# Supreme Court of Florida

____ ___ _______

No. SC 16

- 1253

__ ___ _________

IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT

APPROVED FAMILY LAW FORMS

.

[September 29, 2016]

CORRECTED OPINION

PER CURIAM.

Pursuant to the procedures approved by this Court in Amendments to the

Florida Family Law Rules of Procedure & Family Law Forms , 810 So. 2d 1, 14

(Fla. 2000), this Court has internally reviewed the Florida Supreme Court

Approved Family Law Forms and has determined that amendments to forms

12.982(a), Petition for Change of Name (Adult)

, 12.982(c), Petition for Change of

Name (Minor Child(ren) )

, and 12.982(f)

, Petition for Change of Name (Family )

are necessary in light of certain statutory amendments. Input on th ese issue s was

received from the Advisory Workgr oup on the Florida Supreme Court Approved

Family Law Forms, which provided valuable assistance. We have jurisdiction. See

art. V, § 2(a), Fla. Const.

## - 2

-

S ection 68.07, Florida Statutes

, was amended, effective October 1, 2014, to

require that the result of a state and national criminal history records check for the

purposes of obtaining a name change must indicate whether the petitioner has

registered as a sexual predator or sexual offender. See ch. 2014

- 5, § 1, L aws of

Fla. Additionally, s ubsection 68.07(3) (i) requires that petitions for name change

must state “whether the petitioner has ever been required to register as a sexual

predator under s. 775.21 or as a sexual offender under s. 943.0435.” § 68.07(3)(i),

Fla. Stat. (2014). The amendments to the for ms incorporate this new requirement

.

The amended forms are adopted as set forth in the appendix to this opinion,

fully engrossed, effective for immediate use. The forms may also be accessed and

downloaded from the Florida State Court’s website at

http:// www.flcourts.org/resources

- and

- services/court

- improvement/problem

solving

- courts/family

- courts/family

- law

- forms.stml . By adoption of the amended

forms, we express no opinion as to their correctness or applicability. We also

direct that the new and amende d forms be published for comment. Interested

persons shall have sixty days from the date of this opinion to file comments with

the Court. 1



## 1

. All comments must be filed with the Court on or before November 28,

2016 , as well as a separate request for oral argument if the person filing the

## - 3

-

It is so ordered.

LABARGA, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, POLSTON,

and PERRY, JJ., concur.

T HE FILING O F A MOTION FOR REHEARING SHALL NOT ALTER THE

EFFECTIVE DATE OF THESE AMENDMENTS.

Original Proceeding

– Florida Supreme Court Approved Family Law Forms

comment wishes to participate in oral argument, which may be scheduled in this

case. If filed by an attorney in good standing with The Florida Bar, the comment

must be electro nically filed via the Portal in accordance with In re: Electronic

Filing in the Supreme Court of Florida via the Florida Courts E

- Filing Portal , Fla.

Admin. Order No. AOSC13

- 7 (Feb

. 18, 2013). If filed by a non

- lawyer or a

lawyer not licensed to practice in Florida, the comment must be electronically filed

via e

- mail in accordance with In re Mandatory Submission of Electronic Copies of

Documents , Fla. Admin. Order No. AOSC04

- 84 (Sept. 13, 2004). Electronically

filed documents must be submitted in Microsof t Word 97 or higher. Any person

unable to submit a comment e lectronically must mail or hand deliver the originally

signed comment to the Florida Supreme Court, Office of the Clerk, 500 South

Duval Street, Tallahassee, Florida 32399

- 1927; no additional cop ies are required or

will be accepted.Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 4

- INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.982(a)

PETITIO N FOR CHANGE OF NAME (A DULT) (09/16 )

When should this form be used?

This form should be used when an adult wants the court to change his or her name. This form is not to

be used in connection with a dissolution of marriage or for adoption of child(ren). If you want a change

of name because of a dissolution of marriage or adoption of child(ren) that is not yet final, the change

of name should be requested as part of that case.

This form should be typed or printed in black ink and must be signed before a notary public or depu ty

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?

Unless you are seeking to restore a former name, you must have fingerprints submitted for a state

and national criminal records check. The fingerprints must be taken in a manner approved by the

Department of Law Enforcement and must be submitted to the Department for a state and national

criminal records check. You may not request a hearing on the petition until the clerk of court has

received the results of your criminal history records check . The clerk of court can instruct you on the

process for having the fingerprints taken and submitted, including information on law enforcement

agencies or service providers authorized to submit fingerprints electronically to the Department of Law

Enforcement. The process may take several weeks and you will have to pay for the cost of processing

the fingerprints and conducting the state and national crimina l history records check. Please note that

the state and national criminal records check must indicate whether you have registered as a sexual

predator or a sexual offender and you must also indicate on this petition whether you have ever been

required to register as a sexual predator under section 775.21, Florida Statutes, or as a sexual

offender under section 943.0435, F.S.

Next, you must obtain a hearing date for the court to consider your request. If you are seeking to

restore a former name, a hearing on the petition MAY be held immediately after the petition is filed.

The final hearing on any other petition for a name change may be held immediately after the clerk of

court receives the results of your criminal history records check. You should ask t he clerk of court,

family law intake staff , or judicial assistant about the local procedure for setting a hearing. You may be

required to attend the final hearing . Included in these forms is a Final Judgment of Change of Name

(Adult) , Florida Supreme Cou rt Approved Family Law Form 12.982(b), which the judge may use. You

should check with the clerk, family law intake staff, or judicial assistant, to see if you need to bring a

final judgment form with you. If so, you should type or print the heading, incl uding the circuit, county,

case number, division, and the parties’ names, and leave the rest blank for the judge to complete atInstructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 5

- your hearing or trial.

If the judge grants your petition , he or she will sign this order . This officially changes your name. The

clerk can provide you with certified copies of the signed order. There will be charges for the certified

copies, and the clerk can tell you the amount of the charges.



### Where can I look for more information?

Before proceeding, you should read General I nformation for Self

- Represented Litigants found at the

beginning of these forms. For further information, see Section 68.07, Florida Statutes.



### IMPORTANT INFORMATION REGARDING E

- FILING

The Florida Rules of Judicial Administration now require that all pet itions, pleadings, and documents be

filed electronically except in certain circumstances. Self

- represented litigants may file petitions or other

pleadings or documents electronically; however, they are not required to do so. If you choose to file

your ple adings or other documents electronically, you must do so in accordance with Florida Rule of

Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.

The rules and procedures should be carefully read and followed.



### IMPORTANT INFORMATION REGARDING E

- SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified

process server, the Florida Rules of Judicial Administration now require that all docum ents required or

permitted to be served on the other party must be served by electronic mail (e

- mail) except in certain

circumstances. You must strictly comply with the format requirements set forth in the Rules of

Judicial Administration. If you elect t o participate in electronic service, which means serving or

receiving pleadings by electronic mail (e

- mail), or through the Florida Courts E

- Filing Portal, you must

review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through

the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started,

or Rules of Court in the A

- Z Topical Index.

SELF

- REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E

- MAIL; HOWEVER, THEY ARE NOT

REQUIRED TO DO SO. If a self

- represented litigant elects to serve and receive documents by e

- mail, the

procedures must always be followed once the initial election is made.

To serve and receive documents by e

- mail, you must designate your e

- mail addresses by using the

Designation of Current Mailing and E

- mail Address , Florida Supreme Court Approved Family Law Form

12.915, and you must provide your e

- mail address on each form on which your signature appears.

Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme

Court Approved Family Law Form 12.914; Designation of Current Mailing and E

- mail Address , Florida

Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judi cial Administration 2.516.Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 6

- Special notes...

The heading of the form calls for the name of the petitioner . Your current name should go there, as you

are the one who is asking the court for something. The judicial circuit, case number, and division may b e

obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and/or places that will need a copy of your final

judgment. This list may include the driver’s license office, social securit y office, banks, schools, etc. A

list will help you know how many copies of your order you should get from the clerk of court after your

hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out

these fo rms, 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 num ber on the bottom of the last page of every

form he or she helps you complete.Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 7

-

IN THE CIRCUIT COURT OF THE ____________JUDICIAL CIRCUIT,

IN AND FOR______________________COUNTY, FLORIDA

Case No.: ________________________

Division: _______________________

__

_______________________________,

Petitioner.



## PETITION FOR CHANGE OF NAME (ADULT)

I, {full legal name} _________________________________, being sworn, certify that the following

information is true:

1. My complete present name is: _______________________

________________________________ I request that my name be changed to: ________________________________________________

2. I live in _________________ County, Florida, at {street address}

_____________________________

_____________________________________ ____________________________________________

3. I was born on {date}______________ , in {city}

_________________________, {county}

__________

, {state}

______________________, {country}

_________________.

4. My father’s full legal name: ______________________

____________________________________ My mother’s full legal name: _________________________________________________________

My mother’s maiden name: __________________________________________________________

5. I have lived in the following places since birth:

Dates (to/from) Address

_______/_________

____________________________________________________ _______/_________

____________________________________________________ _______/_________

____________________________________________________

____ ___/_________

____________________________________________________ (___ Please indicate here if you are continuing these facts on an attached page.)

6. Family

[Indicate all that apply]

____ I am not married.

____ I am married. My spouse’s full legal name is: _____________________________________Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 8

- ____ I do not have child(ren).

____ The name(s), age(s), and address(es) of my child(ren) are as follows (all children, including

those over 18 , must be listed):

Name {last, first, middle initial} Age Addre ss, City, State

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________ ________

__________________________________________________________________________________

__________________________________________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page. )

7. Former names

[Indicate all that apply]

My name has never been changed by a court

. My name previously was changed by court order from ______________________________

to _____________________________________on {date}

___________________ ____________ , by {court, city, and state}

. A copy of the court order is attached

.

My name previously was changed by marriage from

__________________________________ to on {date}

,

in {city, county, and state}

. A copy of the marriag e certificate is attached

.

I have never been known or called by any other name.

I have been known or called by the following other name(s): {list name(s) and explain

where you were known or called by such name(s)}

____________________ ______________________________________________________________

8. Occupation

My occupation is:

. I am employed at: {company and address}

. During the past 5 years, I have had the following jobs:

Dates (to/from) Employer and employer’s address

_______/

_______ __________________________________________________________ _______/_______ __________________________________________________________

_______/_______ ______________________________________________________

____ _______/_______ __________________________________________________________

_______/_______ __________________________________________________________

(___ Please indicate here if you are continuing these facts on an atta ched page.)

9. Business [Choose one only]Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 9

- I do not own and operate a business.

I own and operate a business. The name of the business is: ___________________________

The street address is:

. My position with the business is:

. I have b een involved with the business since: {date}

.

10. Profession

[Choose one only]

I am not in a profession.

I am in a profession. My profession is: _________________________________________

I have practiced this profession:

Dates (to/from) Place and address

_______/_______ __________________________________________________________

_______/_______ __________________________________________________________

_______/_______ __________________________________________________________

_______/_______ __________________________________________________________

(____ Please indicate here if you are continuing these facts on an attached page.)

11. Education

I have graduated from the following school(s):

Degree Date of

Received Gra duation School

_________ _____________ __________________________________________________

_________ _____________ __________________________________________________

_________ _____________ __________________________________________________

______ ___ _____________ __________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.)

12. Criminal History

[Indicate all that apply]

I have never been arrested for or charged with, pled guilty or nolo contendere to, or been

found to have committed a criminal offense, regardless of adjudication.

I have a criminal history. In the past I have been arrested for or charged with, pled guilty or

nolo contendere to, or been fo und to have committed a criminal offense, regardless of adjudication.

The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(______ Please indicate here if you are continuing these facts on an attached page.)Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 10

- I _____ have____have not ever be en required to register as a sexual predator under section 775.21,

Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section

943.0435, Florida Statutes.

13. Bankruptcy

[Choose one only]

I have ne ver been adjudicated bankrupt.

I was adjudicated bankrupt on {date} , in {city}

, {county}

, {state}

. (____ Please indicate here if you have filed additional bankruptcies, and explain on an attached

page.)

14. Creditor(s)’ Judgments

[Choos e one only]

I have never had a money judgment entered against me by a creditor.

The following creditor(s)’ money judgment(s) have been entered against me:

Date Amount Creditor Court entering judgment and case num ber {date} if Paid

_____

_____

_____

_____ (_____ Please indicate here if these facts are continued on an attached page.)

15. Fingerprints and Criminal History Records Check

Unless I am seeking to restore a former name, a copy of my fingerprints has been taken in a manner

approved by the Department of Law Enforcement and submitted for a state and national criminal

history records check. I understand that I cannot request a hearing on my Petition until the Clerk

of Court receives the results of t he criminal history records check. I also understand that the state

and national records check must indicate whether I have registered as either a sexual predator or

sexual offender.

16. I have no ulterior or illegal purpose for filing this petition, and gran ting it will not in any manner

invade the property rights of others, whether partnership, patent, good will, privacy, trademark, or

otherwise.

17. My civil rights have never been suspended, or, if my civil rights have been suspended, they have

been fully rest ored.Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n for Change of Name (Adult)

(09/16 )



## - 11

- 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: __________________________________

Designated E

- Mail Address(es):____________________

_____________________________________________

STATE OF FLORIDA

COUNTY OF ____________________

Sworn to or affirmed and signed before m e on ____________ by

_______________________________ .

_____________________________________________ NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________ [Print, type, or stamp commissioned name of notary or

deputy clerk.]

_ ___ Personally known

____ Produced identification

____ Type of identification produced

________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the Petitioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city}

________________, {state}_____,{zip code}_________,{telephone number}

__________________Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name

(Minor Child(ren)) (09/16)



## - 12

- INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY

LAW FORM 12.982(c)

PETITION FOR CHANG E OF NAME (MINOR CHILD(REN)) (09/16 )

When should this form be used?

This form should be used when parents want the court to change the name of their minor

child(ren). For the purposes of this proceeding, a person under the age of 18 is a minor. This

form is not to be used in connection with an adoption, dissolutio n of marriage, or paternity

action . If you want a change of name for your child(ren) because of an adoption or paternity

action that is not yet final, the change of name should be requested as part of that case.

This form should be typed or printed in bl ack ink and must be signed 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. The Petition should only be completed by one

Petitioner for one child. If you wish to change the name of more than one child or if there is

more than one Petitioner, you should complete and file a Supplemental Form for Petition for

Change of Name (Minor Child) for each child and/or a Supplemental Form for Petitio n for

Change of Name. The supplemental form(s) is an attachment to the petition. Be sure that the

bottom of each page of each supplemental form is initialed by the petitioner(s)

.



### What should I do next?

Unless you are seeking to restore a former name, each adult petitioner(s)’s fingerprints must

be submitted for a state and national criminal history records check. The fingerprints must be

taken in a manner approved by the Department of Law Enforcement. The fingerprints must be

submitted to the Departm ent of Law Enforcement for a state and national criminal history

records check. The Petitioner(s) may not request a hearing on the Petition until the copy of

the fingerprints are filed and the clerk of court has received the results of the criminal histor y

records check. The clerk of court can instruct you on the process for having the fingerprints

taken and submitted, including information on law enforcement agencies or service providers

authorized to submit fingerprints electronically to the Department of Law Enforcement. The

process may take several weeks and the parent or guardian of the minor must pay the cost of

processing the fingerprints and conducting the state and national history records check. Please

note that the state and national criminal records check must indicate whether you have

registered as either a sexual predator or a sexual offender and you must also indicate on this

petition whether you have ever been required to register as a sexual predator under section

775.21, Florida Statutes , or as a sexual offender under section 943.0435, Florida Statutes.Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name

(Minor Child(ren)) (09/16)



## - 13

- If both parents agree to the change of name and live in the county where the change of name is

sought, you may both file as petitioners . In this situation, service is not necessary, and you

need only to set a hearing

. You should ask the clerk of court, family law intake staff , or judicial

assistant about the local procedure for setting a hearing.

If only one parent is a resident of the county where the change of name(s) is sought or onl y one

parent asks for the child(ren)’s name(s) to be changed, the other parent must be notified and his

or her consent obtained, if possible. If the other parent consents to the change of name, a

Consent for Change of Name (Minor Child(ren)) , Florida Supr eme Court Approved Family Law

Form 12.982(d), should be filed.

If the other parent does not consent to the change of name, you may still have a hearing on the

petition if you have properly notified the other parent about your petition and the hearing. If

you know where he or she lives, you must use personal service . If you absolutely do not know

where he or she lives, you may use constructive service . For more information about personal

and constructive service, you should refer [to] the “General Instru ctions for Self

- Represented

Litigants” found at the beginning of these forms and the instructions to Florida Family Law Rules

of Procedure Forms 12.910(a) and 12.913(b) and Florida Supreme Court Approved Family Law

Form 12.913(a). However, the law regardi ng constructive service is very complex and you may

wish to consult an attorney regarding that issue.

Next, you must obtain a final hearing date for the court to consider your request. If you are

seeking to restore a former name, a hearing on the petitio n MAY be held immediately after the

petition is filed. The final hearing on any other petition for a name change may be held

immediately after the clerk of court receives the results of your criminal history records check.

You should ask the clerk of cou rt, family law intake staff, or judicial assistant about the local

procedure for setting a hearing. You may be required to attend the hearing. Included in these

forms is a Final Judgment of Change of Name (Minor Child(ren)) , Florida Supreme Court

Approve d Family Law Form 12.982(e), which may be used when a judge grants a change of

name for a minor child(ren). If you attend the hearing, you should take the final judgment with

you. You should complete the top part of the form, including the circuit, count y, case number,

division, and the name(s) of the petitioner(s) and leave the rest blank for the judge to complete.

It should be typed or printed in black ink.

If the judge grants your petition, he or she will sign this order

. This officially changes you r

child(ren)’s name(s). The clerk can provide you with certified copies of the signed order. There

will be charges for the certified copies, and the clerk can tell you the amount of the charges.Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name

(Minor Child(ren)) (09/16)



## - 1 4

-

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 68.07, Florida

Statutes.



### IMPORTANT INFORMATION REGARDING E

- FILING

The Florida Rules of Judicial Administra tion now require that all petitions, pleadings, and

documents be filed electronically except in certain circumstances. Self

- represented litigants

may file petitions or other pleadings or documents electronically; however, they are not

required to do so. I f you choose to file your pleadings or other documents electronically, you

must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow

the procedures of the judicial circuit in which you file. The rules and procedures should be

carefully read and followed.



### IMPORTANT INFORMATION REGARDING E

- SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or

certified process server, the Florida Rules of Judicial Administrati on now require that all

documents required or permitted to be served on the other party must be served by electronic

mail (e

- mail) except in certain circumstances. You must strictly comply with the format

requirements set forth in the Rules of Judicial Ad ministration. If you elect to participate in

electronic service, which means serving or receiving pleadings by electronic mail (e

- mail), or

through the Florida Courts E

- Filing Portal, you must review Florida Rule of Judicial

Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules

of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of

Court in the A

- Z Topical Index.

SELF

- REPRESENTED LITI GANTS MAY SERVE DOCUMENTS BY E

- MAIL; HOWEVER, THEY ARE NOT

REQUIRED TO DO SO. If a self

- represented litigant elects to serve and receive documents by e

mail, the procedures must always be followed once the initial election is made.

To serve and receive d ocuments by e

- mail, you must designate your e

- mail addresses by using

the Designation of Current Mailing and E

- mail Address , Florida Supreme Court Approved Family

Law Form 12.915, and you must provide your e

- mail address on each form on which your

signatur e appears. Please CAREFULLY read the rules and instructions for: Certificate of Service

(General), Florida Supreme Court Approved Family Law Form 12.914; Designation of CurrentIns tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name

(Minor Child(ren)) (09/16)



## - 15

- Mailing and E

- mail Address , Florida Supreme Court Approved Family Law Form 12. 915; and

Florida Rule of Judicial Administration 2.516.



### Special notes...

The heading of the form calls for the name(s) of the petitioner(s) . This means the parent(s) who

is (are) requesting the change of their child(ren)’s name(s). The judicial circuit , case number,

and division may be obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and places that will need a copy of the final

judgment. This list may include the driver’s l icense office, social security office, banks, schools,

etc. A list will help you know how many copies of your order you should get from the clerk of

court after your hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill

out these forms, that person must give you a copy of 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.Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 16

-

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR COUNTY, FLORIDA

Case No.:

Division:

IN RE: THE NAME CHANGE OF

, Petitioner/Father,

, Petitioner/Mother.



## PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

I/We, {full legal name(s)} , being sworn, certify

that the following information is true:

I am/We are the birth or legal parent(s) or guardian of the minor child(ren) na med in this petition.

[Choose only one]

a. ____ There is only one minor child named in this petition.

b. ____ There are {enter number of children} children named in this petition. The

information on the first child is entered below. I/We have attached the completed

supplemental forms for each other child.

The adult petitioner(s)’s fingerprints have been taken in a manner approved by the Department of Law

Enforcement and submitted for a state and national criminal history records check . I /We understand

th at I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of

the criminal history records check. I/We also understand that the state and national records check

must indicate whether I/we have registered as either a sexual predator or a sexual offender.

A. THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # 1 :

1. Minor child’s complete present name is:

I/We request that this minor child’s name be changed to:Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 17

- 2. The minor child lives in County, Florida, at { street address}

.

3. The minor child was born on {date} , in {city, county, state, country}

.

4. The minor child’s father’s full legal name:

. The minor child’s mother’s full legal name:

. The minor child’s mother’s maiden name:

.

5. The minor child has lived in the following places since birth:

Dates (to/from) Address

_______/________

______________________________________________________ _______/________

______________________________________________________ _______/________

_______________ ________________________________________ _______/________

______________________________________________________ _______/________

______________________________________________________ (____ Please indicate here if you are continuing these facts on an attached page.)

6. [Choose one only]

_____The minor child is not married.

_____ The minor child is married to: {full legal name}

__________________________________.

7. [Choose one only]

_____The minor child has no children.

_____The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of

birth} ___________________________________________________________________.

8. Former names.

[Indicate all that apply]

_____The minor child’s name has never been changed by a court.

_____The minor child’s name previously was changed by court order from _______________

to on {date} , by {court, city, and state}

. A copy of the court order is attached.

_____The minor child’s name previously was changed by marriage from ___________

______ to on {date} , in

{city, county, and state}

. A copy of the marriage certificate is attached.Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 18

- _____The minor child has never been known or called by any other name.

_____The minor child has been known or called by the following o ther name(s): {list name(s)

and explain where child was known or called by such name(s)}

____________________

_____________________________________________________________________ _____ . 9. The minor child is not employed in an occupation or profession, do es not own and operate a

business, and has received no educational degrees. If the minor child has a job, explain:

.

10. Criminal History.

[Indicate all that apply]

_____ The minor child has never been arrested for or charged with, pled guilty or nolo

cont endere to, or been found to have committed a criminal offense, regardless of

adjudication.

_____ The minor child has a criminal history. In the past, the minor child was arrested for or

charged with, pled guilty or nolo contendere to, or been found to ha ve committed a

criminal offense, regardless of adjudication. The details of the criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(_____Please indicate here if you are continuing these facts on an attached page.)

__ ___ The minor child _____ has _____has not ever been required to register as a sexual

predator under section 775.21, Florida Statutes.

_____ The minor child _____has _____has not ever been required to register as a sexual

offender under section 943.0435, Florida Statutes

11. Money Judgments.

[Choose one only]

_____ The minor child has never been adjudicated bankrupt, and no money judgment has ever

been entered against him or her.

_____ The following money judgment(s) has been entered against him or her:

Date Amount Creditor Court entering judgment and case number if Paid {date}

_____

____ _

_____

_____Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 19

- B. THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S):

( ) FATHER ( ) MOTHER ( ) GUARDIA N

( ) A Supplemental Form has been attached for the other parent or petitioner.

1. My complete present name is: __________________________________________________.

2. I live in ________________ County, Florida, at {street address}

_________________________ __

_________________________________________________________________ .

3. Bankruptcy

[Choose one only]

I have never been adjudicated bankrupt.

I was adjudicated bankrupt on {date} , in {city}

, {county}

, {state}

. (___ Please indi cate here if you have filed additional bankruptcies, and explain on an attached

page.)

4. Creditor(s)’ Judgments

[Choose one only]

I have never had a money judgment entered against me by a creditor.

The following creditor(s)’ money judgmen t(s) have been entered against me:

Date Amount Creditor Court entering judgment and case number if Paid {date}

_____

_____

_____

_____

5. Criminal History

Indicate all that apply

I have never been ar rested for or charged with, pled guilty or nolo contendere to, or been

found to have committed a criminal offense, regardless of adjudication.

I have a criminal history. In the past I have been arrested for or charged with, pled guilty or

nol o contendere to, or been found to have committed a criminal offense, regardless of

adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 20

- (______ Please indicate here if you are continuing these facts on an attached page.)

I ___ __ have____have not ever been required to register as a sexual predator under section

775.21, Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section

943.0435, Florida Statutes.

6. I have no ulterior o r illegal purpose for filing this petition, and granting it will not in any manner

invade the property rights of others, whether partnership, patent, good will, privacy, trademark,

or otherwise.

7. My civil rights have never been suspended, or, if ever suspe nded, they have been fully restored.

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.

Dat ed: ______________________

_____________________________________________ Signature of PETITIONER

Printed Name: _________________________________

Address: _____________________________________

City, State, Zip: ________________________________

Tel ephone Number: _____________________________

Fax Number: __________________________________

Designated E

- Mail Address(es):____________________

_____________________________________________

STATE OF FLORIDA

COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by

_______________________________ .

_____________________________________________ NOTARY PUBLIC or DEPUTY CLERKIns tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 21

- _____________________________________________ [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 bla nks] This form was prepared for the Petitioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________ ________________ , {city}

________________, {state}_____,{zip code}_________,{telephone number}

__________________Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 22

- ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILDREN)

Case No.: ______________________________

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER(S):

( ) FATHER ( ) MOTHER ( ) GUARDIAN

1. My complete present name is: __________________________________________________

____________________________________________________________________________ __ .

2. I live in ________________ County, Florida, at {street address}

___________________________

______________________________________________________________________________.

3. Bankruptcy

[Choose one only]

I have never been adjudicated bankrupt

. I was adjudicated bankrupt on {date} , in {city}

, {county}

, {state}

. (___ Please indicate here if you have filed additional bankruptcies, and explain on an attached

page.)

4. Creditor(s)’ Judgments

[Choose one only]

I h ave never had a money judgment entered against me by a creditor.

The following creditor(s)’ money judgment(s) have been entered against me:

Date Amount Creditor Court entering judgment and case number if Paid

{date}

______ _

_______ _________ ________________________________

______ ________ _________ ________________________________

______ ________ _________ ________________________________

______ ________ _________

________________________________

______ ________ _________ ________________________________ (____ Please indicate here if these facts are continued on an attached page.)

5. Criminal History

[Indicate all that apply]

I have n ever been arrested for or charged with, pled guilty or nolo contendere to, or been

found to have committed a criminal offense, regardless of adjudication.

I have a criminal history. In the past I have been arrested for or charged with, pled g uiltyIns tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 23

- or nolo contendere to, or been found to have committed a criminal offense, regardless of

adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(____ Please indicate here if you are continuing these facts on an attached pa ge.)

I _____ have____have not ever been required to register as a sexual predator under section

775.21, Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section

943.0435, Florida Statutes.

6. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner

invade the property rights of others, whether partnership, patent, good will, privacy, trademark,

or otherwise.

7. My civil rights have never been suspended, or, if ever suspended, they have been fully restored.Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 24

- 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

imprison ment.

Dated: ______________________

_____________________________________________ Signature of PETITIONER

Printed Name: _________________________________

Address: _____________________________________

City, State, Zip: ___________________________

_____ Telephone Number: _____________________________

Fax Number: __________________________________

Designated E

- Mail Address(es):____________________

_____________________________________________

STATE OF FLORIDA

COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by

_______________________________ .

_____________________________________________ NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________ [Print, type, or stamp commi ssioned 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:

[fil l in all blanks] This form was prepared for the Petitioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

__________________ ____________________________ , {city}

________________, {state}_____,{zip code}_________,{telephone number}

__________________ .Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 25

- SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (MINOR CHILD(REN))

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :

1. Minor child’s complete present name is:

I/We request that this minor child’s name be changed to:

2. The minor child lives in County, Florida, at {street address}

.

3. The minor child was born on {date} , in { city, county, state, country}

.

4. The minor child’s father’s full legal name:

. The minor child’s mother’s full legal name:

. The minor child’s mother’s maiden name:

.

5. The minor child has lived in the following places since birth:

Dates (to/from) Address

_______/________

______________________________________________________ _______/________

__________ _ ________________________________________________ ______/_________

___________________________________________________________ ______/________

_ ___________________________________________________________ ______/_________

___________________________________________________________ ______/_________

___________________________________________________________ (_____ Please indicate here if you are c ontinuing these facts on an attached page.)

## MINOR CHILD # ________, continued

Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 26

- 6. [Choose one only]

_____The minor child is not married.

_____ The minor child is married to: {full legal name}

__________________________________.

7. [Choose one only]

_____The minor child has no children.

_____ The minor child is the parent of the following child(ren): {enter full name(s) and date(s) of

birth} ___________________________________________________________________.

8. Former names.

[Indicate all that apply]

_____The minor child’s name has never been c hanged by a court.

_____The minor child’s name previously was changed by court order from _______________

to on

{date} , by {court, city, and state}

. A copy of the court order is attached.

_____The minor child’s name previously was changed by marriage from _________________

to on {date} , in {city, county, and

state}

. A copy of the marriage certificate is attached.

_____The minor child has never been known or called by any other name.

_____The minor child has been known or called by the following other name(s): {list name(s)

and explain where child was known or called by such name(s)}

____________________

_____________________________________________________________________

_____________________________________________________________________

9. The minor child is not employed in an occupation or profession, does not own and operate a

business, and has received no educational degrees. If the minor child has a job, explain:

.

10. Criminal History.

[Indicate all that apply]

_____ The minor child has never been arrested for or charged with, pled guilty or nolo

co ntendere to, or been found to have committed a criminal offense, regardless of

adjudication.

_____ The minor child has a criminal history. In the past, the minor child was arrested for or

charged with, pled guilty or nolo contendere to, or been found to have committed a

criminal offense, regardless of adjudication. The details of the criminal history are:

## MINOR CHILD # ________, continued

Ins tructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 27

- Date City/State Event (arrest, charge, plea, or adjudication)

(_____ Please indicate here if you are continuing these facts on an attached page. )

_____ The minor child _____ has _____has not ever been required to register as a sexual

predator under section 775.21, Florida Statutes.

_____ The minor child _____has _____has not ever been required to register as a sexual

offender under section 943 .0435, Florida Statutes

11. Money Judgments.

[Choose one only]

_____ The minor child has never been adjudicated bankrupt, and no money judgment has ever

been entered against him or her.

_____ The following money judgment(s) has been entered against him or her:

Date Amount Creditor Court entering judgment and case number {date} if Paid

_____

_____

_____Instructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)

(09/16)



## - 28

- INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.982(f)

PETITIO N FOR CHANGE OF NAME (FAMILY) (09/16 )

When should this form be used?

This form should be used when a family wants the court to change its name. This form is not to be used

in connection with a dissolution of marriage

, paternity , or adoption action. If you want a change of

name because of a dissolution of marriage , paternity, or adoption acti on that is not yet final, the change

of name should be requested as part of that case.

This form should be typed or printed in black ink and must be signed 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. The petition should only be completed for one adult. If you wish to

change the name(s) of another adult and/or any child(ren), you should complete and file with the clerk

of court the attached Supplemental Form(s) for Petition for Change of Name (Family) for each additional

family member. Be sure that the bottom of each page of each supplemental form is initialed.



### What should I do next?

Unless you are seeking to restore a former nam e, each adult petitioner must have fingerprints

submitted for a state and national criminal history records check

. The fingerprints must be taken in a

manner approved by the Department of Law Enforcement and must be submitted to the Department

for a state and national criminal history records check. You may not request a hearing on the petition

until the clerk of court has received the results of your criminal history records check. The clerk of

court can instruct you on the process for having the finger prints taken and submitted, including

information on law enforcement agencies or service providers authorized to submit finger prints

electronically to the Department of Law Enforcement. The process may take several weeks and you will

have to pay for the cost of processing the fingerprints and conducting the state and national criminal

history records check. Please note that the state and national criminal records check must indicate

whether you have registered as either a sexual predator or a sexual offe nder and you must also

indicate on this petition whether you have ever been required to register as a sexual predator under

section 775.21, Florida Statutes, or as a sexual offender under section 943.0435, Florida Statutes.

If any of the children for whom you are requesting this change of name are not the legal children of both

adults filing this petition, you must obtain the consent of the legal parent(s). A parent not named as a

petitioner in this action may consent by submitting a Consent for Change of Name (Minor Child(ren))

, Florida Supreme Court Approved Family Law Form 12.982(d).

If the other parent does not consent to the change of name, you may still have a hearing on the petition

if you have properly notified the other parent about your petition and the hearing. If you know where

he or she lives, you must use personal service . If you absolutely do not know where he or she lives, youInstructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)

(09/16)



## - 29

- may use constructive service

. For more information about personal and constructive service, you

should refer to the “General Instructions for Self

- Represented Litigants” found at the beginning of

these forms and the instructions to Florida Family Law Rules of Procedure Forms 12.910(a) and

12.913(b) and Florida Supreme Court Approved Family Law Form 12.913(a). The l aw on constructive

service is very complex and you may wish to consult an attorney regarding constructive service.

Next, you must obtain a final hearing date for the court to consider your request. If you are seeking to

restore a former name, hearing on t he petition MAY be held immediately after the petition is filed. The

final hearing on any other petition for a name change may be held immediately after the clerk of court

receives the results of your criminal history records check. You should ask the cl erk of court, family law

intake staff , or judicial assistant about the local procedure for setting a hearing. You may be required

to attend the hearing. Included in these forms is a Final Judgment of Change of Name (Family) , Florida

Supreme Court Approve d Family Law Form 12.982(g), which may be used when a judge grants a change

of name for a family. If you attend the hearing, you should take the final judgment form with you. You

should complete the top part of this form, including the circuit, county, c ase number, division, the

name(s) of the petitioner(s) and leave the rest blank for the judge to complete. It should be typed or

printed in black ink.

If the judge grants your petition, he or she will sign this order . This officially changes your family ’s

name. The clerk can provide you with certified copies of the signed order. There will be charges for the

certified copies, and the clerk can tell you the amount of the charges.



### 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 68.07, Florida Statutes.



### IMPORTANT INFORMATION REGARDING E

- FILING

The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be

filed electronically except in certain circumstances. Self

- represented litigants may file petitions or other

pleadings or documents electronically; however, they are not required to do so. If you choose to file

your pleadings or other documents electronically, you must do so in accordance with Florida Rule of

Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.

The rules and procedures should be carefu lly read and followed.



### IMPORTANT INFORMATION REGARDING E

- SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified

process server, the Florida Rules of Judicial Administration now require t hat all documents required or

permitted to be served on the other party must be served by electronic mail (e

- mail) except in certain

circumstances. You must strictly comply with the format requirements set forth in the Rules of

Judicial Administration. I f you elect to participate in electronic service, which means serving orInstructions for Florida Supreme Court Approved Family Law Form 12.982(f), Petition for Change of Name (Family)

(09/16)



## - 30

- receiving pleadings by electronic mail (e

- mail), or through the Florida Courts E

- Filing Portal, you must

review Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through

the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started,

or Rules of Court in the A

- Z Topical Index.

SELF

- REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E

- MAIL; HOWEVER, THEY ARE NOT

REQUIRED TO DO SO. If a self

- represented litigant elects to serve and receive documents by e

- mail, the

procedures must always be followed once the initial election is made.

To serve and receive documents by e

- ma il, you must designate your e

- mail addresses by using the

Designation of Current Mailing and E

- mail Address , Florida Supreme Court Approved Family Law Form

12.915, and you must provide your e

- mail address on each form on which your signature appears.

Plea se CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme

Court Approved Family Law Form 12.914; Designation of Current Mailing and E

- mail Address , Florida

Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.



### Special notes...

The heading of the form calls for the name(s) of the petitioner(s) . This is (are) the parent(s) who is/are

requesting the change of their family’s name(s). The judicial circuit, case number, and division may be

obtained from the clerk of court’s office when you file the petition.

It may be helpful to compile a list of all of the people and places that will need a copy of the final

judgment. This list may include the driver’s license office, soci al security office, banks, schools, etc. A

list will help you know how many copies of your order you should get from the clerk of court after your

hearing.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill ou t

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 tele phone number on the bottom of the last page of every

form he or she helps you complete.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 31

-

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR CO UNTY, FLORIDA

Case No.:

Division:

IN RE: THE NAME CHANGE OF

,

Petitioner/Father,

,

Peti tioner/Mother.



## PETITION FOR CHANGE OF NAME (FAMILY)

I/We, {full legal name(s)} ____________________________________________________, being sworn,

certify that the following information is true:

There are {enter number}

__ adults named in this petition

. A supplemental form is

attached for each adult not set out below.

There are {enter number}

__ children named in this petition. I am/We are the birth or

legal parents or guardian of the minor child(ren) named in this petition. I/We have attached a

co mpleted supplemental form for each minor child.

Unless I am seeking to restore a former name, a copy of the fingerprints of each adult person seeking a

name change in this petition has/have been taken in a manner approved by the Department of Law

Enforceme nt, and submitted for a state and national criminal history records check. I /We understand

that I/we cannot request a hearing on my/our Petition until the clerk of court receives the results of

the criminal history records check

. I/We also understand tha t the state and national records check

must indicate whether I/we have registered as either a sexual predator or sexual offender.

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER:

( ) HUSBAND ( ) WIFE ( ) GUARDIAN

( ) A Supplemental Form has been attached for the other parent or petitioner.

1. My complete present name is:

. I request that my name be changed to:

.

2. I live in County, Florida, at {street address}

.

3. I was born on {date} , in {city}

, {county}

, {state}

, {country}

.

4. My father’s full legal name:

.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 32

- My mother’s full legal name:

. My mother’s maiden name:

.

5. I have lived in the following places since birth:

Dates (to/from) Address

/

/

/

/

/

/

(____ Ple ase indicate here if you are continuing these facts on an attached page.)

6. Family

[Indicate all that apply]

_____ I am not married.

_____ I am married. My spouse’s full legal name is:

. _____ I do not have child(ren).

_____The name(s), age(s), and addres s(es) of my child(ren) are as follows (all children, including

those over 18 , must be listed):

Name {last, first, middle initial} Age Address, City, State

(____ Please indicate here if you are continuing thes e facts on an attached page.)

7. Former names

[Indicate all that apply]

____My name has never been changed by a court

. ____My name previously was changed by court order from

to on {date} , by {court, city, and state}

. A copy o f the court order is attached.

_____My name previously was changed by marriage from

to on

{date} , in {city, county, and state}

. A copy of the marriage certificate is attached.

_____I have never been known or called by any other name.

____ _I have been known or called by the following other name(s): {list name(s) and explain

where you were known or called by such name(s)}

.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 33

- 8. Occupation

My occupation i s:

. I am employed at: {company and address}

. During the past 5 years, I have had t he following jobs:

Dates (to/from) Employer and employer’s address

/

/

/

/

/

/

(____ Please i ndicate here if you are continuing these facts on an attached page.)

9. Business

[Choose one only]

____I do not own and operate a business.

____I own and operate a business. The name of the business is :

. The street address is :

. My position with the business is:

. I have been involved with the business since: {date}

.

10. Profession

[Choose one only]

____I am not in a profession.

____I am in a pro fession. My profession is:___________________________________________

I have practiced this profession:

Dates (to/from) Place and address

/

/

/

(____ Please indicate here if you are continuing these facts on an attached page.)

11. Ed ucation

I have graduated from the following school(s):

Degree Date of

Received Graduation School

(____ Please indicate here if you are continuing these facts on an attached page.)

12. Criminal HistoryFlorida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 34

- [Indicate all that apply]

_____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or

have been found to have committed a criminal offense, regardless of adjudication.

_____ I have a criminal history. In the past I have been arreste d for or charged with, pled

guilty or nolo contendere to, or been found to have committed a criminal offense,

regardless of adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(_____ Ple ase indicate here if you are continuing these facts on an attached page.)

I _____ have____have not ever been required to register as a sexual predator under section

775.21, Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section

943.0435, Florida Statutes.

13. Bankruptcy

[Choose one only]

____ I have never been adjudicated bankrupt.

____ I was adjudicated bankrupt on {date} , in {city}

, {county}

, {state}

. (____ Please indicat e here if you have had additional bankruptcies, and explain on an attached

page.)

14. Creditor(s)’ Judgments

[Choose one only]

____I have never had a money judgment entered against me by a creditor.

____The following creditor(s)’ money judgment(s) have been entered against me:

Date Amount Creditor Court entering judgment and case number if Paid

{date }

____

____

____

____

____ (____ Please indicate here if these facts are continued on an attached page.)

15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any man ner

invade the property rights of others, whether partnership, patent, good will, privacy, trademark,

or otherwise.

16. My civil rights have never been suspended, or, if my civil rights have been suspended, they haveFlorida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 35

- been fully restored.

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:

__________________________________ Designated E

- Mail Address(es):____________________

_____________________________________________

STATE OF FLORIDA

COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by

________ _______________________ .

_____________________________________________ NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________ [Print, type, or stamp commissioned name of notary or

deputy clerk.]

____ Personally known

____ Prod uced identification

____ Type of identification produced

________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the Petitioner.

This form wa s completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city}

________________, {state}_____,{zip code}_________,{telephone number}

__________________ .Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 36

- ADULT SUPPLEMENTAL FORM FOR PETITION FOR CHANGE OF NAME (FAMILY)

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER:

( ) HUSBAND ( ) WIFE ( ) GUARDIAN

1. My compl ete present name is:

. I request that my name be changed to:

.

2. I live in County, Florida, at {street address}

.

3. I was born on {date} , in {city}

, {county}

, {state}

, {country}

.

4. My father’s full legal name:

. My mother’s full legal name:

. My mother’s maiden name:

.

5. I have lived in the following places since birth:

Dates (to/from) Address

/

/

/

/

/

/

/

(____ Please indicate here if you are cont inuing these facts on an attached page.)

6. Family

[Indicate all that apply]

_____ I am not married.

_____I am married. My spouse’s full legal name is:

. _____ I do not have child(ren).

_____The name(s), age(s), and address(es) of my child(ren) are as foll ows (all children, including

those over 18 , must be listed):

Name {last, first, middle initial} Age Address, City, StateFlorida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 37

- (____ Please indicate here if you are continuing these facts on an attached page.)

7. Former names

[Indicate all that apply]

____My name has never been changed by a co urt

.

____My name previously was changed by court order from______________________________

to on

{date} by {court, city, and state}

. A copy of the court order is attached.

____My name previously was changed by marriage from __________________

_____________ to on {date}

in {city, county, and state}

. A copy of the marriage certificate is attached.

____I have never been known or called by any other name.

____I have been known or called by the following other name(s): {list name(s) and e xplain

where you were known or called by such name(s)}

_____________________________________

8. Occupation

My occupation is:

. I am employed at: {company and address}

. During the past 5 years, I have had the following jobs:

Dates (to/from) Employer a nd employer’s address

/

/

/

/

/

/

(____ Please indicate here if you are continuing these facts on an attached page.)

9. Business

[Indicate all that apply]

____ I d o not own and operate a business.

____ I own and operate a business. The name of the business is:

. The street address is:

. My position with the business is:

. I have been involved with the business since: {date}

.

10. Profession

[Indicate all that apply]Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 38

- ____I am not in a profession.

____I am in a profession. My profession is:

. I have practiced this profession:

Dates (to/from) Place and addre ss

/

/

/

/

/

(___ Please indicate here if you are continuing these facts on an attached page.)

11. Education

I have graduated from the following school(s):

Degree Date of

Received Graduation School

(___ Please indicate here if you are continuing these facts on an attached page.)

12. Criminal History

[Indicate all that apply]

____ I have never been arrested for or charged with, pled guilty or nolo contendere to, or been

found to have commi tted a criminal offense, regardless of adjudication.

____ I have a criminal history. In the past I have been arrested for or charged with, pled guilty

or nolo contendere to, or been found to have committed a criminal offense, regardless of

adjudication. The details of my criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(_____ Please indicate here if you are continuing these facts on an attached page.)

I _____ have____have not ever been required to register as a se xual predator under section

775.21, Florida Statutes.

I _____ have ______have not ever been required to register as a sexual offender under section

943.0435, Florida Statutes.

13. Bankruptcy

[Choose one only]

____I have never been adjudicated bankrupt.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 39

- ____I was adjudicated bankrupt on {date} , in {city}

, {county}

, {state}

. (____ Please indicate here if you have had additional bankruptcies, and explain on an attached

page.)

14. Creditors’ Judgments

[Choose one only]

____I have never had a money judgment entered against me by a creditor.

____The following creditor(s)’ money judgment(s) have been entered against me:

Date Amount Creditor Court entering judgment and case number if Paid

{date }

____

____

____

____

____ (____ Please indicate here if you are contin uing these facts on an attached page.)

15. I have no ulterior or illegal purpose for filing this petition, and granting it will not in any manner

invade the property rights of others, whether partnership, patent, good will, privacy, trademark,

or othe rwise.

16. My civil rights have never been suspended, or, if my civil rights have been suspended, they have

been fully restored.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change of Name

(Family) (09/16)



## - 40

- I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this

petition and that the pun ishment for knowingly making a false statement includes fines and/or

imprisonment.

Dated: ______________________

_____________________________________________ Signature of PETITIONER

Printed Name: _________________________________

Address: ________

_____________________________ City, State, Zip: ________________________________

Telephone Number: _____________________________

Fax Number: __________________________________

Designated E

- Mail Address(es):____________________

__________________

___________________________

STATE OF FLORIDA

COUNTY OF ____________________

Sworn to or affirmed and signed before me on ____________ by

_______________________________ .

_____________________________________________ NOTARY PUBLIC or DEPUTY CLERK

_____________________________________________ [Print, type, or stamp commissioned name of notary or

deputy clerk.]

____ Personally known

____ Produced identification

____ Type of identification produced

________________________________

IF A NONLAWY ER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the Petitioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city}

________________, {state}_____,{zip code}_________,{telephone number}

__________________ .Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change

of Name (Family) (09/16)



## - 41

- CHILD SUPPLEMENTAL FORM FOR PET ITION FOR CHANGE OF NAME (FAMILY)

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT MINOR CHILD # :

1. Minor child’s complete present name is:

I/We request that minor child’s name be changed to:

2. The minor child lives in County, Florida, a t {street address}

.

3. The minor child was born on , in {city, county, state, country}

.

4. The minor child’s father’s full legal name:

. The minor child’s mother’s full legal name:

. The minor child’s mother’s maiden name:

.

5. The minor child has l ived in the following places since birth:

Dates (to/from) Address

/

/

/

/

/

/

/

(____ Please indicate here if continuing these facts on an attached page.)

6. [Choose one only]

____The minor child is not married

____The minor child is ma rried to: {full legal name}

.

7. [Choose one only]

____The minor child has no children.

____The minor child is the parent of the following child(ren): {enter name(s) and date(s)

of birth}

.

8. Former names

[Indicate all that apply]

____The minor child’s name has never been changed by court order

. ____The minor child’s name previously was changed by court order from __________

to on {date}

__________________ {court, city, and state}

.Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change

of Name (Family) (09/16)



## - 42

- A copy of the court order is attached.

____ The minor child’s name previously was changed by marriage from ______________

to on { date } __________,

in {city, county, and state}

. A copy of the marriage certificate is attached.

____The minor child has never been known or called by any other name.

____ The minor child has been known or called by the following other n ame(s): {list

name(s) and explain where child was known or called by such name(s)}

_________

____________________________________________________________________

____________________________________________________________________ .

9. The minor child is n ot employed in an occupation or profession, does not own and

operate a business, and has received no educational degrees. If the minor child has a

job, explain: _____________________________________________________________

_______________________________ ________________________________________.

10. Criminal History

[Indicate all that apply]

____ The minor child has never been arrested for or charged with, pled guilty or nolo

contendere to, or been found to have committed a criminal offense, regardless of

ad judication.

____ The minor child has a criminal history. In the past, the minor child was arrested for

or charged with, pled guilty or nolo contendere to, or been found to have committed a

criminal offense, regardless of adjudication. The details of th e criminal history are:

Date City/State Event (arrest, charge, plea, or adjudication)

(____ Please indicate here if you are continuing these facts on an attached page.)

_____ The minor child _____ has _____has not ever been required to register as a

sexual predator under section 775.21, F lorida Statutes.

_____ The minor child _____has _____has not ever been required to register as a sexual

offender under section 943.0435, Florida Statutes.

11. Money Judgments

[Choose one only]

____ The minor child has never been adjudicated bankrupt, and no money judgment has

ever been entered against him or her.

____ The following money judgment(s) has been entered against him or her:

Date Amount Creditor Court entering judgment and case number if Paid

{date}

______ ________ _________ __________ ______________________Florida Supreme Court Approved Family Law Form 12.982(f), Supplemental Form for Petition for Change

of Name (Family) (09/16)



## - 43

- ______ ________ _________ ________________________________ (_____Please indicate here if you are continuing these facts on an attached page.)