
Respondent, to secure such support. 
 
SECTION II.  OTHER RELIEF 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
SECTION III.  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: 
Choose all that apply] 
a. ____ awarding spousal support (alimony) pursuant to Section I of this petition; 
b. ____ awarding other relief as specified in Section II of this petition; and any other terms the Court  
deems necessary. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.904(b), Petition for Support Unconnected with Dissolution of 
Marriage with No Dependent or Minor Child(ren) (10/11) 
165 
 
 
 
 
 
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 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, whose address is {street} _________________________, {city} ______________________, 
{state} ______________,{phone} ______, helped {name} _______________________________, who is 
the petitioner, fill out this form.
 
 
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 (10/11) 
166 
 
 
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 (10/11) 
 
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 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 
 
 
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 (10/11) 
167 
 
 
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 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 
 
 
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 (10/11) 
168 
 
 
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), (b), or (c).  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. 
 
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.
 
 
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  
(10/11) 
169 
 
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 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 [Choose 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 [Choose 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  [Choose 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 [Choose 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  
[ Choose all that apply] (    ) activated (    ) deployed (    ) temporarily assigned to military service as 
 
 
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  
(10/11) 
170 
 
follows:{explain}____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ 
 
6. This temporary modification/amendment is in the best interests of the child(ren).  
 
 
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 [Choose 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. ______________________________________________________________________________ 
 
 
 
 
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  
(10/11) 
171 
 
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 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,   whose address is{street} ____________________________________________, 
 {city} ______________________,{state} ______________,{phone} ______,  
helped {name} _______________________________, who is the petitioner, fill out this form.
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law 
Interrogatories for Original or Enforcement Proceedings (10/11) 
172 
 
 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE 
FORM 12.930(b), STANDARD FAMILY LAW INTERROGATORIES FOR 
ORIGINAL OR ENFORCEMENT PROCEEDINGS (10/11) 
 
When should this form be used? 
 
This form should be used to ask the other party in your case to answer certain standard 
questions in writing. These questions are called interrogatories, and they must relate to your 
case.  If the other party fails to answer the questions, you may ask the judge to order the other 
party to answer the questions.  (You cannot ask these questions before the petition has been 
filed.) 
 
The questions in this form should be used in original proceedings or enforcement proceedings 
and are meant to supplement the information provided in the Financial Affidavit, Florida Family 
Law Rules of Procedure Form 12.902(b) or (c). You should read all of the questions in this form 
to determine which questions, if any, the other party needs to answer in order to provide you 
with information not covered in the financial affidavit forms. If there are questions to which you 
already know the answer, you may choose not to ask them. 
 
This form should be typed or printed in black ink. You must complete the box at the beginning of 
this form to indicate which questions you are requesting that the other party answer. You 
should send an original and one copy of this form and the Notice of Service of Standard Family 
Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), to the other party.  
You should also keep a copy for your records. You shall not file this form with the clerk of the 
circuit court unless the answers are admitted into evidence by the court and are in compliance 
with Florida Rule of Judicial Administration 2.425. However, you must file the Notice of Service 
of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), 
to tell the court that you have sent this form 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.  For further information, see the instructions for Notice 
of Service of Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 
12.930(a), rules 12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure, and 
rules 1.280, 1.340, and 1.380, Florida Rules of Civil Procedure. 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law 
Interrogatories for Original or Enforcement Proceedings (10/11) 
173 
 
 
Special notes... 
 
In addition to the standard questions in this form, you may ask up to 10 additional questions.  
You should type or print legibly your additional questions on a separate sheet of paper and 
attach it to this form.  If you want to ask more than 10 additional questions, you will need to get 
permission from the judge. 
 
You may want to inform the other party of the following information:  As a general rule, within 
30 days after service of interrogatories, the other party must answer the questions in writing 
and mail (have postmarked) the answers to you.  His or her answers shall be written in the blank 
space provided after each separately numbered interrogatory.  If sufficient space is not 
provided, the answering party may attach additional papers with the answers and refer to them 
in the space provided in the interrogatories.  He or she should be sure to make a copy for 
him/herself.  All answers to these questions are made under oath or affirmation as to their 
truthfulness.  Each question must be answered separately and as completely as the available 
information permits.  The original of the answers to the interrogatories is to be provided to the 
requesting party.  DO NOT FILE THE ORIGINAL OR A COPY WITH THE CLERK OF THE COURT 
EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE 1.340(e) AND IN ACCORDANCE 
WITH THE REQUIREMENTS OF FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The other 
party may object to a question by writing the legal reason for the objection in the space 
provided.  He or she may also ask the court for a protective order granting him or her 
permission not to answer certain questions and protecting him or her from annoyance, 
embarrassment, apprehension, or undue burden or expense. If the other party fails to either 
answer or object to the questions within 30 days, he or she may be subject to court sanctions. 
 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill 
out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family 
Law Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill 
out these forms also must put his or her name, address, and telephone number on the bottom 
of the last page of every form he or she helps you complete. 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
174 
 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
 
Case No.:  
 
Division:  
 
      
                                                                        , 
Petitioner, 
 
and 
 
                                                                         , 
Respondent. 
 
 
STANDARD FAMILY LAW INTERROGATORIES 
FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS 
 
 
TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES 
I am requesting that the following standard questions be answered: [check all that apply] 
____1 
Background 
Information 
____2 
Education 
____3 
Employment 
____4 
Assets 
____ 5 
Liabilities 
Affidavit 
____6 
Miscellaneous 
____7 
Long Form 
 
 
 
 
 
 
 
 
   In addition, I am requesting that the attached {#} _________________ questions be answered. 
 
 
The answers to the following questions are intended to supplement the information provided in 
the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c). You should answer 
the group of questions indicated in the above shaded box. The questions should be answered in the 
blank space provided below each separately numbered question. If sufficient space is not provided, you 
may attach additional papers with the answers and refer to them in the space provided in the 
interrogatories.  You should be sure to make a copy for yourself. Each question must be answered 
separately and as completely as the available information permits. All answers are to be made under 
oath or affirmation as to their truthfulness. 
 
AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF THE 
COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC RECORD. 
INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE OTHER PARTY 
AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO INTERROGATORIES, WITH THE CLERK. 
 
I, {name of person answering interrogatories}  
, 
being sworn, certify that the following information is true: 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
175 
 
 
1. BACKGROUND INFORMATION: 
a. State your full legal name and any other name by which you have been known. 
b. State your present residence and telephone numbers. 
 
2. EDUCATION: 
a. List all business, commercial, and professional licenses that you have obtained. 
b. List all of your education including, but not limited to, vocational or specialized training, 
including the following: 
(1) name and address of each educational institution. 
(2) dates of attendance. 
(3) degrees or certificates obtained or anticipated dates of same. 
3. EMPLOYMENT: 
a. For each place of your employment or self-employment during the last 3 years, state the 
following: 
(1) name, address, and telephone number of your employer. 
(2) dates of employment. 
(3) job title and brief description of job duties. 
(4) starting and ending salaries. 
(5) name of your direct supervisor. 
(6) all benefits received, including, for example, health, life, and disability insurance; expense 
account; use of automobile or automobile expense reimbursement; reimbursement for 
travel, food, or lodging expenses; payment of dues in any clubs or associations; and pension 
or profit sharing plans. 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
176 
 
b. Other than as an employee, if you have been engaged in or associated with any business, 
commercial, or professional activity within the last 3 years that was not detailed above, state for 
each such activity the following: 
(1) name, address, and telephone number of each activity. 
(2) dates you were connected with such activity. 
(3) position title and brief description of activities. 
(4) starting and ending compensation. 
(5) name of all persons involved in the business, commercial, or professional activity with you. 
(6) all benefits and compensation received, including, for example, health, life, and disability 
insurance; expense account; use of automobile or automobile expense reimbursement; 
reimbursement for travel, food, or lodging expenses; payment of dues in any clubs or 
associations; and pension or profit sharing plans. 
c. If you have been unemployed at any time during the last 3 years, state the dates of 
unemployment. If you have not been employed at any time in the last 3 years, give the 
information requested above in question 3.a for your last period of employment. 
4. ASSETS: 
a. Real Estate.  State the street address, if any, and if not, the legal description of all real property 
that you own or owned during the last 3 years.  For each property, state the following: 
(1) the names and addresses of any other persons or entities holding any interest and their 
percentage of interest. 
(2) the purchase price, the cost of any improvements made since it was purchased, and the 
amount of any depreciation taken. 
(3) the fair market value on the date of your separation from your spouse. 
(4) the fair market value on the date of the filing of the petition for dissolution of marriage. 
b. Tangible Personal Property.  List all items of tangible personal property that are owned by you 
or in which you have had any interest during the last 3 years including, but not limited to, motor 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
177 
 
vehicles, tools, furniture, boats, jewelry, art objects or other collections, and collectibles whose 
fair market value exceeds $100. For each item, state the following: 
(1) the percentage and type interest you hold. 
(2) the names and addresses of any other persons or entities holding any interest. 
(3) the date you acquired your interest. 
(4) the purchase price. 
(5) the present fair market value. 
(6) the fair market value on the date of your separation from your spouse. 
(7) the fair market value on the date of the filing of the petition for dissolution of marriage. 
c. Intangible Personal Property.  Other than the financial accounts (checking, savings, money 
market, credit union accounts, retirement accounts, or other such cash management accounts) 
listed in the answers to interrogatories 4.d and 4.e below, list all items of intangible personal 
property that are owned by you or in which you have had any ownership interest (including closed 
accounts) within the last 3 years, including but not limited to, partnership and business interests 
(including good will), deferred compensation accounts unconnected with retirement, including but 
not limited to stock options, sick leave, and vacation pay, stocks, stock funds, mutual funds, bonds, 
bond funds, real estate investment trust, receivables, certificates of deposit, notes, mortgages, 
and debts owed to you by another entity or person. For each item, state the following: 
(1) the percentage and type interest you hold. 
(2) the names and addresses of any other persons or entities holding any interest and the 
names and addresses of the persons and entities who are indebted to you. 
(3) the date you acquired your interest. 
(4) the purchase price, acquisition cost, or loaned amount. 
(5) the fair market value or the amounts you claim are owned by or owed to you: 
(a) presently, at the time of answering these interrogatories. 
(b) on the date of your separation from your spouse. 
(c) on the date of the filing of the petition for dissolution of marriage. 
You may comply with this interrogatory (4.c) by providing copies of all periodic (monthly, 
quarterly, semi-annual, or annual) account statements for each such account for the preceding 
3 years.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. However, if the date of 
acquisition, the purchase price and the market valuations are not clearly reflected in the 
periodic statements which are furnished then these questions must be answered separately. 
You do not have to resubmit any periodic statements previously furnished under rule 12.285 
(Mandatory Disclosure). 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
178 
 
d. Retirement Accounts: List all information regarding each retirement account/plan, including but 
not limited to defined benefit plans, 401k, 403B, IRA accounts, pension plans, Florida 
Retirement System plans (FRS), Federal Government plans, money purchase plans, HR10 
(Keogh) plans, profit sharing plans, annuities, employee savings plans, etc. that you have 
established and/or that have been established for you by you, your employer, or any previous 
employer.  For each account, state the following: 
(1) the name and the last 4 digits of the account number of each account/plan and where it is 
located.  
(2) the type of account/plan. 
(3) the name and address of the fiduciary plan administrator/service representative. 
(4) the fair market value of your interest in each account/plan. 
(a) present value. 
(b) value on the date of separation. 
(c) value on the date of filing of the petition for dissolution of marriage 
(5) whether you are vested or not vested; and if vested, in what amount, as of a certain date 
and the schedule of future vesting.  
(6) 
the date at which you became/become eligible to receive some funds in this 
account/plan. 
(7) 
monthly benefits of the account/plan if no fair market value is ascertained. 
(8) 
beneficiary(ies) and/or alternate payee(s). 
e. Financial Accounts.  For all financial accounts (checking, savings, money market, credit union 
accounts, or other such cash management accounts) listed in your Financial Affidavit, in which 
you have had any legal or equitable interest, regardless of whether the interest is or was held in 
your own name individually, in your name with another person, or in any other name, give the 
following: 
(1) name and address of each institution. 
(2) name in which the account is or was maintained. 
(3) the last 4 digits of account numbers. 
(4) name of each person authorized to make withdrawals from the accounts.  
(5) highest balance within each of the preceding 3 years. 
(6) lowest balance within each of the preceding 3 years. 
You may comply with this interrogatory (4.e) by providing copies of all periodic (monthly, 
quarterly, semi-annual, or annual) account statements for each such account for the preceding 
3 years.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit 
account statements previously furnished pursuant to rule 12.285 (Mandatory Disclosure). 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
179 
 
f. Closed Financial Accounts.  For all financial accounts (checking, savings, money market, credit 
union accounts, or other such cash management accounts) closed within the last 3 years, in 
which you have had any legal or equitable interest, regardless of whether the interest is or was 
held in your own name individually, in your name with another person, or in any other name, 
give the following: 
(1) name and address of each institution. 
(2) name in which the account is or was maintained. 
(3) the last 4 digits of account numbers. 
(4) name of each person authorized to make withdrawals from the accounts. 
(5) date account was closed. 
 
g. Trust.  For any interest in an estate, trust, insurance policy, or annuity, state the following: 
(1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for each one 
the following: 
(a) identification of the estate, trust, insurance policy, or annuity. 
(b) the nature, amount, and frequency of any distributions of benefits. 
(c) the total value of the beneficiaries’ interest in the benefit. 
(d) whether the benefit is vested or contingent. 
(2) If you have established any trust or are the trustee of a trust, state the following: 
(a) the date the trust was established. 
(b) the names and addresses of the trustees. 
(c) the names and addresses of the beneficiaries. 
(d) the names and addresses of the persons or entities who possess the trust documents. 
(e) each asset that is held in each trust, with its fair market value. 
h. Canceled Life Insurance Policies.  For all policies of life insurance within the preceding 3 years 
that you no longer hold, own, or have any interest in, state the following: 
(1) name of company that issued the policy and the last 4 digits of policy number. 
(2) name, address, and telephone number of agent who issued the policy. 
(3) amount of coverage. 
(4) name of insured. 
(5) name of owner of policy. 
(6) name of beneficiaries. 
(7) premium amount. 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
180 
 
(8) date the policy was surrendered. 
(9) amount, if any, of monies distributed to the owner. 
 
i. 
Name of Accountant, Bookkeeper, or Records Keeper.  State the names, addresses, and 
telephone numbers of your accountant, bookkeeper, and any other persons who possess your 
financial records, and state which records each possesses. 
j. 
Safe Deposit Boxes, Lock Boxes, Vaults, Etc.  For all safe deposit boxes, lock boxes, vaults, or 
similar types of depositories, state the following: 
(1) The names and addresses of all banks, depositories, or other places where, at any time 
during the period beginning 3 years before the initiation of the action, until the date of your 
answering this interrogatory, you did any of the following: 
(a) had a safe deposit box, lock box, or vault. 
(b) were a signatory or co-signatory on a safe deposit box, lock box, or vault. 
(c) had access to a safe deposit box, lock box, or vault. 
(d) maintained property. 
(2) The box or identification numbers and the name and address of each person who has had 
access to any such depository during the same time period. 
(3) All persons who have possession of the keys or combination to the safe deposit box, lock 
box, or vault. 
(4) Any items removed from any safe deposit boxes, lock boxes, vaults, or similar types of 
depositories by you or your agent during that time, together with the present location and 
fair market value of each item. 
(5) All items in any safe deposit boxes, lock boxes, vaults, or similar types of depositories and 
fair market value of each item. 
5. LIABILITIES: 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
181 
 
a. Loans, Liabilities, Debts, and Other Obligations.  For all loans, liabilities, debts, and other 
obligations (other than credit cards and charge accounts) listed in your Financial Affidavit, 
indicate for each the following: 
(1) name and address of the creditor. 
(2) name in which the obligation is or was incurred. 
(3) the last 4 digits of loan or account number, if any. 
(4) nature of the security, if any. 
(5) payment schedule. 
(6) present balance and current status of your payments. 
(7) total amount of arrearage, if any. 
(8) balance on the date of your separation from your spouse. 
(9) balance on the date of the filing of the petition for dissolution of marriage. 
You may comply with this interrogatory (5.a) by providing copies of all periodic (monthly, 
quarterly, semi-annual, or annual) account statements for each such account for the preceding 
3 years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE.   You do not have to resubmit 
account statements previously furnished under rule 12.285 (Mandatory Disclosure). 
 
b. Credit Cards and Charge Accounts.  For all financial accounts (credit cards, charge accounts, or 
other such accounts) listed in your Financial Affidavit, in which you have had any legal or 
equitable interest, regardless of whether the interest is or was held in your own name 
individually, in your name with another person, or in any other name, give the following: 
(1) name and address of the creditor. 
(2) name in which the account is or was maintained. 
(3) names of each person authorized to sign on the accounts. 
(4) the last 4 digits of account numbers. 
(5) present balance and current status of your payments. 
(6) total amount of arrearage, if any. 
(7) balance on the date of your separation from your spouse. 
(8) balance on the date of the filing of the petition for dissolution of marriage. 
(9) highest and lowest balance within each of the preceding 3 years. 
You may comply with this interrogatory (5.b) by providing copies of all periodic (monthly 
quarterly, semi-annual, or annual) account statements for each such account for the preceding 3 
years. DO NOT FILE THESE DOCUMENTS IN THE COURT FILE.  You do not have to resubmit account 
statements previously furnished under rule 12.285 (Mandatory Disclosure). 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
182 
 
c. Closed Credit Cards and Charge Accounts.  For all financial accounts (credit cards, charge 
accounts, or other such accounts) closed with no remaining balance, within the last 3 years, in 
which you have had any legal or equitable interest, regardless of whether the interest is or was 
held in your own name individually, in your name with another person, or in any other name, 
give the following: 
(1) name and address of each creditor. 
(2) name in which the account is or was maintained. 
(3) the last 4 digits of account numbers. 
(4) names of each person authorized to sign on the accounts. 
(5) date the balance was paid off. 
(6) amount of final balance paid off. 
You may comply with this interrogatory (5.c) by providing copies of all periodic (monthly, 
quarterly, semi-annual, or annual) account statements for each such account for the preceding 
3 years.   DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do not have to resubmit 
account statements previously furnished under rule 12.285 (Mandatory Disclosure). 
6. MISCELLANEOUS: 
a. If you are claiming an unequal distribution of marital property or enhancement or appreciation 
of nonmarital property, state the amount claimed and all facts upon which you rely in your 
claim. 
b. If you are claiming an asset or liability is nonmarital, list the asset or liability and all facts upon 
which you rely in your claim. 
c. If the mental or physical condition of a spouse or child is an issue, identify the person and state 
the name and address of all health care providers involved in the treatment of that person for 
said mental or physical condition. 
d. Detail your proposed parenting plan for the minor child(ren), including your proposed time-
sharing schedule.  Alternatively, attach a copy of your proposed parenting plan. 
e. If you are claiming that the other parent’s  time-sharing with the minor child(ren) should be 
limited,  supervised, or otherwise restricted, or that you should have sole parental responsibility 
for the minor child(ren), with or without time-sharing with the other parent, or that you should 
have ultimate responsibility over specific aspects of the child(ren)’s welfare or that these 
responsibilities should be divided between you and the other parent, state your reasons and all 
facts which you rely upon to support your claim. 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
183 
 
7. LONG FORM AFFIDAVIT:  If you filed the short form affidavit, Florida Family Law Rules of Procedure 
Form 12.902(b), and you were specifically requested in the Notice of Service of Standard Family Law 
Interrogatories to file the Long Form Affidavit, Form12.902(c), you must do so within the time to 
serve the answers to these interrogatories. 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(b), Standard Family Law Interrogatories for Original or 
Enforcement Proceedings (10/11) 
184 
 
I certify that a copy of this document was [check 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 answers to 
these interrogatories 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 
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 [ choose one only]       petitioner or       respondent, fill out this form. 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
185 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 
12.930(c), STANDARD FAMILY LAW INTERROGATORIES FOR 
MODIFICATION PROCEEDINGS (10/11) 
 
When should this form be used? 
This form should be used to ask the other party in your case to answer certain standard questions in 
writing. These questions are called interrogatories, and they must relate to your case. If the other party 
fails to answer the questions, you may ask the judge to order the other party to answer the questions.  
(You cannot ask these questions before the petition has been filed.) 
The questions in this form should be used in modification proceedings and are meant to supplement 
the information provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 
12.902(b) or (c). You should read all of the questions in this form to determine which questions, if any, 
the other party needs to answer in order to provide you with information not covered in the financial 
affidavit forms. If there are questions to which you already know the answer, you may choose not to ask 
them. 
This form should be typed or printed in black ink.  You must complete the box at the beginning of this 
form to indicate which questions you are requesting that the other party answer. You should send an 
original and one copy of this form and the Notice of Service of Standard Family Law Interrogatories, 
Florida Family Law Rules of Procedure Form 12.930(a), to the other party.  You should also keep a copy 
for your records. You do not need to file this form with the clerk of the circuit court.  However, you 
must file the Notice of Service of Standard Family Law Interrogatories, Florida Family Law Rules of 
Procedure Form 12.930(a), to tell the court that you have sent this form to the other party. 
After you receive the completed answers to the interrogatories, DO NOT FILE THE ORIGINAL OR A COPY 
WITH THE CLERK OF THE COURT UNLESS THE ANSWERS ARE ADMITTED INTO  EVIDENCE BY THE 
COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. 
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 the instructions for Notice of Service of 
Standard Family Law Interrogatories, Florida Family Law Rules of Procedure Form 12.930(a), rules 
12.280, 12.285, 12.340, and 12.380, Florida Family Law Rules of Procedure and rules 1.280, 1.340, and 
1.380, Florida Rules of Civil Procedure. 
Special notes... 
In addition to the standard questions in this form, you may ask up to 10 additional questions.  You 
should type or print your additional questions on a separate sheet of paper and attach it to this form.  If 
you want to ask more than 10 additional questions, you will need to get permission from the judge. 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
186 
You may want to inform the other party of the following information:  As a general rule, within 30 days 
after service of interrogatories, the other party must answer the questions in writing and mail (have 
postmarked) the answers to you.  His or her answers shall be written in the blank space provided after 
each separately numbered interrogatory. If sufficient space is not provided, the answering party may 
attach additional papers with the answers and refer to them in the space provided in the 
interrogatories.  He or she should be sure to make a copy for him/herself. All answers to these questions 
are made under oath or affirmation as to their truthfulness. Each question must be answered separately 
and as completely as the available information permits. The original of the answers to the 
interrogatories is to be provided to the requesting party. DO NOT FILE THE ORIGINAL OR A COPY WITH 
THE CLERK OF THE CIRCUIT COURT UNLESS THE ANSWERS ARE ADMITTED INTO EVIDENCE BY THE 
COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE OF JUDICIAL ADMINISTRATION 2.425. The 
other party may object to a question by writing the legal reason for the objection in the space provided. 
He or she may also ask the court for a protective order granting him or her permission not to answer 
certain questions and protecting him or her from annoyance, embarrassment, apprehension, or undue 
burden or expense. If the other party fails to either answer or object to the questions within 30 days, he 
or she may be subject to court sanctions. 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete. 
 
 
 
 
 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
187 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
Case No.: _____________________    
Division: ______________________ 
 
                                                                           , 
Petitioner 
 
and 
 
                                                                         , 
Respondent. 
 
STANDARD FAMILY LAW INTERROGATORIES 
FOR MODIFICATION PROCEEDINGS 
 
 
TO BE COMPLETED BY THE PARTY SERVING THESE INTERROGATORIES 
I am requesting that the following standard questions be answered: [check all that apply] 
____1 
Background 
Information 
____2 
Education 
____3 
Employment 
____4 
Assets 
____ 5 
Liabilities 
Affidavit 
____6 
Miscellaneous 
____7 
Long Form 
 
 
 
 
 
 
 
 
   In addition, I am requesting that the attached {#} _________________ questions be answered. 
 
 
The answers to the following questions are intended to supplement the information 
provided in the Financial Affidavits, Florida Family Law Rules of Procedure Form 12.902(b) or (c).  
You should answer the group of questions indicated in the above shaded box.  The questions 
should be answered in the blank space provided below each separately numbered question.  If 
sufficient space is not provided, you may attach additional papers with the answers and refer to 
them in the space provided in the interrogatories.  You should be sure to make a copy for 
yourself.  Each question must be answered separately and as completely as the available 
information permits.  All answers are to be made under oath or affirmation as to their 
truthfulness. 
 
AFTER YOU ANSWER THE INTERROGATORIES, DO NOT FILE THE ORIGINAL WITH THE CLERK OF 
THE COURT. ALL PERSONAL INFORMATION CONTAINED IN THE COURT FILE BECOMES PUBLIC 
RECORD. INSTEAD, SERVE THE ORIGINAL OF THE ANSWERS TO THE INTERROGATORIES ON THE 
OTHER PARTY AND FILE FORM 12.930(d), NOTICE OF SERVICE OF ANSWERS TO 
INTERROGATORIES, WITH THE CLERK. 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
188 
I, {name of person answering interrogatories}  _______________________________,                                        
being sworn, certify that the following information is true: 
 
1. BACKGROUND INFORMATION: 
a. State your full legal name and any other name by which you have been known. 
b. State your present residence and telephone numbers. 
 
 
2. EDUCATION: 
a. List all business, commercial, and professional licenses that you have obtained since the  
entry of the Final Judgment sought to be modified. 
b. List all of your education since the entry of the Final Judgment sought to be modified 
including, but not limited to, vocational or specialized training, including the following: 
(1) name and address of each educational institution. 
(2) dates of attendance. 
(3) degrees or certificates obtained or anticipated dates of same. 
 
3. EMPLOYMENT: 
a. For each place of your employment or self-employment since the entry of the Final 
Judgment sought to be modified, state the following: 
(1) name, address, and telephone number of your employer. 
(2) dates of employment. 
(3) job title and brief description of job duties. 
(4) starting and ending salaries. 
(5) name of your direct supervisor. 
(6) all benefits received, including, for example, health, life, and disability insurance; 
expense account; use of automobile or automobile expense reimbursement; 
reimbursement for travel, food, or lodging expenses; payment of dues in any clubs 
or associations; and pension or profit sharing plans. 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
189 
 
b. Other than as an employee, if you have been engaged in or associated with any 
business, commercial, or professional activity since the entry of the Final Judgment 
sought to be modified that was not detailed above, state for each such activity the 
following: 
(1) name, address, and telephone number of each activity. 
(2) dates you were connected with such activity. 
(3) position title and brief description of activities. 
(4) starting and ending compensation. 
(5) name of all persons involved in the business, commercial, or professional activity 
with you. 
(6) all benefits and compensation received, including, for example, health, life, and 
disability insurance; expense account; use of automobile or automobile expense 
reimbursement; reimbursement for travel, food, or lodging expenses; payment of 
dues in any clubs or associations; and pension or profit sharing plans. 
 
c. If you have been unemployed at any time since the entry of the Final Judgment sought 
to be modified, state the dates of unemployment. If you have not been employed at any 
time since the entry of the Final Judgment sought to be modified, give the information 
requested above in question 3.a for your last period of employment 
4. ASSETS: 
a. Real Estate.  State the street address, if any, and if not, the legal description of all real 
property that you own or owned during the last 3 years, or since the entry of the Final 
Judgment sought to be modified, if shorter.  For each property, state the following: 
(1) the names and addresses of any other persons or entities holding any interest and 
their percentage of interest. 
(2) the present fair market value. 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
190 
 
 
b. Tangible Personal Property.  List all items of tangible personal property that are owned 
by you or in which you have had any interest during the last 3 years, or since the entry 
of the Final Judgment sought to be modified if shorter, including, but not limited to, 
motor vehicles, tools, furniture, boats, jewelry, art objects or other collections, and 
collectibles whose fair market value exceeds $100. For each item, state the following: 
(1) the percentage and type interest you hold. 
(2) the names and addresses of any other persons or entities holding any interest. 
(3) the present fair market value. 
c. Intangible Personal Property.  Other than the financial accounts (checking, savings, 
money market, credit union accounts, retirement accounts, or other such cash 
management accounts) listed in the answers to interrogatories 4.d and 4.e below, list all 
items of intangible personal property that are owned by you or in which you have had any 
ownership interest (including closed accounts) within the last 3 years, or since the entry of 
the Final Judgment sought to be modified, if shorter, including but not limited to, 
partnership and business interests (including good will), deferred compensation accounts 
unconnected with retirement, including but not limited to stock options, sick leave, and 
vacation pay, stocks, stock funds, mutual funds, bonds, bond funds, real estate investment 
trust, receivables, certificates of deposit, notes, mortgages, and debts owed to you by 
another entity or person. For each item, state the following: 
(1) the percentage and type interest you hold. 
(2) the names and addresses of any other persons or entities holding any interest and 
the names and addresses of the persons and entities who are indebted to you. 
(3) the present fair market value or the amounts you claim are owned by or owed to 
you, at the time of answering these interrogatories. 
You may comply with this interrogatory (4.c) by providing copies of all periodic 
(monthly, quarterly, semi-annual, or annual) account statements for each such 
account for the preceding 3 years, or since the entry of the Final Judgment sought to 
be modified, if shorter.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. 
However, if the date of acquisition, the purchase price, and the market valuations are 
not clearly reflected in the periodic statements which are furnished, then these 
questions must be answered separately.  You do not have to resubmit any periodic 
statements previously furnished under rule 12.285 (Mandatory Disclosure). 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
191 
 
 
 
 
 
 
d. Retirement Accounts: List all information regarding each retirement account/plan, 
including but not limited to defined benefit plans, 401k, 403B, IRA accounts, pension 
plans, Florida Retirement System plans (FRS), Federal Government plans, money 
purchase plans, HR10 (Keogh) plans, profit sharing plans, annuities, employee savings 
plans, etc. that you have established and/or that have been established for you by you, 
your employer, or any previous employer.  For each account, state the following: 
(1) the name and last 4 digits of the account number of each account/plan and where it 
is located.  
(2) the type of account/plan. 
(3) the name and address of the fiduciary plan administrator/service representative. 
(4) the fair market value of your interest in each account/plan. 
(5) whether you are vested or not vested; and if vested, in what amount, as of a certain 
date and the schedule of future vesting.  
(6) the date at which you became/become eligible to receive some funds in this 
account/plan. 
(7) monthly benefits of the account/plan if no fair market value is ascertained. 
(8) beneficiary(ies) and/or alternate payee(s). 
e. Financial Accounts.  For all financial accounts (checking, savings, money market, credit 
union accounts, or other such cash management accounts) listed in your Financial 
Affidavit, in which you have had any legal or equitable interest, regardless of whether 
the interest is or was held in your own name individually, in your name with another 
person, or in any other name, give the following: 
(1) name and address of each institution. 
(2) name in which the account is or was maintained. 
(3) last 4 digits of account numbers. 
(4) name of each person authorized to make withdrawals from the accounts.  
(5) highest balance within each of the preceding 3 years. 
(6) lowest balance within each of the preceding 3 years. 
You may comply with this interrogatory (4.e) by providing copies of all periodic 
(monthly, quarterly, semi-annual, or annual) account statements for each such 
account for the preceding 3 years, or since the entry of the Final Judgment sought to 
be  modified, if shorter.   DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
192 
not have to resubmit account statements previously furnished pursuant to rule 12.285 
(Mandatory Disclosure). 
f. Closed Financial Accounts.  For all financial accounts (checking, savings, money market, 
credit union accounts, or other such cash management accounts) closed within the last 
3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in 
which you have had any legal or equitable interest, regardless of whether the interest is 
or was held in your own name individually, in your name with another person, or in any 
other name, give the following: 
(1) name and address of each institution. 
(2) name in which the account is or was maintained. 
(3)  last 4 digits of account numbers. 
(4) name of each person authorized to make withdrawals from the accounts. 
(5) date account was closed. 
g. Trust.  For any interest in an estate, trust, insurance policy, or annuity, state the 
following: 
(1) If you are the beneficiary of any estate, trust, insurance policy, or annuity, give for 
each one the following: 
(a) identification of the estate, trust, insurance policy, or annuity. 
(b) the nature, amount, and frequency of any distributions of benefits. 
(c) the total value of the beneficiaries’ interest in the benefit. 
(d) whether the benefit is vested or contingent. 
(2) If you have established any trust or are the trustee of a trust, state the following: 
(a) the date the trust was established. 
(b) the names and addresses of the trustees. 
(c) the names and addresses of the beneficiaries. 
(d) the names and addresses of the persons or entities who possess the trust 
documents. 
(e) each asset that is held in each trust, with its fair market value. 
h. Name of Accountant, Bookkeeper, or Records Keeper.  State the names, addresses, and 
telephone numbers of your accountant, bookkeeper, and any other persons who 
possess your records, and state which records each possesses. 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
193 
 
5. LIABILITIES: 
a. Loans, Liabilities, Debts, and Other Obligations.  For all loans, liabilities, debts, and 
other obligations (other than credit cards and charge accounts) listed in your Financial 
Affidavit, indicate for each the following: 
(1) name and address of the creditor. 
(2) name in which the obligation is or was incurred. 
(3)  last 4 digits of loan or account number, if any. 
(4) nature of the security, if any. 
(5) payment schedule. 
(6) present balance and current status of your payments. 
(7) total amount of arrearage, if any. 
You may comply with this interrogatory (5.a) by providing copies of all periodic 
(monthly, quarterly, semi-annual, or annual) account statements for each such 
account for the preceding 3 years, or since the entry of the Final Judgment sought to 
be modified, if shorter.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE.  You do 
not have to resubmit account statements previously furnished under rule 12.285 
(Mandatory Disclosure). 
b. Credit Cards and Charge Accounts.  For all financial accounts (credit cards, charge 
accounts, or other such accounts) listed in your Financial Affidavit, in which you have 
had any legal or equitable interest, regardless of whether the interest is or was held in 
your own name individually, in your name with another person, or in any other name, 
give the following: 
(1) name and address of the creditor. 
(2) name in which the account is or was maintained. 
(3) names of each person authorized to sign on the accounts. 
(4)  last 4 digits of account numbers. 
(5) present balance and current status of your payments. 
(6) total amount of arrearage, if any. 
(7) highest and lowest balance within each of the preceding 3 years, or since the entry 
of the Final Judgment sought to be modified, if shorter. 
You may comply with this interrogatory (5.b) by providing copies of all periodic 
(monthly quarterly, semi-annual, or annual) account statements for each such account 
for the preceding 3 years, or since the entry of the Final Judgment sought to be 
modified, if shorter.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE.  You do not 
have to resubmit account statements previously furnished under rule 12.285 
(Mandatory Disclosure). 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
194 
c. Closed Credit Cards and Charge Accounts.  As to all financial accounts (credit cards, 
charge accounts, or other such accounts) closed with no remaining balance, within the 
last 3 years, or since the entry of the Final Judgment sought to be modified, if shorter, in 
which you have had any legal or equitable interest, regardless of whether the interest is 
or was held in your own name individually, in your name with another person, or in any 
other name, give the following: 
(1) name and address of each creditor. 
(2) name in which the account is or was maintained. 
(3)  last 4 digits of account numbers. 
(4) names of each person authorized to sign on the accounts. 
(5) date the balance was paid off. 
(6) amount of final balance paid off. 
You may comply with this interrogatory (5.c) by providing copies of all periodic 
(monthly, quarterly, semi-annual, or annual) account statements for each such 
account for the preceding 3 years, or since the entry of the Final Judgment sought to 
be modified, if shorter.  DO NOT FILE THESE DOCUMENTS IN THE COURT FILE. You do 
not have to resubmit account statements previously furnished under rule 12.285 
(Mandatory Disclosure). 
6. MISCELLANEOUS: 
a. If you are claiming a diminished earning capacity since the entry of the Final Judgment 
sought to be modified as grounds to modify alimony or deviate from the child support 
established in your case, describe in detail how your earning capacity is lowered and 
state all facts upon which you rely in your claim.  If unemployed, state how, why, and 
when you lost your job. 
b. If you are claiming a change in a mental of physical condition since the entry of the Final 
Judgment sought to be modified as grounds to modify alimony or change the child 
support established in your case, describe in detail how your mental and/or physical 
capacity has changed and state all facts upon which you rely in your claim.  Identify the 
change in your mental and/or physical capacity, and state the name and address of all 
health care providers involved in the treatment of this mental or physical condition. 
c. If you are requesting a change in shared or sole parental responsibility, ultimate 
decision-making, the time-sharing schedule, the parenting plan, or any combination 
thereof, for the minor child(ren), describe in detail the change in circumstances since 
the entry of the Final Judgment sought to be modified that you feel justify the 
requested change.  State when the change of circumstances occurred, how the change 
of circumstances affects the child(ren), and why it is in the best interests of the 
child(ren) that the Court make the requested change.  Attach your proposed parenting 
plan. 
d. If you do not feel the requested change in shared or sole parental responsibility,  
ultimate decision-making, the time-sharing schedule, the parenting plan, or any 
combination thereof, for the minor child(ren) is in their best interests,  or if you feel 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for 
Modification Proceedings (10/11) 
195 
there has not been a change in circumstances since the entry of the Final Judgment 
sought to be modified, describe in detail any facts since the entry of the Final Judgment 
sought to be modified that you feel justify the Court denying the requested change.  
State what requested change, if any in shared or sole parenting responsibility, ultimate 
decision-making, the time-sharing schedule, or of the parenting plan is justified or 
agreeable to you and why it is in the best interests of the child(ren). 
7. LONG FORM AFFIDAVIT:  If you filed the short form affidavit, Florida Family Law Rules of 
Procedure Form 12.902(b), and you were specifically requested in the Notice of Service of 
Standard Family Law Interrogatories to file the Long Form Affidavit, Form 12.902(c), you 
must do so within the time to serve the answers to these interrogatories. 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(c), Standard Family Law Interrogatories for Modification 
Proceedings (10/11) 
196 
I certify that a copy of this document was [check 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 answers to 
these interrogatories 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 [check  one only]       petitioner or       respondent, fill out this form.
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of Answers to Standard 
Family Law Interrogatories (10/11) 
197 
 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 
12.930(d), NOTICE OF SERVICE OF ANSWERS TO STANDARD FAMILY 
LAW INTERROGATORIES (10/11) 
 
When should this form be used?  
You should use this form to tell the court that you have responded to the other party’s request to 
answer certain standard questions (interrogatories) in writing.  
 
This form should be typed or printed in black ink. You must indicate whether you are sending the 
answers to interrogatories for original and enforcement proceedings, Florida Family Law Rules of 
Procedure Form 12.930(b), or modification proceedings, Florida Family Law Rules of Procedure Form 
12.930(c). You must also indicate whether you have additional questions that you were asked to answer. 
After completing this form you should file the original with the clerk of the circuit court in the county 
where your case was filed and keep a copy for your records.  
 
What should I do next?  
A copy of this form and the original completed answers to the interrogatories must be mailed or hand 
delivered to the other party in your case. However, file only this form with the clerk. DO NOT FILE THE 
ORIGINAL ANSWERS TO THE INTERROGATORIES OR ANY ATTACHMENTS WITH THE CLERK UNLESS 
THEY ARE ADMITTED INTO EVIDENCE BY THE COURT AND ARE IN COMPLIANCE WITH FLORIDA RULE 
OF JUDICIAL ADMINISTRATION 2.425.  
 
Where can I look for more information?  
Before proceeding, you should read “General Information for Self‐Represented Litigants” found at the 
beginning of these forms. For further information see Florida Family Law Rules of Procedure Rules 
12.280, 12.285, 12.340, and 12.380, and Florida Rules of Civil Procedure Rules 1.280, 1.340, and 1.380.  
 
Special notes . . .  
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete. 
 
 
Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of Answers to Standard Family Law 
Interrogatories (10/11) 
198 
 
IN THE CIRCUIT COURT OF THE_______________________JUDICIAL CIRCUIT,  
IN AND FOR ________________________COUNTY, FLORIDA  
 
Case No.: _________________  
Division: _________________ 
________________________,  
Petitioner  
and 
_________________________,  
Respondent.  
 
 
NOTICE OF SERVICE OF ANSWERS TO STANDARD FAMILY LAW INTERROGATORIES  
 
I, {full legal name}________________________________ , have on {date}____________ served on 
{name}_________________________ fully completed and sworn answers to the standard family law 
interrogatories served on me, and additional interrogatories if requested. The interrogatories were for  
[check one only] (   ) original or enforcement proceedings (    ) modification proceedings.  
 
I UNDERSTAND THAT I SHOULD NOT FILE THE ANSWERS TO INTERROGATORIES WITH THE CLERK OF 
THE CIRCUIT COURT EXCEPT AS PROVIDED BY FLORIDA RULE OF CIVIL PROCEDURE 1.340(e).  
 
I certify that a copy of this document was [choose only one] (   ) 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: ___________________________________ 
 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.930(d), Notice of Service of Answers to Standard Family Law 
Interrogatories (10/11) 
199 
 
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 
 [check one only] (   ) petitioner or (   ) respondent, fill out this form.
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with 
Mandatory Disclosure (10/11) 
200 
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE 
FORM 12.932, CERTIFICATE OF COMPLIANCE WITH MANDATORY 
DISCLOSURE (10/11) 
 
When should this form be used? 
 
Mandatory disclosure requires each party in a dissolution of marriage case to provide the other 
party with certain financial information and documents.  These documents must be provided by 
mail or hand delivery to the other party within 45 days of service of the petition for dissolution 
of marriage or supplemental petition for modification on the respondent.  The mandatory 
disclosure rule applies to all original and supplemental dissolution of marriage cases, except 
simplified dissolution of marriage cases and cases where the respondent is served by 
constructive service and does not answer.  You should use this form to notify the court and the 
other party that you have complied with the mandatory disclosure rule. 
 
Each party must provide the other party with the documents listed in section 2 of this form if 
the relief being sought is permanent regardless of whether it is an initial or supplemental 
proceeding.  Of the documents listed on this form, the financial affidavit and child support 
guidelines worksheet are the only documents that may be required to be filed with the court 
under Florida Family Law Rules of Procedure 12.285(c) and (k) but must be sent to the other 
party; all other documents should be sent to the other party but not filed with the court.  If your 
individual gross annual income is under $50,000, you should complete the Family Law Financial 
Affidavit (Short Form), Florida Family Law Rules of Procedure Form 12.902(b).  If your individual 
gross annual income is $50,000 or more, you should complete the Family Law Financial 
Affidavit, Florida Family Law Rules of Procedure Form 12.902(c).   
 
In addition, there are separate mandatory disclosure requirements that apply to temporary 
financial hearings, which are listed in section 1 of this form.  The party seeking temporary 
financial relief must serve these documents on the other party with the notice of temporary 
financial hearing.  The responding party must either deliver the required documents to the party 
seeking temporary relief on or before 5:00 p.m., 2 business days before the hearing on 
temporary relief, or mail (postmark) them to the other party seeking temporary relief 7 days 
before the hearing on temporary financial relief.  Any documents that have already been served 
under the requirements for temporary or initial proceedings, do not need to be reserved again 
in the same proceeding.  If a supplemental petition is filed, seeking modification, then the 
mandatory disclosure requirements begin again. 
 
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.  A copy of this form must be mailed or hand delivered to any other party in 
your case. 
 
What should I do next? 
 
 
 
Instructions for Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with 
Mandatory Disclosure (10/11) 
201 
After you have provided the other party all of the financial information and documents and have 
filed this form certifying that you have complied with this rule, you are under a continuing duty 
to promptly give the other party any information or documents that change your financial status 
or that make the information already provided inaccurate.  You should not file with the clerk any 
of the documents listed in the certificate of compliance other than the financial affidavit and 
child support guidelines worksheet.  Refer to the instructions regarding the petition in your case 
to determine how you should proceed after filing this 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. For further information, see rule 12.285, Florida Family Law Rules of 
Procedure.  
 
Special notes… 
 
You may provide copies of required documents; however, the originals must be produced for 
inspection if the other party requests to see them. 
 
Although the financial affidavits are based on individual gross income, either party may ask the 
other party to complete the Family Law Financial Affidavit, Florida Family Law Rules of Procedure 
Form 12.902(c), by serving the appropriate interrogatory form. (See Standard Family Law 
Interrogatories, Florida Family Law Rules of Procedure Form 12.930(b) (original proceedings) or (c) 
(modification proceedings)). 
 
Any portion of the mandatory disclosure rule may be modified by order of the judge or agreement 
of the parties.  Therefore, you and your spouse may agree that you will not require each other to 
produce the documents required under the mandatory disclosure rule.  This exception does not 
apply to the Financial Affidavit, Family Law Rules of Procedure Form 12.902(b) or (c), which is 
required in all cases and cannot be waived. 
 
Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out 
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law 
Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out 
these forms also must put his or her name, address, and telephone number on the bottom of the 
last page of every form he or she helps you complete. 
 
 
Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with Mandatory Disclosure (10/11) 
202 
 
IN THE CIRCUIT COURT OF THE                                                       JUDICIAL CIRCUIT, 
IN AND FOR                                                       COUNTY, FLORIDA 
 
Case No.: 
 
Division:  
 
 
                                                                      , 
Petitioner, 
 
and 
 
                                                                       , 
Respondent. 
 
 
CERTIFICATE OF COMPLIANCE WITH MANDATORY DISCLOSURE 
 
 
I, {full legal name}  
 
 
 
 
 
 
, certify that I have 
complied with the mandatory disclosure required by Florida Family Law Rule 12.285 as follows: 
 
1. FOR TEMPORARY FINANCIAL RELIEF, ONLY: 
The date the following documents were served:  
 
 
 
 
            . 
[Check all that apply] 
a. ___  Financial Affidavit  
 
(     ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) 
 
(     ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) 
b. ___ (     ) All personal (1040) federal tax, gift tax, and intangible personal property tax returns for 
the preceding year; or  
 
    (     ) Transcript of tax return as provided by IRS form 4506-T; or 
  
(    ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the 
past year has not been prepared. 
c. ___ Pay stubs or other evidence of earned income for the 3 months before the service of the 
financial affidavit. 
 
2. FOR INITIAL, SUPPLEMENTAL, AND PERMANENT FINANCIAL RELIEF: 
The date the following documents were served:  
 
 
 
 
            . 
[Check all that apply] 
a. ___ Financial Affidavit  
 
 
(     ) Florida Family Law Rules of Procedure Form 12.902(b) (short form) 
 
 
(     ) Florida Family Law Rules of Procedure Form 12.902(c) (long form) 
b. ___ (     ) All personal (1040) federal and state income tax returns, gift tax returns, and intangible 
personal property tax returns for the preceding 3 years;  
(    ) IRS forms W-2, 1099, and K-1 for the past year because the income tax return for the 
past year has not been prepared. 
c. ___ Pay stubs or other evidence of earned income for the 3 months before the service of the 
financial affidavit. 
 
 
Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with Mandatory Disclosure (10/11) 
203 
d. ___  A statement identifying the source and amount of all income for the 3 months before the 
service of the financial affidavit, if not reflected on the pay stubs produced. 
e. ___ All loan applications and financial statements prepared for any purpose or used for any 
purpose within the 12 months preceding the service of the financial affidavit. 
f. ___ All deeds to real estate in which I presently own or owned an interest within the past 3 
years. All promissory notes in which I presently own or owned an interest within the last 12 
months. All present leases in which I own an interest. 
g. ___ All periodic statements for the last 3 months for all checking accounts and for the last year 
for all savings accounts, money market funds, certificates of deposit, etc. 
h. ___ All brokerage account statements for the last 12 months. 
i. 
___ Most recent statement for any pension, profit sharing, deferred compensation, or 
retirement plan (for example, IRA, 401(k), 403(b), SEP, KEOGH, etc.) and summary plan 
description for any such plan in which I am a participant or alternate payee. 
j. 
___ The declaration page, the last periodic statement, and the certificate for any group 
insurance for all life insurance policies insuring my life or the life of me or my spouse. 
k. ___ All health and dental insurance cards covering either me or my spouse and/or our 
dependent child(ren). 
l. 
___  Corporate, partnership, and trust tax returns for the last 3 tax years, in which I have an 
ownership or interest greater than or equal to 30%. 
m. ___ All credit card and charge account statements and other records showing my (our) 
indebtedness as of the date of the filing of this action and for the prior 3 months. All promissory 
notes on which I presently owe or owned within the past year.  All lease agreements I presently 
owe. 
n. ___ All premarital and marital agreements between the parties to this case. 
o. ___ If a modification proceeding, all written agreements entered into between the parties at 
any time since the order to be modified was entered. 
p. ___ All documents and tangible evidence relating to claims for an unequal distribution of marital 
property, enhancement or appreciation in nonmarital property, or nonmarital status of an asset 
or debt. 
q. ___ Any court order directing that I pay or receive spousal support (alimony) or child support. 
 
I certify that a copy of this document was [Check one only] (    ) mailed (    ) faxed and mailed  
(    ) hand delivered to the person(s) listed below on {date} 
. 
 
 
 
 
Florida Family Law Rules of Procedure Form 12.932, Certificate of Compliance with Mandatory Disclosure (10/11) 
204 
I understand that I am swearing or affirming under oath to the accuracy of my compliance with the 
mandatory disclosure requirements of Fla. Fam. L. R. P. 12.285 and that, unless otherwise indicated with 
specificity, this disclosure is complete. I further understand that the punishment for knowingly making a 
false statement or incomplete disclosure includes fines and/or imprisonment. 
 
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:  
 
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 [Check one only]       petitioner or       respondent, fill out this form.
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support 
Guidelines (10/11) 
205 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.943,  
 MOTION TO DEVIATE FROM CHILD SUPPORT GUIDELINES (10/11) 
 
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.) 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support 
Guidelines (10/11) 
206 
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out 
these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family Law Rules 
of Procedure Form  12.900 (a), before he or she helps you.  A nonlawyer helping you fill out these forms 
also must put his or her name, address, and telephone number on the bottom of the last page of every 
form he or she helps you complete.
 
 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(10/11) 
207 
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 
[Choose only one] 
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: 
[Choose 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: ___________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(10/11) 
208 
 
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: 
[Choose all that apply to your situation] 
1. ___ Extraordinary medical, psychological, educational, or dental expenses; 
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.). If any account 
numbers are listed, please list only the last four (4) digits of the number.  Attach an explanation. 
TOTAL VALUE OF ASSETS OF CHILD(REN) 
 
 
 
 
  $  
 
TOTAL MONTHLY INCOME OF CHILD(REN) 
 
 
 
 
  $  
 
 
 
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). 
 
 
 
Florida Supreme Court Approved Family Law Form 12.943, Motion to Deviate from Child Support Guidelines 
(10/11) 
209 
I certify that a copy of this document was [Choose only one] (    ) 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:  __________________________________ 
 
 
_____________________________________________ 
Signature of Party or his/her attorney 
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 
(10/11) 
210 
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, whose address is {street} _____________________________________________,  
{city} ______________________,{state} ______________,{phone} _________, 
 helped {name} _______________________________, who is the petitioner, fill out this form.
 
 
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) (10/11) 
211 
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) (10/11) 
 
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. 
 
 
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) (10/11) 
212 
 
Special notes... 
 
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. Florida Supreme Court Family Law Form 12.995(a), 12.995(b), or 12.995(c). 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. 
 
 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time-Sharing 
with Dependent or Minor Child(ren) (10/11) 
213 
 THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
MOTION FOR TEMPORARY SUPPORT AND TIME-SHARING  
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, without giving account 
numbers} 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
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}  _____________________________________ 
______________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time-Sharing 
with Dependent or Minor Child(ren) (10/11) 
214 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
The Court should do this because: __________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
d. ___   Require temporary payment of specific marital debts.  {Explain without using account 
numbers} _____________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
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 } ______________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.947(a), Motion for Temporary Support and Time-Sharing 
with Dependent or Minor Child(ren) (10/11) 
215 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
_________________________________________________________________________________ 
 
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. 
 
7. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), if required, 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 [Choose only one] (    ) 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:  __________________________________ 
 
 
 
_____________________________________________ 
Signature of Party or his/her attorney 
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, whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} _________, 
 helped {name} _______________________________, who is the petitioner, fill out this form.
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
216 
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 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
217 
court order. 
 
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 
 
 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
218 
 
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 
 
 
 
 
 
 
 
 Auto loan 
 
 
 
 
 
 
 
 Bank/Credit Union loans 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Money owed (not evidenced by a note) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Other 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION II.  TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME 
[Choose 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: ________________________________________________________________ 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
219 
 
 
 
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 
 
 
 
 
 
 
 
 
 
 
 
 
 
3. Temporary Parental Responsibility for the Minor Child(ren). 
[Choose only one] 
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: 
[Choose only one] 
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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
220 
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}:  
 
 
 
 
 
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: 
[Choose 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). 
[Choose 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}  
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
221 
 
 
 
 
 
 
 
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. 
[Choose 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. 
 
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 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
222 
(    ) 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: 
[Choose 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:                                ____________ years; 
 
 
c. ___ health of party receiving temporary alimony: (    ) excellent (    ) good (    ) poor (    )other 
 __________________________________________________________________________; 
d. ___  other factors ____________________________________________________________ 
___________________________________________________________________________ 
 
 
 
 
________ Please indicate here if additional pages are attached. 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
223 
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. 
[Choose 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 
a month (    ) {explain}  
 
 
 
beginning {date}  
 
 
, and continuing until further court order or until 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
224 
 
{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. 
[Choose 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. 
[Choose all that apply] 
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. 
 
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 beneficiary (ies) OR naming the  
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
225 
(    ) Mother Father (   ) other {name}: ________________________________________________ 
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: __________________________________________________________________ 
______________________________________________________________________________ 
 
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. State Disbursement Unit. 
[Choose if applies] 
a. ___  Obligor shall pay temporary court-ordered support directly to the State Disbursement 
Unit, along with any applicable 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 State 
Disbursement Unit. However, either party may subsequently apply, pursuant to section 
61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit. 
2. Income Deduction. 
[Choose if applies] 
_____ 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  State Disbursement Unit or the Obligee, 
as previously set forth in this order. 
 
_____ 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 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
226 
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 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:   
 
 
 
 
 
 
 
 
 
DONE AND ORDERED at ______________________, Florida on {date}                                            . 
 
 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(b), Temporary Order of Support and Time-Sharing with 
Dependent or Minor Child(ren) (10/11)  
227 
CIRCUIT JUDGE 
A copy of the {name of document(s)} _________________________________ was [Choose one 
only] (   )  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) 
State Disbursement Unit 
Other:   
 
 
 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with 
No Dependent or Minor Child(ren) (10/11) 
228 
INSTRUCTIONS FOR FLORIDA  SUPREME COURT APPROVED FAMILY LAW 
FORM 12.947(c), MOTION FOR TEMPORARY SUPPORT WITH NO 
DEPENDENT OR MINOR CHILD(REN)(10/11) 
 
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); and other relief. 
 
 
OR 
 
(2) the petitioner in a pending action for support unconnected with a dissolution.  For you to use this 
form, a petition for support unconnected with a dissolution of marriage must have already been 
filed. You should use this form to ask the court to award temporary spousal support (alimony). 
 
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 AGeneral Information for Self-Represented Litigants@ found at the 
beginning of these forms.  Words in Abold 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. 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with 
No Dependent or Minor Child(ren) (10/11) 
229 
 
Special notes... 
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: 
 
 
Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c).  
(This must be filed within 45 days if not filed at the time of the petition.) 
 
Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j). 
 
Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of Procedure 
Form 12.932. 
 
 
Temporary Order... These family law forms contain a Temporary Support Order with No Dependent or 
Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.947(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. 
 
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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent 
or Minor Child(ren) (10/11) 
230 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
 
MOTION FOR TEMPORARY SUPPORT WITH 
NO DEPENDENT OR MINOR CHILD(REN) 
 
(    ) 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, without using account 
numbers} _____________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
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} 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent 
or Minor Child(ren) (10/11) 
231 
 
The Court should do this because: __________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
d. ___ Require temporary payment of specific marital debts. {Explain, without using account 
numbers} 
_____________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
The Court should do this because: __________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
2. Support.  Award temporary spousal support/alimony of $___________ per month. The Court should 
do this because: ______________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
3. Attorney’s fees and costs. 
a. ___ Award temporary attorney’s fees of $ __________. 
b. ___ Award temporary costs of $__________. 
The Court should do this because: __________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
4. Other Relief.  {specify}______________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
__________________________________________________________________________________ 
 
5. A completed Certificate of Compliance with Mandatory Disclosure, Florida Family Law Rules of 
Procedure Form 12.932, is filed with this motion or has already been filed with the Court. 
 
6. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j),if required, 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 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent 
or Minor Child(ren) (10/11) 
232 
and any other relief this Court may deem just and proper. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(c), Motion for Temporary Support with No Dependent 
or Minor Child(ren) (10/11) 
233 
I certify that a copy of this document was [Choose only one] (    ) 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 : __________________________________ 
 
 
_____________________________________________ 
Signature of Party or his/her attorney 
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, whose address is {street} ____________________________________________,  
{city} ______________________,{state} ______________,{phone} _________,  
helped {name} _______________________________, who is the petitioner, fill out this form.
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
234 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
TEMPORARY SUPPORT ORDER WITH NO DEPENDENT OR MINOR CHILD(REN) 
 
This cause came before this Court for a hearing on a Motion for Temporary Support with No 
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 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
235 
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(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
236 
 
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) 
 
$ 
 
$ 
 
$ 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
237 
 
LIABILITIES:  DESCRIPTION OF DEBT(S) 
 
 
Current 
Amount 
Owed 
 
Wife 
Shall Pay 
 
Husband 
Shall Pay 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Charge/credit card accounts 
 
 
 
 
 
 
 
 
 
Auto loan 
 
 
 
 
 
 
 
Auto loan 
 
 
 
 
 
 
 
Bank/Credit Union loans 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Money owed (not evidenced by a note) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
SECTION II.  TEMPORARY EXCLUSIVE USE AND POSSESSION OF HOME 
 
[ Choose 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:  
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
238 
 
 
 
 
 
SECTION III.  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: 
[ Choose 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(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
239 
c. ___ health of party receiving temporary alimony: (    ) excellent (    ) good (    ) poor (    ) 
other  
; 
d. ___ other factors  
 
 
 
 
 
 
 
___  Please indicate 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. 
[ Choose 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 IV.  METHOD OF PAYMENT 
 
Obligor shall pay any temporary court-ordered alimony and arrears, if any, as follows: 
1. State Disbursement Unit. 
[ Choose if applies] 
a. ___ Obligor shall pay temporary court-ordered support directly to the State Disbursement 
Unit, along with any applicable service charge. 
b. ___ Both parties have requested and the court finds that it is in the best interests that 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
240 
temporary support payments need not be directed through the State Disbursement Unit.  
However, either party may subsequently apply to the depository pursuant to section 
61.13(1)(d)3, Florida Statutes, to require payments through the State Disbursement Unit. 
 
2. Income Deduction. 
[ Choose  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 support payments are deducted from Obligor’s paycheck, Obligor is 
responsible for making timely payments directly to the State Disbursement Unit 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: there are no minor child(ren) common to the parties, 
 
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 State Disbursement Unit 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 temporary payment: ____________________________ 
 
 
 
 
 
SECTION V.  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  
 
 
. 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.947(d), Temporary Support Order With No Dependent or 
Minor Child(ren) (10/11) 
241 
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 VI.  OTHER PROVISIONS 
 
Other Provisions:  
 
 
 
 
 
 
 
 
 
 
 
DONE AND ORDERED in _______________________, Florida on {date} __________________., 
 
____________________________________________ 
CIRCUIT JUDGE 
COPIES TO: 
Petitioner (or his or her attorney) 
Respondent (or his or her attorney) 
State Disbursement Unit 
Other:   
 
 
 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and 
for Related Relief (10/11)  
242 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.983(a), PETITION TO DETERMINE PATERNITY AND FOR 
RELATED RELIEF (10/11) 
 
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 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and 
for Related Relief (10/11)  
243 
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? 
 
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 indicated 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),12.995(b), or 
12.995(c).  If the parents have reached an agreement, a signed and notarized Parenting Plan 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and 
for Related Relief (10/11)  
244 
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 
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. 
 
 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and 
for Related Relief (10/11)  
245 
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. 
 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related 
Relief (10/11)  
246 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ 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 
Birth date 
(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. 
 
5. Petitioner [Choose only one] (    ) is (   ) is not a member of the military service. 
Respondent [Choose only one] (    ) is (   ) is not a member of the military service. 
6. Neither Petitioner nor Respondent is mentally incapacitated. 
 
 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related 
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7. 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. 
 
8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 
12.902(j), is filed with this petition. 
 
9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) 
or (c), is, or will be, filed. 
 
10. Paternity Facts. 
[Choose only one] 
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)} ____________in {city and state} _______________________________________ 
c. 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: 
[Choose only one] 
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 Related 
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______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
Explain why this schedule is in the best interests of the child(ren):  _______________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
______________________________________________________________________________ 
 
4. The minor child(ren) should 
[Choose 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). ___________________________________ 
c. The name change would be in the best interest of the child(ren) because:___________________ 
__________________________________________________________________________ 
 
SECTION III.  CHILD SUPPORT 
[Choose as applicable] 
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: 
[Choose only one] 
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: 
[Choose only one] 
a. ___Father. 
b. ___Mother. 
 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related 
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4. ___Petitioner requests that uninsured medical/dental expenses for the child(ren) be paid by: 
[Choose only one] 
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. ___Petitioner requests that life insurance to secure child support be provided by: 
[Choose only one] 
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: 
[Choose 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). 
 
 
Florida Supreme Court Approved Family Law Form 12.983(a), Petition to Determine Paternity and for Related 
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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 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, whose address is {street} _________________________, {city} ______________________, 
{state} ______________,{phone} ______, helped {name} _______________________________, who is 
the petitioner, fill out this form.
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and 
Counterpetition to Determine Paternity and for Related Relief (10/11) 
251 
INSTRUCTIONS FOR FLORIDA FAMILY LAW FORM 12.983(c), 
ANSWER TO PETITION AND COUNTERPETITION TO DETERMINE 
PATERNITY AND FOR RELATED RELIEF (10/11) 
 
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 (10/11) 
252 
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: 
 
 
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).  
(This must be filed within 45 days of service of the petition on you if not filed with 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 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), 12.995(b), or (c).  
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 (10/11) 
253 
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 Recommendations 
 
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), 12.995(b), or 12.995(c) 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.
 
 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
254 
 
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT, 
IN AND FOR ______________________________ COUNTY, FLORIDA 
 
 
 
Case No: ________________________ 
 
Division: ________________________ 
 
_________________________________, 
Petitioner, 
And 
 
_________________________________, 
Respondent. 
 
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 
Birth Date  
(1). ___________________________________________________________________________ 
(2). ___________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
255 
(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 . 
5. Petitioner [Choose only one] (    ) is (   ) is not a member of the military service. 
Respondent [Choose only one] (    ) is (    ) is not a member of the military service. 
 
6. Neither Petitioner nor Respondent is mentally incapacitated. 
 
7. 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. 
 
8. A completed Notice of Social Security Number, Florida Supreme Court Approved Family Law 
Form 12.902(j), is filed with this counterpetition. 
 
9. A completed Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 
12.902(b) or (c), is, or will be, filed. 
 
10. Paternity Facts. 
[Choose only one] 
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)}  
____________, in: {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 
 
 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
256 
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: 
[Choose only one] 
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  
 
[___] 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 interest of the child(ren):________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
5. The minor child(ren) should: 
[Choose only one] 
a. retain his/her (their) present name(s). 
b. receive a change of name as follows: 
 
 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
257 
present name(s) 
(1).  
_______________________ 
(2).  
_______________________ 
(3).  
_______________________ 
(4).  
_______________________ 
(5).  
_______________________ 
(6).  
_______________________ 
be changed to 
(1).  
______________________ 
(2).  
______________________ 
(3).  
______________________ 
(4).  
______________________ 
(5).  
______________________ 
(6).  
______________________ 
 
SECTION III.  CHILD SUPPORT 
[Choose 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: 
[Choose only one] 
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: 
[Choose only one] 
a. ___Father. 
b. ___Mother. 
 
4. ___Respondent requests that uninsured medical/dental expenses for the child(ren) be paid by: 
[Choose only one] 
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(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
258 
5. ___Respondent requests that life insurance to secure child support be provided by: 
[Choose only one] 
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). 
 
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: 
[Choose 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 [Choose only one] (   ) mailed (   ) faxed and mailed  
(   ) hand-delivered to the person(s) listed below on {date}______________________________.
 
 
Florida Supreme Court Approved Family Law Form 12.983(c), Answer to Petition and Counterpetition to Determine 
Paternity and for Related Relief (10/11) 
259 
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:  
 
 
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, whose address is {street}   
 
 
 
, {city}  
, 
{state}   
 
, {phone}  
 
 
, helped {name}  
, 
who is the respondent, fill out this form.
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
260 
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.995(a), PARENTING PLAN (10/11) 
 
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. If the 
case involves relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance 
Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) 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, 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
261 
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; 
 
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 
 
 
Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
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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.  
 
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.
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
263 
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) 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
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Name  
 
 
 
 
 
Date of Birth 
 
 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
 
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  
 
[   ] Mother 
[   ] Father 
Non-emergency health care 
 
 
 
[   ] Mother 
[   ] Father 
___________________________ 
 
[   ] Mother 
[   ] Father 
___________________________ 
 
[   ] Mother 
[   ] Father 
___________________________ 
 
[   ] Mother 
[   ] Father 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
265 
 
       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 
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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
266 
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. 
 
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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
267 
[   ] 
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: 
 
A. 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)  _____________________________________________________ 
 ___________________________________________________________________ 
___________________________________________________________________. 
 
B.The child(ren) shall spend time with the Father on the following dates and times: 
WEEKENDS:  [    ] Every [   ] Every Other [   ] Other (specify)  ____________________ 
From____________________________ to _________________________________ 
WEEKDAYS: Specify days  _______________________________________________ 
From _____________________________ to  _______________________________ 
OTHER: (Specify)  _____________________________________________________ 
 ___________________________________________________________________ 
___________________________________________________________________. 
 
C. 
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. 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
268 
 
[   ] 
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 
__________ 
_________ 
__________ 
_________________ 
 
_______________ 
__________ 
_________ 
__________ 
_________________ 
 
_______________ 
__________ 
_________ 
__________ 
_________________ 
 
 
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. 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
269 
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. 
 
[   ] 
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. 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
270 
 
 
[   ] 
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 
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 __________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
271 
 
____________________________________________________________ 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 purposes of school boundary determination and registration, the  
      *   + Mother’s *    + 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 (10/11) 
272 
 
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 (10/11) 
273 
 
_________________________________________________________________________ 
 
_________________________________________________________________________ 
 
_________________________________________________________________________. 
 
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 (10/11) 
274 
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. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
275 
 
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:  
 
 
STATE OF FLORIDA 
COUNTY OF _________________________                                         
 
Sworn to or affirmed and signed before me on                                by  
. 
 
 
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (10/11) 
276 
 
 
 
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 
 
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
 
 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW 
FORM 12.995(b), 
SUPERVISED/SAFETY-FOCUSED PARENTING PLAN (10/11) 
 
 
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) or a similar form should be used. If the case involves 
relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance Parenting 
Plan, Florida Supreme Court Approved Family Law Form 12.995(c) 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).  
 
 
 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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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; 
 
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; 
 
 
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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 
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.  
 
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.
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT 
IN AND FOR _________________ COUNTY, FLORIDA 
 
Case No: _____________________ 
Division: _____________________ 
 
_______________________________ 
Petitioner, 
and 
_______________________________ 
Respondent. 
 
SUPERVISED/SAFETY-FOCUSED 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 
 
 
 
_______________________________________________________________________ 
 
_______________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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_______________________________________________________________________ 
 
_______________________________________________________________________ 
 
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. 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 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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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) 
______________________________________________. 
 
[   ] 
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 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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[   ] 
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  
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     VIII. DESIGNATION FOR OTHER LEGAL PURPOSES 
 
1. 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. 
2. For purposes of school boundary determination and registration, the *    + Mother’s 
*    + Father’s address shall be designated. 
 
 
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. 
 
IX. COMMUNICATION 
 
1.  
Between Parents (Choose only one) 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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[   ] 
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:________________________________________________________________. 
 
[   ] 
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: 
_____________________________________________________________________ 
_____________________________________________________________________ 
_____________________________________________________________________. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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X. 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 
___________________________________________________________________. 
 
XI. 
CHILD(REN)’S  SAFETY 
 
 
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: _____________________________________________________________. 
 
XII. 
CHANGES OR MODIFICATIONS OF THE PARENTING PLAN 
 
All changes to the Supervised/Safety-Focused Parenting Plan must be pursuant to a court order. 
 
XIII. OTHER PROVISIONS 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
________________________________________________________________________ 
 
_________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
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________________________________________________________________________. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan  
(10/11) 
288 
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  
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STATE OF FLORIDA 
COUNTY OF ________________________                                         
 
Sworn to or affirmed and signed before me on                                by  
. 
 
 
 
NOTARY PUBLIC or DEPUTY CLERK 
 
 
 
[Print, type, or stamp commissioned name of notary or 
clerk.] 
        
Personally known 
        
Produced identification 
Type of identification produced 
 
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 
 
 
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