Supreme Court of Florida

____________

No. SC2024-0072

____________

IN RE: AMENDMENTS TO FLORIDA FAMILY LAW RULES OF

PROCEDURE – FORMS 12.900(h) AND 12.928.

February 22, 2024

PER CURIAM.

This matter is before the Court for consideration of proposed 

amendments to the Florida Family Law Rules of Procedure Forms. 

We have jurisdiction. See art. V, § 2(a), Fla. Const.; see also Fla. R. 

Gen. Prac. & Jud. Admin. 2.140(e).

The Florida Bar’s Family Law Rules Committee has filed a fasttrack report proposing amendments to forms 12.900(h) (Notice of 

Related Cases) and 12.928 (Cover Sheet for Family Court Cases) in 

response to recent legislation creating section 61.1255, Florida 

Statutes. See ch. 2023-213, § 1, Laws of Fla. The Board of 

Governors of The Florida Bar unanimously recommends adopting 

the proposed amendments. The Committee did not publish the 

proposals for comment before filing them with the Court.
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Chapter 2023-213, section 1, Laws of Florida, created section 

61.1255, Florida Statutes, which established procedures and 

guidelines for obtaining support for dependent adult children. The 

Committee proposes amending forms 12.900(h) and 12.928 to add

“Support for Dependent Adult Children” to the types of proceedings 

in each of these forms. Having considered the Committee’s report 

and the relevant legislation, we hereby amend the forms as 

proposed by the Committee.

Accordingly, the Florida Family Law Rules of Procedure Forms

are amended as reflected in the appendix to this opinion, with the 

forms fully engrossed and ready for use. The forms may be 

accessed and downloaded from the Florida State Courts’ website at 

http://www.flcourts.org/resources-and-services/courtimprovement/family-courts/family-law-forms.stml. The 

amendments shall take effect immediately upon the release of this 

opinion. Because the amendments were not published for comment 

prior to their adoption, interested persons shall have 75 days from 

the date of this opinion in which to file comments with the Court.1

1. All comments must be filed with the Court on or before May 

7, 2024, as well as a separate request for oral argument if the 
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It is so ordered.

MUÑIZ, C.J., and CANADY, LABARGA, COURIEL, GROSSHANS, 

FRANCIS, and SASSO, JJ., concur.

THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER 

THE EFFECTIVE DATE OF THESE AMENDMENTS.

Original Proceeding – Florida Family Law Rules of Procedure

Hon. Howard Ogle McGillin, Jr., Chair, Family Law Rules 

Committee, St. Augustine, Florida, Joshua E. Doyle, Executive 

Director, The Florida Bar, Tallahassee, Florida, and Kelly N. Smith, 

Staff Liaison, The Florida Bar, Tallahassee, Florida,

for Petitioner

person filing the 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 electronically 

filed via the Florida Courts E-Filing Portal (Portal). If filed by a 

nonlawyer or a lawyer not licensed to practice in Florida, the 

comment may be, but is not required to be, filed via the Portal. Any 

person unable to submit a comment electronically 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.
Instructions for Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (02/24)

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APPENDIX

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 

12.900(h), NOTICE OF RELATED CASES (02/24)

 

When should this form be used?

Florida Rule of General Practice and Judicial Administration 2.545(d) requires the petitioner in a family 

law case to file with the court a notice of related cases, if any. Your circuit may also require this form to 

be filed even if there are no related cases. A case is considered related if:

• it involves the same parties, children, or issues and is pending when the family law case is 

filed; or

• it affects the court’s jurisdiction to proceed; or

• an order in the related case may conflict with an order on the same issues in the new case; or

• an order in the new case may conflict with an order in the earlier case.

This form is used to provide the required notice to the court. 

This form should be typed or printed in black ink. It must be filed with the clerk of the circuit court with 

the initial pleading in the family law case. 

What should I do next?

A copy of the form must be served on the presiding judge, either the chief judge or the family law 

administrative judge, and all parties in the related cases. You should also keep a copy for your records. 

Service must be in accordance with Florida Rule of General Practice and Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the 

beginning of these forms. The words that are in ”bold and underline” in these instructions are defined 

there. For further information, see Florida Rule of General Practice and Judicial Administration 2.545(d).

Special notes . . .

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

forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of 

Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms must

also put his or her name, address, and telephone number on the bottom of the last page of every form he 

or she helps you complete.
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (02/24)

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IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR COUNTY, FLORIDA

Case No.: 

Division: 

_____________________________,

Petitioner,

and

_____________________________,

Respondent.

NOTICE OF RELATED CASES

1. Petitioner submits this Notice of Related Cases as required by Florida Rule of General Practice and 

Judicial Administration 2.545(d). A related case may be an open or closed civil, criminal, guardianship, 

domestic violence, juvenile delinquency, juvenile dependency, or domestic relations case. A case is 

“related” to this family law case if it involves any of the same parties, children, or issues and it is 

pending at the time the party files a family case; if it affects the court’s jurisdiction to proceed; if an 

order in the related case may conflict with an order on the same issues in the new case; or if an order 

in the new case may conflict with an order in the earlier litigation.

[check one only]

____ There are no related cases.

____ The following are the related cases (add additional pages if necessary):

Related Case No. 1

Case Name(s): _____________________________________________________________________

Petitioner ________________________________________________________________________ 

Respondent _______________________________________________________________________

Case No.: _________________________________ Division: ________________________________

Type of Proceeding: [check all that apply] 

____ Dissolution of Marriage ____ Paternity 

____ Custody ____ Adoption 

____ Child Support ____ Support for Dependent Adult Children

____ Modification/Enforcement/Contempt Proceedings

____ Juvenile Dependency ____ Juvenile Delinquency 

____ Termination of Parental Rights ____ Criminal 

____ Domestic/Sexual/Dating/Repeat ____ Mental Health

____ Violence or Stalking Injunctions ____ Other {specify} ___________________________

State where case was decided or is pending: ____ Florida ____ Other: {specify} _________________

Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion 

County, Florida): _______________________
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (02/24)

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___________________________________________

Title of last Court Order/Judgment (if any): ______________________________________________ 

Date of Court Order/Judgment (if any): _________________________________________________

Relationship of cases check all that apply]:

____ pending case involves same parties, children, or issues; 

____ may affect court’s jurisdiction; 

____ order in related case may conflict with an order in this case; 

____ order in this case may conflict with previous order in related case.

Statement as to the relationship of the cases: ____________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Related Case No. 2

Case Name(s): _____________________________________________________________________

Petitioner ________________________________________________________________________ 

Respondent _______________________________________________________________________

Case No.: _________________________________ Division: ________________________________

Type of Proceeding: [check all that apply] 

____ Dissolution of Marriage ____ Paternity 

____ Custody ____ Adoption 

____ Child Support ____ Support for Dependent Adult Children

____ Modification/Enforcement/Contempt Proceedings 

____ Juvenile Dependency ____ Juvenile Delinquency 

____ Termination of Parental Rights ____ Criminal 

____ Domestic/Sexual/Dating/Repeat ____ Mental Health

____ Violence or Stalking Injunctions ____ Other {specify} __________________________

State where case was decided or is pending: ____ Florida ____ Other: {specify} _________________

Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion 

County, Florida): ___________________________________________________________________

Title of last Court Order/Judgment (if any): ______________________________________________ 

Date of Court Order/Judgment (if any): _________________________________________________

Relationship of cases check all that apply]:

____ pending case involves same parties, children, or issues.

____ may affect court’s jurisdiction; 

____ order in related case may conflict with an order in this case; 

____ order in this case may conflict with previous order in related case.

Statement as to the relationship of the cases: ____________________________________________

__________________________________________________________________________________

__________________________________________________________________________________
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (02/24)

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Related Case No. 3

Case Name(s): ______________________________________________________________________

Petitioner _________________________________________________________________________ 

Respondent _______________________________________________________________________

Case No.: _________________________________ Division: ________________________________

Type of Proceeding: [check all that apply] 

____ Dissolution of Marriage ____ Paternity 

____ Custody ____ Adoption 

____ Child Support ____ Support for Dependent Adult Children

____ Modification/Enforcement/Contempt Proceedings 

____ Juvenile Dependency ____ Juvenile Delinquency 

____ Termination of Parental Rights ____ Criminal 

____ Domestic/Sexual/Dating/Repeat ____ Mental Health

____ Violence or Stalking Injunctions ____ Other {specify} __________________________

State where case was decided or is pending: ____ Florida ____ Other: {specify} _________________

Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion 

County, Florida): __________________________________________________________________

Title of last Court Order/Judgment (if any): ______________________________________________ 

Date of Court Order/Judgment (if any): _________________________________________________

Relationship of cases check all that apply]:

____ pending case involves same parties, children, or issues; 

____ may affect court’s jurisdiction; 

____ order in related case may conflict with an order in this case; 

____ order in this case may conflict with previous order in related case.

Statement as to the relationship of the cases: ____________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

2. [check one only]

____ I do not request coordination of litigation in any of the cases listed above.

____ I do request coordination of the following cases: _____________________________________

______________________________________________________________________________

______________________________________________________________________________

3. [check all that apply]

____ Assignment to one judge 

____ Coordination of existing cases will conserve judicial resources and promote an efficient 

determination of these case because:_______________________________________________

______________________________________________________________________________
Florida Family Law Rules of Procedure Form 12.900(h), Notice of Related Cases (02/24)

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4. The Petitioner acknowledges a continuing duty to inform the court of any cases in this or any other 

state that could affect the current proceeding.

Dated: _________________ _______________________________________

Petitioner’s Signature

Printed Name: 

Address: 

City, State, Zip: 

Telephone Number: 

Fax Number: 

E-mail Address(es): 

CERTIFICATE OF SERVICE

I CERTIFY that I delivered a copy of this Notice of Related Cases to the _____________________ County 

Sheriff’s Department or a certified process server for service on the Respondent, and [check all used] 

( ) e-mailed ( ) mailed ( ) hand delivered, a copy to {name}________________________, who is the 

[check all that apply] ( ) judge assigned to new case, ( ) chief judge or family law administrative 

judge, ( ) {name}__________________________________ a party to the related case, ( ) {name}

____________________________, a party to the related case on {date} _________________________.

_______________________________________

Signature of Petitioner/Attorney for Petitioner 

Printed Name: 

Address: 

City, State, Zip: 

Telephone Number: 

E-mail Address(es): 

Florida Bar Number: 

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 {choose only one}: ( ) Petitioner ( ) Respondent.

This form was completed with the assistance of:

{name of individual} ,

{name of business}_______________________________________________________________, 

{address} ,

{city} _______________________{state} __________, {telephone number} .
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE 

FORM 12.928

COVER SHEET FOR FAMILY COURT CASES (02/24)

When should this form be used?

The Cover Sheet for Family Court Cases and the information contained in it does not replace nor 

supplement the filing and service of pleadings or other documents as required by law. This form 

shall be filed by the petitioner/party opening or reopening a case for the use of the clerk of the 

circuit court for the purpose of reporting judicial workload data pursuant to Florida Statutes 

section 25.075. 

This form should be typed or printed in black ink. The petitioner must file this cover sheet with 

the first pleading or motion filed to open or reopen a case in all domestic and juvenile cases. 

What should I do next?

Follow these instructions for completing the form:

I. Case Style. Enter the name of the court, the appropriate case number assigned at the time 

of filing of the original petition, the name of the judge assigned (if applicable), and the name 

(last, first, middle initial) of the petitioner(s) and respondent(s). 

II. Type of Action /Proceeding. Place a check beside the proceeding you are initiating. If you are 

filing more than one type of proceeding, (such as a modification and an enforcement 

proceeding) against the same party at the same time, then you must complete a separate 

cover sheet for each action being filed. 

(A) Initial Action/Petition 

(B) Reopening Case. If you check “Reopening Case,” indicate whether you are filing a 

modification or supplemental petition or an action for enforcement by placing a check 

beside the appropriate action/petition. 

1. Modification/Supplemental Petition 

2. Motion for Civil Contempt/ Enforcement

3. Other – All reopening actions not involving modification/supplemental petitions or 

petition enforcement. 

III. Type of Case. Place a check beside the appropriate case. If the case fits more than one 

category, select the most definitive. Definitions of the categories are provided below. 

(A) Simplified Dissolution of Marriage- petitions for the termination of marriage pursuant to 

Florida Family Law Rule of Procedure 12.105. 

(B) Dissolution of Marriage - petitions for the termination of marriage pursuant to Chapter 
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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(C) 61, Florida Statutes, other than simplified dissolution. 

(D) Domestic Violence - all matters relating to injunctions for protection against domestic 

violence pursuant to section 741.30, Florida Statutes. 

(E) Dating Violence - all matters relating to injunctions for protection against dating 

violence pursuant to section 784.046, Florida Statutes. 

(F) Repeat Violence - all matters relating to injunctions for protection against repeat 

violence pursuant to section 784.046, Florida Statutes.

(G) Sexual Violence - all matters relating to injunctions for protection against sexual 

violence pursuant to section 784.046, Florida Statutes.

(H) Stalking-all matters relating to injunctions for protection against stalking pursuant to 

section 784.0485, Florida Statutes

(I) Support - IV-D - all matters relating to child or spousal support in which an application 

for assistance has been filed with the Department of Revenue, Child Support 

Enforcement under Title IV-D, Social Security Act, except for such matters relating to 

dissolution of marriage petitions (sections 409.2564, 409.2571, and 409.2597, Florida 

Statutes), paternity, or UIFSA. 

(J) Support-Non IV-D - all matters relating to child or spousal support in which an 

application for assistance has not been filed under Title IV-D, Social Security Act. 

(K) UIFSA- IV-D - all matters relating to Chapter 88, Florida Statutes, in which an application 

for assistance has been filed under Title IV-D, Social Security Act. 

(L) UIFSA - Non IV-D - all matters relating to Chapter 88, Florida Statutes, in which an 

application for assistance has not been filed under Title IV-D, Social Security Act. 

(M) Support for Dependent Adult Children – all matters related to support of a dependent 

adult child.

(N) Other Family Court - all matters involving time-sharing and/or parenting plans relating 

to minor child(ren), support unconnected with dissolution of marriage, annulment, 

delayed birth certificates pursuant to Florida Statutes section 382.0195, expedited 

affirmation of parental status pursuant to Florida Statutes section 742.16, termination 

of parental rights proceedings pursuant to Florida Statutes section 63.087, declaratory 

judgment actions related to premarital, marital, post-marital agreements, or other 

matters not included in the categories above.

(O) Adoption Arising Out Of Chapter 63 - all matters relating to adoption pursuant to 

Chapter 63, Florida Statutes, excluding any matters arising out of Chapter 39, Florida 

Statutes. 

(P) Name Change - all matters relating to name change, pursuant to section 68.07, Florida 

Statutes.

(Q) Paternity/Disestablishment of Paternity – all matters relating to paternity pursuant to 

Chapter 742, Florida Statutes.

(R) Juvenile Delinquency - all matters relating to juvenile delinquency pursuant to Chapter 

985, Florida Statutes. 

(S) Petition for Dependency - all matters relating to petitions for dependency. 

(T) Shelter Petition – all matters relating to shelter petitions pursuant to Chapter 39, Florida 

Statutes.

(U) Termination of Parental Rights Arising Out Of Chapter 39 – all matters relating to 
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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(V) termination of parental rights pursuant to Chapter 39, Florida Statutes.

(W)Adoption Arising Out Of Chapter 39 – all matters relating to adoption pursuant to 

Chapter 39, Florida Statutes.

(X) CINS/FINS – all matters relating to children in need of services (and families in need of 

services) pursuant to Chapter 984, Florida Statutes.

(Y) Petition for Temporary or Concurrent Custody by Extended Family-all matters relating to 

petitions for temporary or concurrent custody pursuant to Chapter 751.

(Z) Emancipation of a Minor-all matters relating to emancipation of a minor pursuant to 

Chapter 743.

ATTORNEY OR PARTY SIGNATURE. Sign the Cover Sheet for Family Court Cases. Print legibly the 

name of the person signing the Cover Sheet for Family Court Cases. Attorneys must include a 

Florida Bar number. Insert the date the Cover Sheet for Family Court Cases is signed. Signature is 

a certification that filer has provided accurate information on the Cover Sheet for Family Court 

Cases. 

Nonlawyer Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer 

helps you fill out these forms, that person must give you a copy of 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. 

A copy of this form must be filed with the court and served on the other party or his or her 

attorney. The copy you are serving to the other party must be either mailed, e-mailed, or handdelivered to the opposing party or his or her attorney on the same day indicated on the 

certificate of service. If it is mailed, it must be postmarked on the date indicated in the 

certificate of service.

IMPORTANT INFORMATION REGARDING E-FILING 

The Florida Rules of General Practice and Judicial Administration now require that all petitions, 

pleadings, and documents be filed electronically except in certain circumstances. Selfrepresented 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 General Practice 

and 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 General Practice and Judicial Administration 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 Florida Rules of General Practice and Judicial 

Administration. 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 
Instructions for Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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review Florida Rule of General Practice and Judicial Administration 2.516. You may find this rule 

at www.flcourts.org through the link to the Rules of General Practice and 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 

email, 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 General Practice and Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” 

found at the beginning of these forms. For further information, see Rule 12.100, Florida Family 

Law Rules of Procedure. 
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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COVER SHEET FOR FAMILY COURT CASES

I. Case Style 

IN THE CIRCUIT COURT OF THE __ ____ JUDICIAL CIRCUIT,

IN AND FOR _____________ _____ COUNTY, FLORIDA

Case No.: __________ ______

Judge: ________________ __

__________________________ ___,

Petitioner,

and 

_________________________ ____,

Respondent.

II. Type of Action/Proceeding. Place a check beside the proceeding you are initiating. If you are filing 

more than one type of proceeding (such as a modification and an enforcement proceeding) against 

the same party at the same time, then you must complete a separate cover sheet for each action 

being filed. If you are reopening a case, choose one of the three options below it. 

(A) ____ Initial Action/Petition 

(B) ____ Reopening Case 

1. ____ Modification/Supplemental Petition 

2. ____ Motion for Civil Contempt/Enforcement

3. ____ Other

III. Type of Case. If the case fits more than one type of case, select the most definitive.

(A) ____ Simplified Dissolution of Marriage 

(B) ____ Dissolution of Marriage 

(C) ____ Domestic Violence

(D) ____ Dating Violence 

(E) ____ Repeat Violence 

(F) ____ Sexual Violence 

(G) ____ Stalking

(H) ____ Support IV-D (Department of Revenue, Child Support Enforcement)

(I) ____ Support Non-IV-D (not Department of Revenue, Child Support Enforcement)

(J) ____ UIFSA IV-D (Department of Revenue, Child Support Enforcement)

(K) ____ UIFSA Non-IV-D (not Department of Revenue, Child Support Enforcement)

(L) ____ Support for Dependent Adult Children – all matters related to support of a dependent adult 

child.

(M) ____ Other Family Court

(N) ____ Adoption Arising Out Of Chapter 63 
Florida Family Law Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases 

(02/24)

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(O) ____ Name Change

(P) ____ Paternity/Disestablishment of Paternity

(Q) ____ Juvenile Delinquency 

(R) ____ Petition for Dependency 

(S) ____ Shelter Petition

(T) ____ Termination of Parental Rights Arising Out Of Chapter 39

(U) ____ Adoption Arising Out Of Chapter 39

(V) ____ CINS/FINS

(W) ____ Petition for Temporary or Concurrent Custody by Extended Family 

(X) ____ Emancipation of a Minor

IV. Rule of General Practice and Judicial Administration 2.545(d) requires that a Notice of Related Cases 

Form, Family Law Form 12.900(h), be filed with the initial pleading/petition by the filing attorney or 

self-represented litigant in order to notify the court of related cases. Is Form 12.900(h) being filed 

with this Cover Sheet for Family Court Cases and initial pleading/petition?

____ No, to the best of my knowledge, no related cases exist.

____ Yes, all related cases are listed on Family Law Form 12.900(h).

ATTORNEY OR PARTY SIGNATURE 

I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my 

knowledge and belief. 

Signature _______________________________________ FL Bar No.: _____________________ 

Attorney or party (Bar number, if attorney) 

 ________________________________________ __________________________

 (Type or print name) (E-mail Address(es))

 ____________________________

 Date

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: {choose only one} _____Petitioner _____ Respondent

This form was completed with the assistance of:

{name of individual} ,

{name of business} ,

{address} , 

{city} , {state} ____, {zip code} ______, {telephone number} .