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

Citation: 

Docket Number: 

State: florida

Court: Florida Supreme Court

Date: 2012-03-15T00:00:00Z

Document:
Supreme Court of Florida 
 
 
____________ 
 
No. SC10-2344 
____________ 
 
 
IN RE:  AMENDMENTS TO FLORIDA SUPREME COURT APPROVED 
FAMILY LAW FORMS. 
 
[March 15, 2012] 
 
PER CURIAM. 
 
In our opinion in this case issued April 7, 2011, the Court adopted six new 
Supreme Court Approved Family Law Forms: form 12.970(a) (Petition for 
Temporary Custody by Extended Family); form 12.970(b) (Petition for Concurrent 
Custody by Extended Family); form 12.970(c) (Waiver of Service of Process and 
Consent for Temporary Custody by Extended Family); form 12.970(d) (Waiver of 
Service of Process and Consent for Concurrent Custody by Extended Family); 
form 12.970(e) (Order Granting Petition for Temporary Custody by Extended 
Family); and form 12.970(f) (Order Granting Petition for Concurrent Custody by 
Extended Family).  See In re Amendments to the Fla. Supreme Court Approved 
 
 
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Family Law Forms, 60 So. 3d 979 (Fla. 2011).1  The six forms were developed in 
response to recent legislative changes made by chapter 2010-30, Laws of Florida, 
which was passed by the Florida Legislature and took effect July 1, 2010.  See ch. 
2010-30, § 9, Laws of Fla.  The Court’s opinion invited interested persons to 
provide comments on the new forms within sixty days.  The Court received one 
comment from the Florida Department of Revenue (DOR), addressing forms 
12.970(e) and 12.970(f).2   
 
Forms 12.970(e) and 12.970(f) are orders granting petitions for temporary 
custody by an extended family member and concurrent custody by an extended 
family member, respectively.  The comment from DOR urges the Court to revise 
the sections in each form pertaining to “Method of Payment” in order to make a 
number of clarifying changes.3  Upon consideration of DOR’s comment, and with 
input from the Advisory Workgroup on the Florida Supreme Court Approved 
Family Law Forms, we amend forms 12.970(e) and 12.970(f) as reflected in the 
appendix to this opinion.  The forms are fully engrossed and ready for use.  The 
                                         
 
1.  Pursuant to our opinion in Amendments to the Florida Family Law Rules 
of Procedure & Family Law Forms, 810 So. 2d 1, 13-14 (Fla. 2000), this Court 
internally reviews and maintains the Florida Supreme Court Approved Family Law 
Forms. 
 
2.  We have jurisdiction.  See art. V, § 2(a), Fla. Const. 
 
3.  In form 12.970(e), section V addresses “Method of Payment.”  In form 
12.970(f), section IV addresses “Method of Payment.” 
 
 
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forms may also be accessed and downloaded from the Florida State Court’s 
website at www.flcourts.org/gen_public/family/forms_rules/index.shtml.  By 
adoption of these forms, we express no opinion as to their correctness or 
applicability.  The amendments shall become effective immediately upon release 
of this opinion. 
 
It is so ordered. 
CANADY, C.J., and PARIENTE, LEWIS, QUINCE, POLSTON, LABARGA, 
and PERRY, JJ., concur. 
 
THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE 
EFFECTIVE DATE OF THESE AMENDMENTS. 
 
 
Original Proceeding – The Florida Supreme Court Family Law Forms 
 
Steven Patrick Combs, Chair, the Family Law Rules Committee, Jacksonville, 
Florida, 
 
 
for Petitioner 
 
Joan K. Koch, Chief Legal Counsel, Florida Department of Revenue Child Support 
Enforcement Program, Tallahassee, Florida, 
 
 
responding with comments 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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APPENDIX 
 
IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT 
IN AND FOR __________________________ COUNTY, FLORIDA 
 
 
 
 
 
 
 
 
 
Case No: ______________________ 
 
 
 
 
 
 
 
 
Division: ______________________ 
 
__________________________________, 
 
 
                          Petitioner, 
and 
__________________________________, 
 
 
 
Respondent/Mother 
 
__________________________________, 
 
 
 
Respondent/Father. 
 
ORDER GRANTING PETITION FOR  
TEMPORARY CUSTODY BY EXTENDED FAMILY 
 
 
This case came before this Court for a hearing on a Petition for Temporary Custody by 
Extended Family.  The Court, having reviewed the file and heard the testimony, makes these 
findings of fact and reaches these conclusions of law: 
 
SECTION I. FINDINGS: 
 
1. The Court has jurisdiction over the subject matter and the parties. 
 
2. The minor child(ren) at issue in this matter are: 
Name  
 
 
 
 
 
 
Date of Birth 
___________________________________________________________________ 
___________________________________________________________________ 
___________________________________________________________________ 
___________________________________________________________________ 
 
3. The Petitioner, {full legal name} _____________________________________ is the 
{extended family relationship}___________________________________________ of 
the child(ren). 
 
4. The Mother {full legal name} _________________________________ of the child(ren):  
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
- 5 - 
(Choose one only) 
___ 
Filed a Waiver and Consent 
___ 
Was served with the petition and failed to file an Answer 
___      Is deceased as evidenced by: __________________________________________ 
___ 
Objected to the petition.  Based upon clear and convincing evidence, the Court 
finds that the Mother is unfit to provide for the care and control of the 
child(ren).  Specifically, the Mother has abused, abandoned, or neglected the 
child(ren) as defined in Chapter 39, Florida Statutes.   It is in the best interest of 
the child(ren) that the Petitioner have temporary custody because: {facts in 
support of finding} __________________________________________________ 
 
__________________________________________________________________ 
 
__________________________________________________________________ 
 
__________________________________________________________________ 
 
_________________________________________________________________. 
 
5. The Father {full legal name} _________________________________ of the child(ren):  
(Choose one only) 
___ 
Filed a Waiver and Consent 
___ 
Was served with the petition and failed to file an Answer 
___      Is deceased as evidenced by:  __________________________________________ 
___ 
Objected to the petition.  Based upon clear and convincing evidence, the Court 
finds that the Father is unfit to provide for the care and control of the child(ren).  
Specifically, the Father has abused, abandoned, or neglected the child(ren) as 
defined in Chapter 39, Florida Statutes.   It is in the best interest of the child(ren) 
that the Petitioner have temporary custody because: {facts in support of finding} 
_________________________________________________________________ 
 
_________________________________________________________________ 
 
_________________________________________________________________ 
 
_________________________________________________________________ 
 
_________________________________________________________________. 
 
6. It is in the best interest of the child(ren) for the Petitioner to have temporary custody. 
 
SECTION II: TEMPORARY CUSTODY 
 
1. The Petitioner, ___________________________________, is granted temporary 
custody of the minor child(ren). 
 
2. The Petitioner shall have all the rights and responsibilities of a legal parent. 
 
3. The Petitioner is authorized to make all reasonable and necessary decisions for the 
minor child(ren), including but not limited to: 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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a) Consent to all necessary and reasonable medical and dental care for the child(ren), 
including nonemergency surgery and psychiatric care; 
b) Secure copies of the child(ren)’s records, held by third parties, that are necessary for 
the care of the child(ren), including, but not limited to: 
i. 
Medical, Dental, and psychiatric records; 
ii. 
Birth certificates and other records; and 
iii. 
Educational records. 
 
4. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be 
tested or placed in special school programs, including exceptional education; and 
 
5. Do all other things necessary for the care of the child(ren). 
 
SECTION III. TEMPORARY TIME-SHARING WITH MINOR CHILD(REN) 
 
The parent(s) shall have: (Choose one only) 
1. ___ reasonable time-sharing with the minor child(ren) as agreed to by the parties, 
subject to the following limitations: __________________________________________ 
_______________________________________________________________________. 
 
2. ___ the following specified time-sharing schedule: {specify days and times} _______ 
______________________________________________________________________. 
Mother’s Temporary Time-Sharing Schedule. 
________________________________________________________________________ 
________________________________________________________________________ 
_______________________________________________________________________. 
Father’s Temporary Time-Sharing Schedule. 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________. 
 
3. ___ Time-Sharing in accordance with the temporary Parenting Plan attached as  
        Exhibit ___. 
 
4. ___ (   ) Mother (   ) Father shall have No Contact with the minor child(ren) until further 
order of the Court, due to existing conditions that are detrimental to the welfare of the 
minor child(ren): {explain} _________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________. 
 
SECTION IV.  CHILD SUPPORT 
 
1. The Petitioner ____ did  ____ did not request the establishment of child support. 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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2. ___ If child support is requested, the parents have received personal or substituted 
service of process, the petition requests an order for support of the child(ren), and there 
is evidence of the parents’ ability to pay the support ordered.  The(   ) Mother (   ) Father 
has the present ability to pay child support.  
(Choose one only)  
___ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules 
of Procedure Form 12.902(e) filed by the (   ) Mother (   ) Father are correct; 
OR 
___ The Court makes the following findings:  The Mother’s net monthly income is 
$_______________, (Child Support Guidelines ___%). The Father’s net monthly income 
is $____________________, (Child Support Guidelines ____%)  Monthly child care costs 
are $_________________.  Monthly health/dental insurance costs are $_____________. 
OR 
 
___ The (   ) Mother (   ) Father is currently ordered to pay child support to the other 
parent in the amount of $_____________ per ________________ as established in the 
case of {style of case and number}  ___________________________________________ 
 
_______________________________________________________________________. 
 
(    ) All of the child support or (   ) a portion of the child support in the amount of 
$_________ shall be redirected to the Petitioner. 
 
3. Amount 
a) Father’s Obligation  
      The Father shall be obligated to pay child support in the amount of $___________ 
for the______ children {total number of parties’ minor or dependent children} 
commencing ____________________ {month, day, year} and terminating 
______________________ {month, day, year}. 
 
      Upon the termination of the obligation of child support for one of the parties’ 
children, child support in the amount of $__________ for the remaining_______ 
children {total number of remaining children} shall be paid commencing 
________________ {month, day, year} and terminating _______________________ 
{month, day, year}. 
 
     {Insert paragraph for the child support obligation, including the amount, 
commencement, and termination dates, for the remaining minor or dependent 
children, which shall be payable as the obligation for each child ceases.}       
   
      The Father shall pay child support until all minor or dependent children: reach the 
age of 18; become emancipated, marry, join the armed services, die, or become self-
supporting; or until further order of the court or agreement of the parties.  The child 
support obligation shall continue beyond the age of 18 and until high school 
graduation for any child who is dependent in fact, between the ages of 18 and 19, 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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and is still in high school, performing in good faith with a reasonable expectation of 
graduation before the age of 19. 
 
 
If the child support ordered deviates from the guidelines more than 5%, the factual 
findings which support that deviation are: __________________________________ 
 
_____________________________________________________________________ 
 
____________________________________________________________________. 
 
      Child support shall be payable (   ) at least once a month and in accordance with 
Father’s employer’s payroll cycle, or (    ) other {explain}_______________________ 
      _____________________________________________________________________. 
 
b)  Mother’s Obligation 
The Mother shall be obligated to pay child support in the amount of $____________ 
for the ______ children {total number of parties’ minor or dependent children} 
commencing __________________________ {month, day, year} and terminating 
______________________ {month, day, year}. 
 
Upon the termination of the obligation of child support for one of the parties’ 
children, child support in the amount of $___________ for the remaining ______ 
children {total number of remaining children} shall be paid commencing 
_______________ {month, day, year} and terminating ________________________ 
{month, day, year}. 
 
{Insert paragraph for the child support obligation, including the amount, 
commencement, and termination dates, for the remaining minor or dependent 
children which shall be payable as the obligation for each child ceases.} 
 
The Mother shall pay child support until all of the minor or dependent children:  
reach the age of 18; become emancipated, marry, join the armed services, die, or 
become self-supporting; or until further order of the court or agreement of the 
parties.  The child support obligation shall continue beyond the age of 18 and until 
high school graduation for any child who is dependent in fact, between the ages of 
18 and 19, and is still in high school, performing in good faith with a reasonable 
expectation of graduation before the age of 19. 
 
If the child support ordered deviates from the guidelines more than 5%, the factual 
findings which support that deviation are:  __________________________________ 
_____________________________________________________________________ 
____________________________________________________________________. 
 
Child support shall be payable (   ) at least once a month and in accordance with the 
Mother’s employer’s payroll cycle, or (   ) other {explain} ______________________ 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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____________________________________________________________________. 
 
4. Arrearages/Retroactive Child Support 
a) The (  ) Mother (  ) Father owes child support arrearages in the amount of 
$_________ as of {date} ________________ to the other parent. The child support 
arrearages shall be repaid in the amount of $_______ per month, payable (   ) in 
accordance with the employer’s payroll cycle, and in any event at least once per 
month (   ) other {explain} _______________________________________________ 
commencing {date} _____________________, until paid in full including statutory 
interest. 
 
b) The (   ) Mother (   ) Father owes retroactive child support in the amount of 
$_________ as of {date} ________________ to the Petitioner. The retroactive child 
support  shall be repaid in the amount of $_______ per month, payable (   ) in 
accordance with the employer’s payroll cycle, and in any event at least once per 
month (   )other {explain} ________________________________________________ 
_____________________________________________________________________ 
commencing {date} ______________________, until paid in full including statutory 
interest. 
 
5. Insurance 
 
(Choose all that apply) 
a) (   ) Mother (   ) Father shall be required to maintain  (   ) health and/or (   ) dental 
insurance for the parties’ minor child(ren), so long as reasonable in cost and 
accessible to the child(ren).  The party providing insurance shall be required to 
convey insurance cards demonstrating said coverage to the Petitioner and other 
parent. 
OR 
(   ) health and/or (   ) dental insurance is either not reasonable in cost or accessible 
to the child(ren) at this time. 
 
b) ___ Reasonable and necessary uninsured medical/dental/prescription drug costs for 
the minor child(ren) shall be assessed as follows: 
(   ) Shared equally by both parents. 
(   ) Prorated according to the child support guidelines percentages. 
(   ) Other {explain} ______________________________________________ 
 
As to these uninsured medical/dental/prescription drug expenses, the party who 
incurs the expense shall submit a request for reimbursement to the parent or 
parents within 30 days, and the parent or parents, within 30 days of receipt, shall 
submit the applicable reimbursement for that expense. 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
- 10 - 
 
SECTION V. METHOD OF PAYMENT 
 
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows: 
1. Place of Payment  
 
a) ___Parent(s) shall pay court-ordered support directly to either the State 
Disbursement Unit or the central depository, as required by statute, along with any 
fee required by statute. 
 
OR 
 
b) ___ The Petitioner and the Parent(s) have requested and the Court finds that it is in 
the best interest of the child(ren) that support payments need not be directed 
through either the State Disbursement Unit or the central depository at this time; 
however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3), 
Florida Statutes, to require payment through either the State Disbursement Unit or 
the central depository. 
 
2. Income Deduction 
(If applicable) 
a) ___ Immediate. (   ) Mother (   ) Father, hereinafter, Obligor(s), shall pay through 
income deduction, pursuant to a separate Income Deduction Order which shall be 
effective immediately.  Obligor is individually responsible for paying this support 
obligation until all of said support is deducted from his/her income.  Until support 
payments are deducted, the Obligor is responsible for making timely payments 
directly to the State Disbursement Unit or the Petitioner as previously set forth in 
this Order. 
b) ___ Deferred. Income deduction is ordered this day, but it shall not be effective until 
a delinquency of $_____________, or, if not specified, an amount equal to one 
month’s obligation occurs.  Income deduction is not being implemented 
immediately based on the following findings:  Income deduction is not in the best 
interests of the child(ren) because: {explain}  ________________________________ 
_____________________________________________________________________ 
____________________________________________________________________. 
AND 
There is proof of timely payment of a previously ordered obligation without an 
Income Deduction Order, 
AND 
(   ) there is an agreement by the Obligor(s) to advise the State Disbursement Unit of 
any change in Payor and/or health insurance OR (   ) there is a signed, written 
agreement providing an alternative arrangement between the Petitioner and the 
Obligor(s). 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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3. Bonus/one-time payments. 
[Choose one only] 
 
(   ) All (   ) __________% (   ) No income paid in the form of a bonus or other similar one-
time payment, up to the amount of any arrearage or the remaining balance thereof 
owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the 
payment method prescribed above. 
 
4. Other provisions relating to method of payment: _______________________________ 
_______________________________________________________________________. 
 
SECTION VI.  ATTORNEY FEES, COSTS, AND SUIT MONEY 
(Choose one only) 
 
1. ___ (   ) Petitioner’s (    )Respondents’ request(s) for attorney fees, costs, and suit money 
is (are) denied because ____________________________________________________ 
_______________________________________________________________________. 
 
2. ___ The Court finds there is a need for and ability to pay attorney fees, costs, and suit 
money. (   ) Petitioner (   ) Respondent(s) is (are) ordered to pay the other party 
$________ in attorney fees, and $ ______ in costs.  The Court further finds that the 
attorney fees are awarded based on the reasonable rate of $________________ per 
hour and ________________ reasonable hours.  Other provisions relating to attorney 
fees, costs, and suit money are as follows: _____________________________________ 
_______________________________________________________________________. 
 
SECTION VII. OTHER PROVISIONS 
 
1. Other Provisions   ________________________________________________________ 
________________________________________________________________________ 
________________________________________________________________________ 
_______________________________________________________________________. 
 
2. The Court reserves jurisdiction to modify and enforce this Order for Temporary Custody. 
 
Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by 
Extended Family 03/12 
 
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DONE AND ORDERED in ______________________, Florida on {date} __________________ 
 
 
 
 
 
 
 
 
 
 
_____________________________ 
 
 
 
 
 
 
 
CIRCUIT JUDGE 
 
A copy of this Order for Temporary Custody was:  [Choose one only]  
(   ) mailed (   ) faxed and mailed (   ) hand delivered to the parties listed below on  
{date} _______________ by ________________________________{clerk of court or designee}. 
 
Petitioner (or his or her attorney) 
Respondents (or his or her attorney) 
State Disbursement Unit 
Other _________________________________ 
 
 
 
 
 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT 
IN AND FOR __________________________ COUNTY, FLORIDA 
 
 
 
 
 
 
 
 
 
Case No: ______________________ 
 
 
 
 
 
 
 
 
Division: ______________________ 
 
__________________________________, 
Petitioner, 
and 
__________________________________, 
 
 
 
Respondent/Father 
 
__________________________________, 
 
 
 
Respondent/Mother. 
 
 
ORDER GRANTING PETITION FOR  
CONCURRENT CUSTODY BY EXTENDED FAMILY 
 
 
This case came before this Court for a hearing on a Petition for Concurrent Custody by 
Extended Family.  The Court, having reviewed the file and heard the testimony, makes these 
findings of fact and reaches these conclusions of law: 
 
SECTION I. FINDINGS: 
 
1. The Court has jurisdiction over the subject matter and the parties. 
 
2. The minor child(ren) at issue in this matter are: 
Name  
 
 
 
 
 
 
Date of Birth 
___________________________________________________________________ 
___________________________________________________________________ 
___________________________________________________________________ 
___________________________________________________________________ 
 
3. The Petitioner, {full legal name} _____________________________________ is the 
{extended family relationship}___________________________________________ of 
the child(ren). 
 
4. The Petitioner currently has physical custody of the child(ren) and has had physical 
custody of the child(ren) for at least 10 days in any 30-day period within the last 12 
months. 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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5. The Petitioner does not have signed, written documentation from the parent(s) which is 
sufficient to enable the custodian to do all the things necessary to care for the child(ren) 
which are available to custodians who have an order for temporary custody by extended 
family. 
 
6. The Mother {full legal name} _________________________________ of the child(ren):  
(choose one only) 
___ 
Filed a Waiver and Consent 
___ 
Was served with the petition and failed to file an Answer 
            ___      Is deceased as evidenced by: _______________________________________ 
 
7. The Father {full legal name} _________________________________ of the child(ren):  
(choose one only) 
___ 
Filed a Waiver and Consent 
___ 
Was served with the petition and failed to file an Answer 
___      Is deceased as evidenced by: _______________________________________ 
 
8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody. 
 
SECTION II: CONCURRENT CUSTODY 
 
1. The Petitioner,___________________________________________________, is granted 
concurrent custody of the minor child(ren). 
 
2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent. 
 
3. The Petitioner is authorized to make all reasonable and necessary decisions for the 
minor child(ren), including but not limited to: 
a) Consent to all necessary and reasonable medical and dental care for the 
child(ren), including nonemergency surgery and psychiatric care; 
b) Secure copies of the child(ren)’s records, held by third parties, that are necessary 
for the care of the child(ren), including, but not limited to: 
i. 
Medical, Dental, and psychiatric records; 
ii. 
Birth certificates and other records; and 
iii. 
Educational records. 
 
4. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be 
tested or placed in special school programs, including exceptional education; and 
 
5. Do all other things necessary for the care of the child(ren). 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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SECTION III. CHILD SUPPORT 
 
1. The Petitioner ____ did  ____ did not request the establishment of child support. 
 
2. ___ If child support is requested, the parents have received personal or substituted 
service of process, the petition requests an order for support of the child(ren), and there 
is evidence of the parents’ ability to pay the support ordered. The (   ) Mother (   ) Father 
has the present ability to pay child support  
(Choose one only)  
___ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules 
of Procedure Form 12.902(e) filed by the (   ) Mother (   ) Father are correct; 
OR 
___ The Court makes the following findings:  The Mother’s net monthly income is 
$_______________, (Child Support Guidelines ___%). The Father’s net monthly income 
is $____________________, (Child Support Guidelines ____%)  Monthly child care costs 
are $_________________.  Monthly health/dental insurance costs are $_____________. 
OR 
 
___ The (   ) Mother (   ) Father is currently ordered to pay child support to the other 
parent in the amount of $_____________ per ________________ as established in the 
case of (style of case and number}  _________________________________________ 
 
_____________________________________________________________________. 
 
(    ) All of the child support or (   ) a portion of the child support in the amount of 
$_________ shall be redirected to the Petitioner. 
 
3. Amount 
      a) Father’s Obligation  
 
The Father shall be obligated to pay child support in the amount of $__________ for the 
_______children {total number of parties’ minor or dependent children} commencing 
_________________ {month, day, year} and terminating ________________________ 
{month, day, year}. 
 
      Upon the termination of child support for one of the parties’ children, child support in 
the amount of $_____________ for the remaining _________ children {total number of 
remaining children} shall be paid commencing __________________ {month, day, year} 
and terminating _________________________ {month, day, year}. 
 
     {Insert paragraph for the child support obligation, including the amount, 
commencement, and termination dates, for the remaining minor or dependent 
children, which shall be payable as the obligation for each child ceases.} 
 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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      The Father shall pay child support until all of the minor or dependent children:  reach the 
age of 18, become emancipated, marry, join the armed services, die, or become self-
supporting; or until further order of the court or agreement of the parties.  The child 
support obligation shall continue beyond the age of 18 and until high school graduation 
for any child who is dependent in fact, between the ages of 18 and 19, and is still in high 
school, performing in good faith with a reasonable expectation of graduation before the 
age of 19. 
 
 
 
 
 
If the child support ordered deviates from the guidelines more than 5%, the factual 
findings which support that deviation are: ____________________________________ 
 
_______________________________________________________________________ 
 
_______________________________________________________________________. 
 
 
Child support shall be payable (  ) at least once a month and in accordance with the 
Father’s employer’s payroll cycle, or (  ) other {explain}___________________________ 
 
________________________________________________________________________ 
 
 
b) Mother’s Obligation 
The Mother shall be obligated to pay child support in the amount of $____________ for 
the ________children {total number of parties’ minor or dependent children} 
commencing {month, day, year} and terminating __________________ {month, day, 
year}. 
 
Upon the termination of the obligation of child support for one of the parties’ children, 
child support in the amount of $__________ for the remaining ______ children {total 
number of remaining children} shall be paid commencing _____________________ 
{month, day, year} and terminating ________________________ month, day, year}. 
 
{Insert paragraph for the child support obligation, including the amount, 
commencement, and termination dates, for the remaining minor or dependent 
children, which shall be payable as the obligation for each child ceases.} 
 
The Mother shall pay child support until all of the minor or dependent children: reach 
the age of 18; become emancipated, marry, join the armed services, die, or become self-
supporting; or until further order of the court or agreement of the parties.  The child 
support obligation shall continue beyond the age of 18 and until high school graduation 
for any child who is dependent in fact, between the ages of 18 and 19, and is still in high 
school, performing in good faith with a reasonable expectation of graduation before the 
age of 19. 
 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
- 17 - 
If the child support ordered deviates from the guidelines more than 5%, the factual 
findings which support that deviation are:______________________________________ 
________________________________________________________________________ 
_______________________________________________________________________. 
 
Child support shall be payable (   ) at least once a month and in accordance with the 
Mother’s employer’s payroll cycle, or (   ) other {explain}__________________________ 
_______________________________________________________________________.  
 
 
4. Arrearages/Retroactive Child Support 
a) The (   ) Mother (   ) Father owes child support arrearages in the amount of 
$_________ as of {date} ________________ to the other parent. The child 
support arrearages shall be repaid in the amount of $_______ per month, 
payable (   ) in accordance with the employer’s payroll cycle, and in any event at 
least once per month (   )other {explain} ________________________________ 
__________________________________________________________________ 
commencing {date} ______________________, until paid in full including 
statutory interest. 
 
b) The (   ) Mother (   ) Father owes retroactive child support in the amount of 
$_________ as of {date} ________________ to the Petitioner. The retroactive 
child support  shall be repaid in the amount of $_______ per month, payable (   ) 
in accordance with the employer’s payroll cycle, and in any event at least once 
per month (   )other {explain} __________________________________________ 
__________________________________________________________________ 
commencing {date} ______________________, until paid in full including 
statutory interest. 
 
5. Insurance 
 
(Choose all that apply) 
a) (   ) Mother (   ) Father shall be required to maintain  (   ) health and/or (   ) dental 
insurance for the parties’ minor child(ren), so long as reasonable in cost and 
accessible to the child(ren).  The party providing insurance shall be required to 
convey insurance cards demonstrating said coverage to the Petitioner and other 
parent. 
OR 
(   ) health and/or (   ) dental insurance is either not reasonable in cost or 
accessible to the child(ren) at this time. 
 
b) ___ Reasonable and necessary uninsured medical/dental/prescription drug costs 
for the minor child(ren) shall be assessed as follows: 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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(   ) Shared equally by both parents. 
(   ) Prorated according to the child support guidelines percentages. 
(    ) Other {explain} ______________________________________________ 
 
As to these uninsured medical/dental/prescription drug expenses, the party who 
incurs the expense shall submit a request for reimbursement to the parent or 
parents within 30 days, and the parent or parents, within 30 days of receipt, shall 
submit the applicable reimbursement for that expense. 
 
SECTION IV.  METHOD OF PAYMENT 
 
The parent(s) shall pay court-ordered child support and arrearages, if any, as follows: 
1. Place of Payment 
 
     
                 a) ___Parents shall pay court-ordered support directly to either the State  
 
 
         Disbursement Unit or the central depository, as required by statute, along 
                     with any applicable fee required by statute. 
 
 
            OR 
                
               b)  ___ The Petitioner and the Parents have requested and the court finds that it is in   
 
         the best interest of the child(ren) that support payments need not be directed   
 
 
         through either the State Disbursement Unit or the central depository at this  
 
 
         time; however, any party may subsequently apply, pursuant to section  
  
       
 
         61.13(1)(d)(3), Florida Statutes, to require payment through either the State  
 
 
          Disbursement Unit or the central depository. 
 
2. Income Deduction 
(If applies) 
a) ___ Immediate. (   ) Mother (   ) Father, hereinafter, Obligor(s), shall pay through 
income deduction, pursuant to a separate Income Deduction Order which shall 
be effective immediately.  Obligor is individually responsible for paying this 
support obligation until all of said support is deducted from his/her income.  
Until support payments are deducted, the Obligor is responsible for making 
timely payments directly to the State Disbursement Unit or the Petitioner as 
previously set forth in this Order. 
b) ___ Deferred. Income deduction is ordered this day, but it shall not be effective 
until a delinquency of $_____________, or, if not specified, an amount equal to 
one month’s obligation occurs.  Income deduction is not being implemented 
immediately based on the following findings:  Income deduction is not in the 
best interests of the child(ren) because: {explain} _________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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_______________________________________________________________ 
_______________________________________________________________. 
 
 
AND 
There is proof of timely payment of a previously ordered obligation without an 
Income Deduction Order, 
AND 
(   ) there is an agreement by the Obligor(s) to advise the State Disbursement 
Unit of any change in Payor and/or health insurance OR (   ) there is a signed, 
written agreement providing an alternative arrangement between the Petitioner 
and Obligor(s). 
 
3. Bonus/one-time payments. 
[Choose one only] 
(   ) All (   ) __________% (   ) No income paid in the form of a bonus or other similar one-
time payment, up to the amount of any arrearage or the remaining balance thereof 
owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the 
payment method prescribed above. 
 
4. Other provisions relating to method of payment: _______________________________ 
________________________________________________________________________ 
 
SECTION V.   ATTORNEY FEES, COSTS, AND SUIT MONEY 
(Choose one only) 
 
1. ___ (   ) Petitioner’s (   ) Respondents’ request(s) for attorney fees, costs, and suit money 
is (are) denied because ____________________________________________________ 
_____________________________________________________________________. 
2. ___ The Court finds there is a need for and ability to pay attorney fees, costs, and suit 
money. (   ) Petitioner (   ) Respondent(s) is (are) ordered to pay the other party 
$________ in attorney fees, and $ ______ in costs.  The Court further finds that the 
attorney fees are awarded based on the reasonable rate of $________________ per 
hour and ________________ reasonable hours.  Other provisions relating to attorney 
fees, costs, and suit money are as follows: _____________________________________ 
_______________________________________________________________________. 
 
SECTION VI.  OTHER PROVISIONS 
 
1. Other Provisions _________________________________________________________ 
________________________________________________________________________ 
________________________________________________________________________ 
________________________________________________________________________ 
 
 
Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by 
Extended Family 03/12 
 
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2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody. 
 
3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent 
or parents to obtain physical custody of the child(ren) at any time. 
 
 
DONE AND ORDERED in _____________________, Florida on {date} ____________________ 
 
 
 
 
 
 
 
 
 
 
_____________________________ 
 
 
 
 
 
 
 
CIRCUIT JUDGE 
 
A copy of this Order for Concurrent Custody was:  
[Choose one only] (   ) mailed (   ) faxed and mailed (   ) hand delivered to the parties listed 
below on {date}___________ by____________________________. {Clerk of court or designee} 
 
Petitioner (or his or her attorney) 
Respondents (or his or her attorney) 
State Disbursement Unit or Central Depository 
 
Other _________________________________