# Supreme Court of Florida

____ ___ _______

No. SC 16

- 1253

__ ___ _________

IN RE: AMENDMENTS TO THE FLORIDA SUPREME COURT

APPROVED FAMILY LAW FORMS

.

[September 29, 2016]

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 Nam e (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 Workgroup 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 forms incorporate thi s 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/r esources

- 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 amended forms be publish ed 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 OF A MOTION FOR REH EARING 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 a ttorney in good standing with The Florida Bar, the comment

must be electronically 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 Microsoft 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 copies are required or

will be accepted.Instructions for Florida Supreme Court Approved Family Law Form 12.982(a), Petitio n fo r 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 (ADULT) (09/16 )

Whe n 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 deputy

clerk

. You sho uld 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 criminal 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 sexu al 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 M AY 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 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 Court 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, including 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 fo r 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 prov ide 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 Sel f

- Represented Litigants found at the

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



### Special notes...

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

are th e one who is asking the court for something. 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/or places that will nee d a copy of your final

judgment. This list may include the driver’s license 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 n onlawyer helping you fill out these forms

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

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

(09/16 )



## - 6

-

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, c ertify 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. Fami ly

[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 fo r Change of Name (Adult)

(09/16 )



## - 7

- ____ I do not have child(ren).

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

those over 18 , must be listed):

Name {last, first, middle initial} Age Address, 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 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)}

__________________________________________________________________________________

8. Occupation

My occupation is:

. I am employed at: {company and address}

. During the pas t 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 attached page.)

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

(09/16 )



## - 8

- 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 profession. My professio n 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 Graduation School

_________ _____________ __________________________________________________

_________ _____________ _____________________________________ _____________

_________ _____________ __________________________________________________

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

12. C riminal 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 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 indi cate 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 fo r Change of Name (Adult)

(09/16 )



## - 9

- 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 indicate here if you h ave filed 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 en tered against me:

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

_____

_____

_____

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

15. Fingerprints and Cri minal 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 understan d that I cannot request a hearing on my Petition until the Clerk

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

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

sexual offender.

16. 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.

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

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

(09/16 )



## - 10

- 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 knowingl y 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 NONLAWYER HELPED YOU FILL OU T 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 busine ss}

, {address}

______________________________________________ , {city}

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

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

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



## - 11

- INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY

L AW 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 unde r the age of 18 is a minor. This

form is not to be used in connection with an adoption, dissolution 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 c hange 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 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 Petition 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 initiale d 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 manne r approved by the Department of Law Enforcement. The fingerprints must be

submitted to the Department 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 o f

the fingerprints are filed and the clerk of court has received the results of the 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 enforcemen t 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 conducti ng 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.Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name

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



## - 12

- If both parents agree to the change of name and live in the county where the change of n ame 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 he aring.

If only one parent is a resident of the county where the change of name(s) is sought or only 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 p arent consents to the change of name, a

Consent for Change of Name (Minor Child(ren)) , Florida Supreme 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 t he

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 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) an d 12.913(b) and Florida Supreme Court Approved Family Law

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

wish to consult an attorney regarding that issue.

Next, you must obtain a final hearing date for the cou rt 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 the 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 hearing. Included in these

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

Approved 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 f inal judgment with

you. You should complete the top part of the form, including the circuit, county, 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 in k.

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

. This officially changes your

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

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



## - 13

-

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, Fl orida

Statutes.



### 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 obtain ed 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, social security office, ba nks, 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 per son 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

bot tom of the last page of every form he or she helps you complete.Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 14

-

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 F OR 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) named 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 oth er 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

that I/we cannot request a hearing on my/ou r 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. TH E 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:Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 15

- 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 b irth:

Dates (to/from) Address

_______/________

______________________________________________________ _______/________

______________________________________________________ _______/________

_______________________________________________________ _______/________

______________________________________________________ _______/________

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

6. [Choose one only]

_____T he 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.Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 16

- _____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 w here 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 ha s 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 committe d 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, regardle ss 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 no t 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}

_____

_____

_____

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

Child(ren)) (09/16)



## - 17

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

( ) FATHER ( ) MOTHER ( ) GUARDIAN

( ) A Supplemental Form has been at tached 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 indicate here if you have filed additional ba nkruptcies, 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 judgment(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 arrested for or charged with, pled guilty o r 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 found to have co mmitted a criminal offense, regardless of

adjudication. The details of my criminal history are:

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

Child(ren)) (09/16)



## - 18

- (______ 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 or illegal purpose for filing this petitio n, 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.

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

Child(ren)) (09/16)



## - 19

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

deputy clerk.]

____ Persona lly 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 Petit ioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city }

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

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

Child(ren)) (09/16)



## - 20

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

Case No.: ______________________________

THE FOLLOWING INFORMATION IS TRUE ABOUT PETIT IONER(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 have never had a money judgment entered ag ainst 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 never been arrested for or charged with, p led 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 guiltyInstructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 21

- or nolo contendere to, or been foun d 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 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 t his 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 res tored.Instructions for Florida Supreme Court Approved Family Law Form 12.982(c), Petition for Change of Name (Minor

Child(ren)) (09/16)



## - 22

- 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

____ 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 f or the Petitioner.

This form was completed with the assistance of:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city}

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

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

Child(ren)) (09/16)



## - 23

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

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT CHILD # :

1. Minor child’s c omplete 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 mi nor 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 .)

## MINOR CHILD # ________, continued

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

Child(ren)) (09/16)



## - 24

- 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 foll owing 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.

_____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

contendere to, or been found to have commit ted 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, regard less of adjudication. The details of the criminal history are:

## MINOR CHILD # ________, continued

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

Child(ren)) (09/16)



## - 25

- 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 Cred itor 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)



## - 26

- 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 cha nge 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 action that is not yet final, the change

of n ame 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

k eep 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 Petitio n 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 name, each adult petitioner must have finger prints

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 ch eck. 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

inf ormation 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 c onducting 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 offender and you must also

indicate on this p etition 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 a re 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 o r 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)



## - 27

- may use constructive service

. For more information about personal and constructive service, you

should refer to the “General Instructions for Self

- Repres ented 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 law on constructive

service is very comple x 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 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 the 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 hearing. Included in these forms is a Final Judgment of Change of Name (Family) , Florida

Supreme Court Approved 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, case 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

- Represente d Litigants” found at the

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



### 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 th e final

judgment. This list may include the driver’s license 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 i s NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out

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

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

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

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

(Family) (09/16)



## - 28

-

IN THE CIRCUIT COURT OF THE JUDICIAL CI RCUIT,

IN AND FOR COUNTY, FLORIDA

Case No.:

Division:

IN RE: THE NAME CHANGE OF

,

Petitioner/Father,

, Petitioner/Mother.



## PETITION FOR CHANGE OF NAME (FAMILY)

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

certify that the following inform ation 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 guardia n of the minor child(ren) named in this petition. I/We have attached a

completed 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 h as/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

that I/we cannot request a hearing on my/our Petition until the clerk of court receives th e 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 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 For m for Petition for Change of Name

(Family) (09/16)



## - 29

- My mother’s full legal name:

. My mother’s maiden name:

.

5. I have lived in the following places sin ce 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 i s:

. _____ 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 Address, 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 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 For m for Petition for Change of Name

(Family) (09/16)



## - 30

- 8. Occupation

My occupation i s:

. I am emp loyed at: {company and address}

. During the past 5 years, I have had the 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. Pr ofession

[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 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 For m for Petition for Change of Name

(Family) (09/16)



## - 31

- [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 adjudi cation.

_____ 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:

Da te 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 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 indicate 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 b y 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 ill egal 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.

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 For m for Petition for Change of Name

(Family) (09/16)



## - 32

- 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

impr isonment.

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 com missioned 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:

[f ill 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 For m for Petition for Change of Name

(Family) (09/16)



## - 33

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

Case No.:

THE FOLLOWING INFORMATION IS TRUE ABOUT PETITIONER:

( ) HUSBAND ( ) WIFE ( ) GUARDIAN

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}

, {cou nty}

, {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:

. _____ I do not have child(re n).

_____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 Address, City, StateFlorida Supreme Court Approved Family Law Form 12.982(f), Supplemental For m for Petition for Change of Name

(Family) (09/16)



## - 34

- (____ 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 attache d.

____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 hav e 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 th e past 5 years, I have had the following jobs:

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

/

/

/

/

/

/

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

9. Business

[Indicate all that apply]

____ 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

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

(Family) (09/16)



## - 35

- ____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):

Degre e 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 ch arged 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 bee n 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 attach ed 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. Bank ruptcy

[Choose one only]

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

(Family) (09/16)



## - 36

- ____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 continuing 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 o thers, 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 have

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

(Family) (09/16)



## - 37

- I understand that I am swearing or affirming under oat h 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 PETITI ONER

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 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 o f:

{name of individual}

_____________________________________ , {name of business}

, {address}

______________________________________________ , {city}

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

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

of Name (Family) (09/16)



## - 38

- CHILD SUPPLEMENTAL FORM FOR PETITION 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 chil d’s name be changed to:

2. The minor child lives in County, Florida, at {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 lived in the following places since birth:

Dates (to/from) Address

/

/

/

/

/

/

/

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

6. [Cho ose 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 name(s) and date(s)

of bi rth}

.

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, a nd state}

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

of Name (Family) (09/16)



## - 39

- 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 na me.

____ 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

contender e 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 co mmitted 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 e ver 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 o ne 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 For m for Petition for Change

of Name (Family) (09/16)



## - 40

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