Opinion ID: 2789478
Heading Depth: 4
Heading Rank: 4

Heading: other: {specify}

Text: A copy of any judgment is attached. 2. Child support. My child support obligation for the child(ren), {name(s) and birth date(s)}, was established by {Choose only one} a. a final judgment of dissolution of marriage, entered by {court} ______ _____________________on {date} . b. an administrative proceeding to establish child support in {location} ______________on {date} . c. __ a paternity proceeding in {court} on {date} . d. __other {specify} _______ A copy of any judgment is attached. Florida Supreme Court Approved Family Law Form 12.951(a), Petition to Disestablish Paternity and/or Terminate Child Support Obligation (03/15) - 410 - 3. Newly discovered evidence. Newly discovered evidence concerning the paternity of this/these child(ren) has come to my knowledge since the initial paternity determination or establishment of the child support obligation. {Explain} ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________. 4. Scientific tests. a. _The results of scientific tests that are generally acceptable within the scientific community to show a probability of paternity, administered within 90 days prior to the filing of this petition, indicate that I cannot be the father of the child(ren) for whom support is required. A copy of the test results is attached. b. __ I did not have access to the child(ren) to have scientific testing performed before the filing of this petition and I request that the court order the child(ren) to be tested. 5. Fulfillment of child support obligation. {Choose only one} a. __ I am current on all child support payments for the child(ren) for whom relief is sought. b. __I have substantially complied with my child support obligation for the child(ren) and any delinquency in my child support obligation for the child(ren) arose from my inability for just cause to pay the delinquent child support when the delinquent child support became due. I ask the court to enter an order to: {Indicate all that apply} a. __ disestablish my paternity to {name(s) of child(ren)} __________________________ ____________________________________________________________________ b. __terminate my obligation to pay child support for {name(s) of child(ren)} ___________ ________________________________________________________________________ c. __other: ______________________________________________________________ __________________________________________________________________ ___________________________________________________________________ . Florida Supreme Court Approved Family Law Form 12.951(a), Petition to Disestablish Paternity and/or Terminate Child Support Obligation (03/15) - 411 - I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand delivered to the person(s) listed below on {date} _____________________. Respondent or his/her attorney: Name: Address: City, State, Zip: Fax Number: Designated E-mail Address(es):______ ______________________________ 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 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 12.951(a), Petition to Disestablish Paternity and/or Terminate Child Support Obligation (03/15) - 412 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. ORDER DISESTABLISHING PATERNITY AND/OR TERMINATING CHILD SUPPORT OBLIGATION This cause came before the court on {date} on {full legal name} ’s petition to {Indicate all that apply} __ Disestablish paternity to {child(ren)’s names and birth date(s)} __ Terminate a child support obligation for {child(ren)’s names and birth date(s)} The court having been fully advised in the premises FINDS all of the following: 1. Newly discovered evidence relating to the paternity of the child(ren) has come to the petitioner’s knowledge since the initial _____ paternity determination ____ establishment of a child support obligation. 2. Scientific tests that are generally acceptable within the scientific community to show a probability of paternity showing that the petitioner cannot be the father of the children were properly conducted. 3. The petitioner {Choose only one} __ is current on all child support payments for the child(ren). __ has substantially complied with his child support obligation for the applicable child(ren) and any delinquency in his child support obligation arose from his inability for just cause to pay the delinquent child support when it became due. 4. The petitioner has not adopted the child. Florida Supreme Court Approved Family Law Form 12.951(b), Order Disestablishing Paternity and/or Terminating Child Support Obligation (03/15) - 413 - 5. The child(ren) was/were not conceived by artificial insemination while the petitioner and the child(ren)’s mother were married. 6. The petitioner did not act to prevent the biological father of the child(ren) from asserting his paternal rights with respect to the child(ren). 7. The child(ren) was/were younger than 18 years of age when the petition was filed. 8. Since learning that he is not the biological father of the child(ren), the petitioner has not a. married the mother of the child(ren) while known as the reputed father in accordance with section 742.091, Florida Statutes, and voluntarily assumed the parental obligation and duty to pay child support; b. acknowledged paternity in a sworn statement; c. consented to be named as the child(ren)’s biological father on the child(ren)’s birth certificate(s); d. voluntarily promised in writing to support the child(ren) and was required to support the child(ren) based on that promise; e. received written notice from any state agency or any court directing him to submit to scientific testing which he disregarded; or f. signed a voluntary acknowledgment of paternity as provided by section 742.10(4), Florida Statutes. It is therefore ORDERED AND ADJUDGED: {Indicate all that apply} __ Petitioner’s, {name} paternity of {name(s) of child(ren)} ____is disestablished. __ Petitioner’s, {name} child support obligation to {name(s) of child(ren)} is terminated. DONE AND ORDERED ON ______________ in _________________________, Florida CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.951(b), Order Disestablishing Paternity and/or Terminating Child Support Obligation (03/15) - 414 - I certify that a copy of the Order Disestablishing Paternity and/or Terminating Child Support Obligation was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties and any entities listed below on {date} ____________________________. _____________________________________ {Clerk of court, designee, or Judicial Assistant} Petitioner Respondent Department of Revenue Department of Health, Office of Vital Statistics Court depositor/State Disbursement Unit Other Florida Supreme Court Approved Family Law Form 12.951(b), Order Disestablishing Paternity and/or Terminating Child Support Obligation (03/15) - 415 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.960, MOTION FOR CIVIL CONTEMPT/ENFORCEMENT (03/15) When should this form be used? You may use this form to ask the court to enforce a prior court order or final judgment. What should I do next? To initiate a civil contempt/enforcement proceeding against a party who is not complying with a prior court order, you must file a motion with the court explaining what the party has failed to do. This form should be typed or printed in black ink. After completing this form, you should sign it before a notary public or deputy clerk. You should then file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Instructions for Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 416 - 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 Judicial Administration 2.516. A copy of this form must be personally served by a sheriff or private process server or mailed, e- mailed, or hand delivered to any other party(ies) in your case. Please note that if notice is mailed or e-mailed, the court in certain circumstances may not consider mailing or e-mailing, to be adequate notice. If you want to be sure, you should have the motion personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a). The court will then set a hearing. You should check with the clerk of court, judicial assistant, or family law intake staff for information on the local procedure for scheduling a hearing. Once you know the time and date of the hearing, you will need to complete Notice of Hearing on Motion for Contempt/Enforcement, Florida Supreme Court Approved Family Law Form 12.961, or, if applicable, Notice of Hearing (Child Support Enforcement Hearing Officer), Florida Supreme Court Approved Family Law Form 12.921, or [Notice of Hearing Before] General Magistrate, Florida Family Law Rules of Procedure Form 12.920[(c)], which will specify a time and place for a hearing on the issue. A copy of this form must be mailed, e-mailed, or hand delivered to the other party. Again, if notice is mailed, the court in certain circumstances may not consider mailing or e-mailing to be adequate notice. If you want to be sure, you should have the notice personally served. This is a technical area of the law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a). At the hearing, as in any other civil proceeding, you, as the moving party, will have the burden of proving the other party has not obeyed a prior court order. Once noncompliance is established, the other party will have an opportunity to show an inability to comply with the prior court order. If he or she is unable to do so, the judge may find the other party to be in contempt. If so, the judge may order appropriate sanctions to compel compliance by the other party, including jail, payment of attorneys’ fees, suit money, or costs, and coercive or compensatory fines, and may order any other relief permitted by law. 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. See also section 61.14, Florida Statutes and rule 12.615, Florida Family Law Rules of Procedure. Instructions for Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 417 - 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. Instructions for Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 418 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. MOTION FOR CIVIL CONTEMPT/ENFORCEMENT _____ Petitioner _____ Respondent requests that the Court enter an order of civil contempt/enforcement against _____ Petitioner _____ Respondent in this case because: 1. A final judgment or order {title of final judgment or order}__________________________ in this case was entered on {date} , by {court, city, and state} . _____Please indicate here if the judgment or order is not from this Court and attach a copy. 2. This order of the Court required the other party in this case to do or not do the following: {Explain what the other party was ordered to do or not do.} __________________________ ______Please indicate here if additional pages are attached. 3. The other party in this case has willfully failed to comply with this order of the Court: {Explain what the other party has or has not done.} _________________________________ _______ Please indicate here if additional pages are attached. 4. I respectfully request that the Court issue an order holding the above-named person in civil contempt, if appropriate, and/or providing the following relief: Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 419 - a. _____enforcing or compelling compliance with the prior order or judgment; b. _____awarding a monetary judgment; c. _____if a monetary judgment was included in the prior order, issuing a writ of execution or garnishment or other appropriate process; d. _____awarding prejudgment interest; e. _____requiring the other party to pay costs and fees in connection with this motion; f. _____if the other party is found to be in civil contempt, ordering a compensatory fine; g. _____if the other party is found to be in civil contempt, ordering a coercive fine; h. _____if the other party is found to be in civil contempt, ordering incarceration of the other party with a purge; i. _____issuing a writ of possession for real property, writ for possession of personal property, or other appropriate writ; j. _____issuing a writ of bodily attachment if the other party fails to appear at the hearing set on this motion; k. _____requiring the other party to make payments through the central governmental depository; l. _____requiring the support payments to be automatically deducted from the other party’s income or funds; m. _____requiring the other party to seek employment; n. _____awarding make-up time-sharing with minor child(ren) as follows {explain}: ; and o. _____awarding other relief {explain}: __________________________________ . I certify that a copy of this document was: ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) handdelivered to the person(s) listed below on {date} ____________________. Other party or his/her attorney: Name: Address: City, State, Zip: ________ Fax Number: Designated E-mail Address(es):_____________ _____________________________________ Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 420 - I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: _______________________ Signature of Party 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 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: {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} _____________. Florida Supreme Court Approved Family Law Form 12.960, Motion for Civil Contempt/Enforcement (03/15) - 421 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.961 NOTICE OF HEARING ON MOTION FOR CONTEMPT/ENFORCEMENT (03/15) When should this form be used? Use this form anytime you have set a hearing on a Motion for Contempt/Enforcement, Florida Supreme Court Approved Family Law Form 12.960, for a support matter under rule 12.615, Florida Family Law Rules of Procedure. Before you fill out this form, you should coordinate a hearing time and date with the judge or hearing officer and the other party. If the Department of Revenue is a party to the case, you may need to schedule your hearing time with the attorney for the Department of Revenue. If your case is to be heard by a child support enforcement hearing officer, the following information applies: A child support enforcement hearing officer is an attorney who has been appointed by administrative order of the court to take testimony and recommend decisions in cases involving the establishment, enforcement, and/or modification of child support, and the enforcement of alimony in conjunction with an ongoing child support arrearage order. If your case only involves issues pertaining to child support, you cannot object to the referral of your case to a hearing officer. If your case is going to be heard by a general magistrate, you should use Notice of Hearing Before General Magistrate, Florida Family Law Rules of Procedure Form 12.920(c). This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your case was filed and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. What should I do next? A copy of this form must be personally served by a sheriff or private process server, mailed, e-mailed, or hand-delivered to any other party(ies) in your case. Please note that if notice is mailed, the court in certain circumstances may not consider mailing to be adequate notice. This is a technical area of the Instructions for Florida Supreme Court Approved Family Law Form 12.961, Notice of Hearing on Motion for Contempt /Enforcement (03/15) - 422 - law; if you have any questions about it, you should consult a lawyer. For more information on personal service, see the instructions for Summons: Personal Service on an Individual, Florida Family Law Rules of Procedure Form 12.910(a). IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of 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 rules 12.615 and 12.941, Florida Family Law Rules of Procedure. Special notes An attorney who has been appointed by the court to serve as a child support enforcement hearing officer can also be appointed to serve as a general magistrate. If your case involves only child support issues, your case properly may be referred to a general magistrate acting as a child support enforcement hearing officer. 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. Instructions for Florida Supreme Court Approved Family Law Form 12.961, Notice of Hearing on Motion for Contempt /Enforcement (03/15) - 423 - IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT, IN AND FOR ____________________ COUNTY, FLORIDA Case No.: __________________________ Division: ___________________________ ______________________________________, Petitioner, and ______________________________________, Respondent. NOTICE OF HEARING ON MOTION FOR CONTEMPT/ENFORCEMENT IN SUPPORT MATTERS (RULE 12.615) TO: {name of other party} ____________________________________________________________ There will be a hearing before ________________________________ {name of judge or hearing officer}, on {date}________________, at {time} ______ m., in room _______ of the _________________________ Courthouse, on the _____ Petitioner's _____ Respondent's Motion for Contempt in Support Matters. ____hour(s)/____ minutes have been reserved for this hearing. FAILURE TO APPEAR AT THE HEARING MAY RESULT IN THE COURT ISSUING A WRIT OF BODILY ATTACHMENT FOR YOUR ARREST. IF YOU ARE ARRESTED, YOU MAY BE HELD IN JAIL UP TO 48 HOURS BEFORE A HEARING IS HELD. This part is to be filled out by the court or to be filled in with information obtained from the court: If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact: __________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.961, Notice of Hearing on Motion for Contempt/ Enforcement (03/15) - 424 - {identify applicable court personnel by name, address, and telephone number } at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. If you are represented by an attorney or plan to retain an attorney for this matter, you should notify the attorney of this hearing. If this matter is resolved, the moving party shall contact the judge or hearing officer’s office to cancel this hearing. I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand delivered to the person(s) listed below on {date} ______________. Other party or his/her attorney: Name: ________________________________________ Address: ______________________________________ City, State, Zip: _________________________________ Fax Number: ___________________________________ Designated E-mail Address(es):_____________________ Dated: _____________________ _____________________________________________ Signature of Party Printed Name: _________________________________ Address: ______________________________________ City, State, Zip: _________________________________ Telephone Number: _____________________________ Fax Number: ___________________________________ Designated E-mail Address(es):____________________ _____________________________________________ 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} ____________________. Florida Supreme Court Approved Family Law Form 12.961, Notice of Hearing on Motion for Contempt/ Enforcement (03/15) - 425 - IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT, IN AND FOR __________________COUNTY, FLORIDA Case No:__________________________ Division: __________________________ ____________________________, Petitioner, and ____________________________, Respondent. WRIT OF BODILY ATTACHMENT (Child Support) TO ALL AND SINGULAR SHERIFFS AND OTHER AUTHORIZED LAW ENFORCEMENT PERSONNEL OF THE STATE OF FLORIDA YOU ARE ORDERED to take into custody __________________________________________ {see attached Description Sheet} and confine him/her in the county jail. The individual failed to appear before the court as ordered, failed to appear at a properly noticed hearing, and/or failed to comply with the previous order of the court which is attached and incorporated herein. Service of this writ may be made on any day of the week and any time of the night or day, including Sunday and holidays. YOU ARE FURTHER DIRECTED to bring this person before the court within 48 hours of execution of the writ for a hearing to determine the individual’s present ability to pay support and, if so, whether the failure to pay such support is willful, pursuant to Rule 12.615(c)(2)(B), Florida Family Law Rules of Procedure. NOTICE OF EXECUTION OF THIS WRIT SHALL IMMEDIATELY BE GIVEN TO THE FOLLOWING: {Indicate all that apply} _____ The Office of the Judge/General Magistrate/Child Support Hearing Officer: __________________________________________________________________ __________________________________________________________________ _____ Counsel for the Department of Revenue: __________________________________________________________________ _____ Department of Revenue: __________________________________________________________________ _____ Other: Florida Supreme Court Approved Family Law Form 12.962, Writ of Bodily Attachment (Child Support) (03/15) - 426 - _________________________________________________________________ IT IS FURTHER ORDERED that the individual may purge this contempt and be immediately released from custody at any time by the payment of the sum of $_______________________, which includes (if applicable): $ ___________________, to be applied to unpaid support, $ ___________________, Sheriff’s fee, $___________________, Department of Revenue costs. $ ___________________, other The court previously found in this proceeding that the individual had the ability to pay said sum. The Sheriff, or other authorized law enforcement personnel, executing this writ or having custody of the individual is authorized to assess and collect the actual costs associated with service of this writ and transportation of the individual pursuant to Section 61.11(2)(a), Florida Statutes. PAYMENT SHALL BE MADE to the Sheriff of ___________________________ County, Florida and shall be in the form of cash, cashier’s check, certified funds, or money order. The purge payment, clearly marked with the individual’s name and case number, and denoted as a purge payment shall be remitted to: {Indicate which are applicable}: _____ The Office of the Clerk of Circuit Court for ________________________, County, _________________________________________________________________ _____ Other ____________________________________________________________. The Sheriff’s office, or other authorized law enforcement personnel’s office, receiving payment shall provide the individual with a written receipt acknowledging payment. The receipt must be carried by the individual for a period of at least 30 days as proof of payment. If the individual pays the purge and secures his/her release, the Sheriff shall immediately notify: _____________________________________________________________________________. THIS ORDER SUPERSEDES ALL PRIOR CONFLICTING ORDERS. DONE AND ORDERED in ____________ County, Florida this _____day of ___________, 20____. ________________________________ CIRCUIT JUDGE Florida Supreme Court Approved Family Law Form 12.962, Writ of Bodily Attachment (Child Support) (03/15) - 427 - I certify that a copy of this {name of document}____________________________________________ was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties or entities listed below on {date}___________________________. by___________________________________ {Clerk of court or designee} Petitioner (or his/her attorney) Respondent (or his/her attorney) Department of Revenue Sheriff of ____________________County Other:____________________________ Florida Supreme Court Approved Family Law Form 12.962, Writ of Bodily Attachment (Child Support) (03/15) - 428 - DESCRIPTION SHEET NAME: _________________________________________ DATE OF BIRTH: _______________ OTHER NAMES THE INDIVIDUAL GOES BY (ALIASES OR NICKNAMES): ______________________ ______________________________________________________________________________ ADDRESS: _____________________________________________________________________ ALTERNATE ADDRESS: ___________________________________________________________ TELEPHONE: _________________________ ALTERNATE PHONE: _________________________ SOCIAL SECURITY NUMBER: ______________________ GENDER:________ RACE: ________ HEIGHT: _____________ WEIGHT: ____________ EYE COLOR: ____________ HAIR COLOR, LENGTH, STYLE: _____________________________________________________ DISTINGUISHING MARKS, SCARS, TATTOOS: _____________________________________ OTHER CHARACTERISTICS: ________________________________________________________ EMPLOYER: ____________________________________ EMPLOYER PHONE: _______________ EMPLOYER ADDRESS: ____________________________________________________________ VEHICLE (MAKE/MODEL): ________________________________________________________ FLORIDA DRIVER’S LICENSE NUMBER: _______________________________________________ Please use the space below for any additional information you would like to provide. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.962, Writ of Bodily Attachment (Child Support) (03/15) - 429 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(a) PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY (03/15) When should this form be used? This form should be used by an extended family member to obtain temporary custody of a child or children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent seeking to establish parental responsibility or time-sharing with a child or children. An Extended Family Member is: A relative of a minor child within the third degree by blood or marriage to the parent; OR The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. You may file a Petition for Temporary Custody if: You have the signed, notarized consents of the child(ren)’s legal parents; OR You are an extended family member who is caring full time for the child(ren) in the role of a substitute parent and with whom the child(ren) is (are) presently living. If one of the minor child(ren)’s parents objects to the Petition, the court shall grant the Petition only upon a finding, by clear and convincing evidence, that the child(ren)’s parent or parents are unfit to provide for the care and control of the child(ren). In determining that a parent is unfit, the court must find that the parent has abused, abandoned, or neglected the child(ren), as defined in Chapter 39, Florida Statutes. If you do not have the parents’ consents you should consult a family law attorney before you file your papers. If you do not meet the qualifications above, you should talk to an attorney about other options. You may also report any suspected abuse, abandonment, or neglect to the appropriate authorities. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 430 - The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. What should I do next? IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s mother and father, and the case is uncontested, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. If one of the parents is deceased, you must file a certified copy of the proof of death. IF YOU DO NOT HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s parents, you must properly notify the parents of the petition. If you know where he or she lives, you should use personal service. If you absolutely do not know where he or she lives after conducting a diligent search, you may use constructive service. You must complete all of the searches listed in the Affidavit of Diligent Search and Inquiry, Florida Family Law Rules of Procedure Form 12.913(b), and file the form with the clerk. You should seek legal advice on constructive service as this is a complicated area of the law. If the identity of one parent is unknown, you will need to seek legal advice to determine the proper way to serve an unknown parent. For more information, see Chapter 49, Florida Statutes. If personal service is used, the parents have 20 days to answer after being served with your petition. Your case will generally proceed in one of the following ways: DEFAULT... If after 20 days, no answer has been filed, you may file a Motion for Default, Florida Supreme Court Approved Family Law Form 12.922(a), with the clerk of court. You must file a Notice for Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 431 - Trial, Florida Supreme Court Approved Family Law Form 12.924. Then, if you have filed all of the required papers, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. CONTESTED... If either parent files an answer which disagrees with or denies anything in your petition, and you are unable to settle the disputed issues, you must file a Notice for Trial, Florida Supreme Court Approved Family Law Form 12.924, to request a final hearing. Some circuits may require the completion of mediation before a final hearing may be set. You should contact the clerk, family law intake staff, or judicial assistant for instructions on how to set your case for trial (final hearing). At any time, either or both of the child(ren)’s parents may petition the court to modify or terminate the order granting temporary custody. The court shall terminate the order upon a finding that the parent is a fit parent, or by the consent of the parties. The court may modify an order granting temporary custody if the parties consent or if the modification is in the best interest of the child(ren). Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see Chapter 751 and Chapter 39, Florida Statutes. Special Notes. . . If you do not have the money to pay the filing fee, you may obtain an application for Determination of Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred. With this petition, you must file the following and provide a copy to the other party:  Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).  Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).  Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.  Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required only for obtaining a default on petitions that have been personally or constructively served. Not required if both parents have signed a waiver and consent) 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. Instructions for Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 432 - IN THE CIRCUIT COURT OF THE ____________ JUDICIAL CIRCUIT, IN AND FOR ___________________________ COUNTY, FLORIDA Case No: _______________________ Division: _______________________ __________________________________, Petitioner, and __________________________________, Respondent/Mother, __________________________________, Respondent/Father. PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY Petitioner, {full legal name} _________________________________, being sworn, certifies that the following information is true: 1. This is an action for temporary custody pursuant to Chapter 751, Florida Statutes. 2. Petitioner requests temporary custody of the following minor child(ren): Name Date of Birth Current Address __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition. The affidavit includes the names and current addresses of the persons with whom the child(ren) has(have) lived during the past 5 years, the places where the child(ren) has(have) lived during the past 5 years, and information concerning any custody proceeding in this or any other state with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed with the Petition, the case may be dismissed without hearing. 4. Petitioner is an extended family member who is: {Choose one only} _____ Related to the minor child(ren) within the third degree by blood or marriage to a parent; OR _____ The stepparent of the minor child(ren), is married to the ____ Mother ____ Father and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 433 - 5. Petitioner’s relationship to the minor child(ren) is: ____________________________________. 6. The residence and post office address of the Petitioner is: ______________________________ ____________________________________________________________________________ . 7. Petitioner is a proper person to be awarded temporary custody because: {Choose one only} ____ Petitioner has the signed, notarized consent from both of the child(ren)’s legal parents; OR ____ Petitioner is caring full time for the child(ren) in the role of a substitute parent and the child(ren) currently live with the Petitioner. If Petitioner does not have the signed consents from both parents or is not caring for the child(ren) full time as a substitute parent, Petitioner cannot obtain temporary custody under Chapter 751, Florida Statutes. Petitioner should consult an attorney about other options. 8. The legal mother of the child(ren) is ____________________________________, whose current address is: _____________________________________________________________________. 9. The legal father of the child(ren) is ______________________________________, whose current address is: ___________________________________________________________. 10. The Consents of ______Father and/or _________ Mother is/are attached to the Petition. OR {If Applicable} The Consent of the _________________ is not attached because that parent is deceased. A certified copy of the proof of death is attached. OR Consent has NOT been obtained from the parents. The specific acts or omissions of the parents which demonstrate that the parents have abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes are: (attach additional sheets if necessary) __________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ . 11. Petitioner requests temporary custody be granted for the following period of time:___________ ___________________________________________________________________________ . The reasons that support this request are: ___________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ . 12. It is in the best interests of the child(ren) that the Petitioner have temporary custody of the child(ren) for the following reasons: _______________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 434 - ______________________________________________________________________________ . Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 435 - 13. ORDER OF PROTECTION _____ Petitioner IS NOT aware of any temporary or permanent order for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. OR _____ Petitioner IS aware of the following temporary or permanent orders for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. The court entering the order and the case number is: _______ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________. 14. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS _____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the minor child(ren). OR _____ Petitioner IS aware of the following temporary or permanent order for child support for the minor child(ren). The court entering the order and the case number is:_________ _______________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . 15. CHILD SUPPORT (Choose one only} (You must have proof or waiver of service of process upon the parent(s) or a Waiver of Service of Process and Consent for the court to consider an award for child support) _____ Petitioner requests the court to order the parents to pay child support. _____ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner. _____ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner, and to award the Petitioner child support arrearages. 16. Petitioner ____ requests _____ does not request that the court establish reasonable visitation or a time-sharing schedule with the parents. 17. Other _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________. WHEREFORE, Petitioner requests that this Court grant the Petitioner temporary custody of the child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any other relief Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 436 - that the Court deems necessary. Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 437 - 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 Code: ________________________ Telephone Number: _________________________ Number: _______________________________ 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 of: {name of individual} ____________________________________________________________ , {name of business} _____________________________________________________________ , {address} ______________________________________________________________________ , {city} __________________, {state} ____,{zip code} ___________, {telephone number} _________. Florida Supreme Court Approved Family Law Form 12.970(a), Petition for Temporary Custody By Extended Family (03/15) - 438 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(b) PETITION FOR CONCURRENT CUSTODY BY EXPENDED FAMILY (03/15) When should this form be used? This form should be used by an extended family member to obtain concurrent custody of a child or children pursuant to Chapter 751, Florida Statutes. This form should not be used if you are a parent seeking to establish parental responsibility or time-sharing with a child or children. “Concurrent custody” means that an eligible extended family member is awarded custodial rights to care for a child or children concurrently with the child(ren)’s parent or parents. An Extended Family Member is: A relative of a minor child within the third degree by blood or marriage to the parent; OR The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. You may file a Petition for Concurrent Custody if: You have the signed, notarized consents of the child(ren)’s legal parents; OR You are an extended family member who is caring full time for the child(ren) in the role of a substitute parent and with whom the child(ren) is (are) presently living. In addition, you must currently have physical custody of the child(ren) and have had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months; and not have signed, written documentation from a parent which is sufficient to enable you to do all the things necessary to care for the child(ren). If you do not meet the qualifications above, you should talk to an attorney about other options. You may also report any suspected abuse, abandonment, or neglect to the appropriate authorities. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where you live and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 439 - IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. What should I do next? IF YOU HAVE SIGNED AND NOTARIZED WAIVERS OF SERVICE OF PROCESS AND CONSENTS from the child(ren)’s mother and father, you may call the clerk, family law intake staff, or judicial assistant, to set a final hearing. You must notify the child(ren)’s parents of the hearing by using a Notice of Hearing (General), Florida Supreme Court Approved Family Law Form 12.923, or other appropriate notice of hearing form. If one of the parents is deceased, you must file a certified copy of the proof of death. If one of the minor child(ren)’s parents objects to the Petition for Concurrent Custody in writing, the court may not grant the petition even if the other parent consents, in writing, to the entry of the order. If a parent objects, you have the option of converting the Petition to a Petition for Temporary Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a). If the Petition is not converted into a Petition for Temporary Custody by Extended Family, it shall be dismissed without prejudice. At any time, the Petitioner or either or both of the child(ren)’s parents may move the court to terminate the order granting concurrent custody. The court shall terminate the order upon a finding that either or both of the child(ren)’s parents objects to the order. The fact that the order for concurrent custody has been terminated does not preclude any person who is otherwise eligible to petition for temporary custody from filing such petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 440 - beginning of these forms. The words that are in bold underline in these instructions are defined there. For further information, see Chapter 751 and Chapter 39, Florida Statutes. Special Notes. . . If you do not have the money to pay the filing fee, you may obtain an application for Determination of Civil Indigent Status, fill it out, and the clerk will determine whether you are eligible to have filing fees deferred. With this petition, you must file the following and provide a copy to the other party:  Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d).  Notice of Related Cases, Florida Family Law Rules of Procedure Form 12.900(h).  Family Court Cover Sheet, Florida Family Law Rules of Procedure Form 12.928.  Non-Military Affidavit, Florida Supreme Court Approved Family Law Form 12.912(b). (Required only for obtaining a default on petitions that have been personally or constructively served. Not required if both parents have signed a waiver and consent.) 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. Instructions for Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 441 - IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT, IN AND FOR _______________________________ COUNTY, FLORIDA Case No: _______________________ Division: _______________________ __________________________________, Petitioner, and __________________________________, Respondent/Mother, __________________________________, Respondent/Father. PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY Petitioner, {full legal name} _________________________________, being sworn, certifies that the following information is true: 1. This is an action for concurrent custody pursuant to Chapter 751, Florida Statutes. 2. Petitioner requests concurrent custody of the following minor child(ren): Name Date of Birth Current Address __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Petitioner completed a Uniform Child Custody Jurisdiction and Enforcement Act Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), which was filed with this Petition. The affidavit includes the names and current addresses of the persons with whom the child(ren) has (have) lived during the past 5 years, the places where the child(ren) has(have) lived during the past 5 years, and information concerning any custody proceeding in this or any other state with respect to the child(ren). If the Affidavit is not completely filled out, signed under oath, and filed with the Petition, the case may be dismissed without a hearing. 4. Petitioner is an extended family member who is: {Choose one only} _____ Related to the minor child(ren) within the third degree by blood or marriage to a parent; OR _____ The stepparent of the minor child(ren), is married to the ( )Mother ( )Father and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 442 - 5. Petitioner’s relationship to the minor child(ren) is: ____________________________________. 6. The residence and post office address of the Petitioner is: ______________________________ ______________________________________________________________________________. 7. The legal mother of the child(ren) is _____________________________________, whose current address is:__________________________________________________________ . 8. The legal father of the child(ren) is ______________________________________, whose current address is: ______________________________________________________________. 9. Petitioner currently has physical custody of the child(ren) and has had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months. Detail the time periods during the past 12 months when the child(ren) have resided with the Petitioner: ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________. 10. Petitioner does not have signed, written documentation from a parent which is sufficient to enable the Petitioner to do all of the things necessary to care for the child(ren). 11. {If applicable} Describe the type of documents, if any, provided by the parent or parents which enables the Petitioner to act on behalf of the child(ren): ________________________________ ______________________________________________________________________________. These documents are attached to this Petition as Exhibit ________. 12. Petitioner is unable to obtain or undertake the following services or actions without an order of custody: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 13. The Consents of ______Father and/or _________ Mother is/are attached to the Petition. OR {If applicable} The Consent of the _________________ is not attached because that parent is deceased. A certified copy of the proof of death is attached. 14. Petitioner requests concurrent custody be granted for the following period of time:________________________________________________________________________. The reasons that support this request are: ___________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. 15. It is in the best interests of the child(ren) that the Petitioner have concurrent custody of the child(ren) for the following reasons: ________________________________________________ Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 443 - ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. 16. ORDER OF PROTECTION ____ Petitioner IS NOT aware of any temporary or permanent order for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. OR ____ Petitioner IS aware of the following temporary or permanent orders for protection entered on behalf of or against either parent, the Petitioner, or the child(ren) in Florida or any other jurisdiction. The court entering the order and the case number is: _______ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________. 17. TEMPORARY OR PERMANENT CHILD SUPPORT ORDERS ____ Petitioner IS NOT aware of any temporary or permanent orders for child support for the minor child(ren). OR ____ Petitioner IS aware of the following temporary or permanent order for child support for the minor child(ren). The court entering the order and the case number is:__________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________. 18. CHILD SUPPORT (If Petitioner is seeking child support) {Choose one only} (You must have proof of service upon or waiver of process by the parent(s) or a Waiver of Service of Process and Consent for the court to consider an award for child support) ____ Petitioner requests the court to order the parents to pay child support. ____ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner. ____ Petitioner requests the court to redirect all or part of Mother’s and/or Father’s existing child support obligation to the Petitioner, and to award the Petitioner child support arrearages. 19. Petitioner ____ requests _____ does not request that the court establish reasonable visitation or a time-sharing schedule with the parents. 20. Other _______________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ WHEREFORE, Petitioner requests that this Court grant the Petitioner concurrent custody of the child(ren) subject to this proceeding; award the Petitioner other relief as requested; and award any Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 444 - other relief that the Court deems necessary. Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 445 - 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 Code: ________________________ 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 of: {name of individual} ____________________________________________________________ , {name of business} ____________________________________________________________ , {address} ______________________________________________________________________ , {city} _________________, {state} _____, {zip code}__________, {telephone number} ______________ . Florida Supreme Court Approved Family Law Form 12.970(b), Petition for Concurrent Custody By Extended Family (03/15) - 446 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(c), WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY CUSTODY BY EXTENDED FAMILY (03/15) This form is to be completed and signed by a parent who agrees to grant temporary custody of a minor child or child(ren) to an extended family member and agrees to waive service of process. Service of process occurs when a summons and a copy of the petition (or other pleading) that has been filed with the court are delivered by a deputy or private process server. An Extended Family Member is: A relative of a minor child within the third degree by blood or marriage to the parent; OR The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where the Petition for Temporary Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(a) is filed and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. 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. Instructions for Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for Temporary Custody By Extended Family (03/15) - 447 - IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT, IN AND FOR _______________________________ COUNTY, FLORIDA Case No: _______________________ Division: _______________________ __________________________________, Petitioner, and __________________________________, Respondent/Mother, __________________________________, Respondent/Father. WAIVER OF SERVICE OF PROCESS AND CONSENT FOR TEMPORARY CUSTODY BY EXTENDED FAMILY I, _____________________________________________, the legal _____ Mother ____ Father of {child(ren)’s name)s)} _____________________________________________, having received a copy of the Petition for Temporary Custody by Extended Family filed herein and waived service of process, freely and voluntarily consent to the Petition filed by: {Petitioner’s Name} __________________________. I realize that by signing this document, I am consenting to the Petitioner having temporary legal custody of the minor child(ren) and that such temporary custody is in the best interest of the child(ren). Upon entry of an Order, the Petitioner shall be able to: 1. Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care; 2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to: a. Medical, dental, and psychiatric records; b. Birth Certificates and other records, and c. Educational records. 3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and 4. Do all other things necessary for the care of the child(ren). Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for Temporary Custody By Extended Family (03/15) - 448 - I realize that the custody of my child(ren) by the Petitioner is temporary and that I may, at any time, petition the court to return legal custody to me. Dated: __________________ _________________________________________ Signature of Parent Printed Name: ____________________________ Address: _________________________________ City, State, Zip Code: _______________________ 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 {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} ______________. Florida Supreme Court Approved Family Law Form 12.970(c), Waiver of Service of Process and Consent for Temporary Custody By Extended Family (03/15) - 449 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.970(d), WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT CUSTODY BY EXTENDED FAMILY (03/15) This form is to be completed and signed by a parent who agrees to grant concurrent custody of a minor child or child(ren) to an extended family member and who agrees to waive service of process. Service of process occurs when a summons and a copy of the petition (or other pleading) that has been filed with the court are delivered by a deputy or private process server. “Concurrent custody” means that an eligible extended family member is awarded custodial rights to care for a child or children concurrently with the child(ren)’s parent or parents. An Extended Family Member is: A relative of a minor child within the third degree by blood or marriage to the parent; OR The stepparent of a minor child if the stepparent is currently married to the parent of the child and is not a party in a pending dissolution, separate maintenance, domestic violence, or other civil or criminal proceeding in any court of competent jurisdiction involving one or both of the child(ren)’s parents as an adverse party. This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk. You should file the original with the clerk of the circuit court in the county where the Petition for Concurrent Custody by Extended Family, Florida Supreme Court Approved Family Law Form 12.970(b) is filed and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. 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. Instructions for Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for Concurrent Custody By Extended Family (03/15) - 450 - IN THE CIRCUIT COURT OF THE _______________ JUDICIAL CIRCUIT, IN AND FOR _______________________________ COUNTY, FLORIDA Case No: _______________________ Division: _______________________ __________________________________, Petitioner, and __________________________________, Respondent/Mother, __________________________________, Respondent/Father. WAIVER OF SERVICE OF PROCESS AND CONSENT FOR CONCURRENT CUSTODY BY EXTENDED FAMILY I, ____________________________________________, the legal _____ Mother _____ Father of {child(ren)’s name(s)} _____________________________________, having received a copy of the Petition for Concurrent Custody by Extended Family filed herein and waived service of process, freely and voluntarily consent to the Petition filed by {Petitioner’s Name} ______________________________ . I realize that by signing this document, I am consenting to the Petitioner having temporary concurrent custody of the minor child(ren) and that such concurrent custody is in the best interest of the child(ren). Upon entry of an Order, the Petitioner shall be able to: 1. Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care; 2. Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to: a. Medical, dental, and psychiatric records; b. Birth Certificates and other records, and c. Educational records. 3. Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and 4. Do all other things necessary for the care of the child(ren). Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for Concurrent Custody By Extended Family (03/15) - 451 - I realize that the concurrent custody of my child(ren) by the Petitioner is temporary and that I may, at any time, petition the court to return legal custody to me. Dated: __________________________ _________________________________________ Signature of Parent Printed Name: _____________________________ Address: __________________________________ City, State, Zip Code: ________________________ 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 {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} ___________ . Florida Supreme Court Approved Family Law Form 12.970(d), Waiver of Service of Process and Consent for Concurrent Custody By Extended Family (03/15) - 452 - IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT IN AND FOR __________________________ COUNTY, FLORIDA Case No: ______________________ Division: ______________________ __________________________________, Petitioner, and __________________________________, Respondent/Mother __________________________________, Respondent/Father. ORDER GRANTING PETITION FOR TEMPORARY CUSTODY BY EXTENDED FAMILY This case came before this Court for a hearing on a Petition for Temporary Custody by Extended Family. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: SECTION I. FINDINGS: 1. The Court has jurisdiction over the subject matter and the parties. 2. The minor child(ren) at issue in this matter are: Name Date of Birth ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 3. The Petitioner, {full legal name} _______________________________________ is the {extended family relationship}_____________________________________________ of the child(ren). 4. The Mother {full legal name} _________________________________ of the child(ren): {Choose one only} ____ Filed a Waiver and Consent ____ Was served with the petition and failed to file an Answer Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 453 - ____ Is deceased as evidenced by: _________________________________________ ____ Objected to the petition. Based upon clear and convincing evidence, the Court finds that the Mother is unfit to provide for the care and control of the child(ren). Specifically, the Mother has abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes. It is in the best interest of the child(ren) that the Petitioner have temporary custody because: {facts in support of finding} __________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________ . 5. The Father {full legal name} _________________________________ of the child(ren): {Choose one only} ____ Filed a Waiver and Consent ____ Was served with the petition and failed to file an Answer ____ Is deceased as evidenced by: _________________________________________ ____ Objected to the petition. Based upon clear and convincing evidence, the Court finds that the Father is unfit to provide for the care and control of the child(ren). Specifically, the Father has abused, abandoned, or neglected the child(ren) as defined in Chapter 39, Florida Statutes. It is in the best interest of the child(ren) that the Petitioner have temporary custody because: {facts in support of finding} _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________. 6. It is in the best interest of the child(ren) for the Petitioner to have temporary custody. SECTION II: TEMPORARY CUSTODY 1. The Petitioner, ________________________________________, is granted temporary custody of the minor child(ren). 2. The Petitioner shall have all the rights and responsibilities of a legal parent. 3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor child(ren), including but not limited to: a) Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care; Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 454 - b) Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to: medical, dental, and psychiatric records; birth certificates and other records; and educational records; c) Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and d) Do all other things necessary for the care of the child(ren). SECTION III. TEMPORARY TIME-SHARING WITH MINOR CHILD(REN) The parent(s) shall have: {Choose one only} 1. ____ reasonable time-sharing with the minor child(ren) as agreed to by the parties, subject to the following limitations: __________________________________________ _______________________________________________________________________. 2. ____ the following specified time-sharing schedule: {specify days and times} _______ ______________________________________________________________________. Mother’s Temporary Time-Sharing Schedule. ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________. Father’s Temporary Time-Sharing Schedule. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________. 3. ____ Time-Sharing in accordance with the temporary Parenting Plan attached as Exhibit ____. 4. The____ Mother _____ Father shall have No Contact with the minor child(ren) until further order of the Court, due to existing conditions that are detrimental to the welfare of the minor child(ren): {explain} ____________________________________________ _______________________________________________________________________ _______________________________________________________________________. SECTION IV. CHILD SUPPORT 1. The Petitioner ____ did ____ did not request the establishment of child support. 2. ____ If child support is requested, the parents have received personal or substituted Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 455 - service of process, the petition requests an order for support of the child(ren), and there is evidence of the parents’ ability to pay the support ordered. The _____ Mother _____Father has the present ability to pay child support. {Choose one only} a. ____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e) filed by the _____Mother _____ Father are correct; OR b. ____ The Court makes the following findings: The Mother’s net monthly income is $____________, (Child Support Guidelines ____%). The Father’s net monthly income is $_____________, (Child Support Guidelines ____%) Monthly child care costs are $_________________. Monthly health/dental insurance costs are $_____________. OR c. The ____ Mother _____ Father is currently ordered to pay child support to the other parent in the amount of $_____________ per _______________ as established in the case of {style of case and number} __________________________________________ _______________________________________________________________________. _____ All of the child support or _____ a portion of the child support in the amount of $____________ shall be redirected to the Petitioner. 3. Amount a) Father’s Obligation The Father shall be obligated to pay child support at the rate of $___________ per month for the ______ children {total number of parties’ minor or dependent children} commencing ___________________________ {month, day, year} and terminating ________________________ {month, day, year}. Child support shall be paid in the amount of $___________ per ___________ {week, month, other} which is consistent with the Father’s current payroll cycle. Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $______ for the remaining_______ children {total number of remaining children} shall be paid commencing _______________ {month, day, year} and terminating _______________________ {month, day, year}. This child support shall be paid in the amount of $____________ per ________ {week, month, other} consistent with the Father’s current payroll cycle. {Insert paragraph for the child support obligation, including the amount, and commencement and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.} The Father shall pay child support until all minor or dependent children: reach the age of 18; become emancipated, marry, join the armed services, die, or become selfFlorida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 456 - supporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any child who is dependent in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a reasonable expectation of graduation before the age of 19. If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: __________________________________ _____________________________________________________________________ ____________________________________________________________________. b) Mother’s Obligation The Mother shall be obligated to pay child support at the rate of $____________ per month for the ______ children {total number of parties’ minor or dependent children} commencing _____________________ {month, day, year} and terminating ______________________ {month, day, year}. Child support shall be paid in the amount of $_________ per _________ {week, month, other} consistent with the Mother’s current payroll cycle. Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $___________ for the remaining ______ children {total number of remaining children} shall be paid commencing _______________ {month, day, year} and terminating ________________________ {month, day, year}. This child support shall be paid in the amount of $____________ per _____________{week, month, other} consistent with the Mother’s current payroll cycle. {Insert paragraph for the child support obligation, including the amount, and commencement and termination dates, for the remaining minor or dependent children which shall be payable as the obligation for each child ceases.} The Mother shall pay child support until all of the minor or dependent children: reach the age of 18; become emancipated, marry, join the armed services, die, or become self-supporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any child who is dependent in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a reasonable expectation of graduation before the age of 19. If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: __________________________________ ____________________________________________________________________. Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 457 - 4. Arrearages/Retroactive Child Support a) The _____ Mother _____ Father owes child support arrearages in the amount of $_____________ as of {date} ________________ to the other parent. The child support arrearages shall be repaid in the amount of $_________ per month, payable _____ in accordance with the employer’s payroll cycle, and in any event at least once per month _____other {explain} ______________________________________ commencing {date} _____________________, until paid in full including statutory interest. b) The _____ Mother _____ Father owes retroactive child support in the amount of $___________ as of {date} ________________ to the Petitioner. The retroactive child support shall be repaid in the amount of $_______ per month, payable _____ in accordance with the employer’s payroll cycle, and in any event at least once per month _____other {explain} ____________________________________________ _____________________________________________________________________ commencing {date} ______________________, until paid in full including statutory interest. 5. Insurance {Choose all that apply} a) The _____ Mother _____ Father shall be required to maintain _____ health and/or _____ dental insurance for the parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren). The party providing insurance shall be required to convey insurance cards demonstrating said coverage to the Petitioner and other parent. OR _____ Health and/or _____ dental insurance is either not reasonable in cost or accessible to the child(ren) at this time. b) ____ Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: _____ Shared equally by both parents. _____ Prorated according to the child support guidelines percentages. _____ Other {explain} ______________________________________________ As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit a request for reimbursement to the parent or parents within 30 days, and the parent or parents, within 30 days of receipt, shall submit the applicable reimbursement for that expense. Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 458 - SECTION V. METHOD OF PAYMENT The parent(s) shall pay court-ordered child support and arrearages, if any, as follows: 1. Place of Payment a) ____Parent(s) shall pay court-ordered support directly to either the State Disbursement Unit or the central depository, as required by statute, along with any fee required by statute. OR b) ____ The Petitioner and the Parent(s) have requested and the Court finds that it is in the best interest of the child(ren) that support payments need not be directed through either the State Disbursement Unit or the central depository at this time; however, any party may subsequently apply, pursuant to section 61.13(1)(d)(3), Florida Statutes, to require payment through either the State Disbursement Unit or the central depository. 2. Income Deduction (If applicable) a) ____ Immediate. _____ Mother _____ Father, hereinafter, Obligor(s), shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from his/her income. Until support payments are deducted, the Obligor is responsible for making timely payments directly to the State Disbursement Unit or the Petitioner as previously set forth in this Order. b) ____ Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $_____________, or, if not specified, an amount equal to one month’s obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} _____________________________________________ _____________________________________________________________________ ____________________________________________________________________. AND There is proof of timely payment of a previously ordered obligation without an Income Deduction Order, AND _____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the clerk of court, and the Petitioner of any change in Payor and/or health insurance OR _____ there is a signed, written agreement providing an alternative arrangement between the Petitioner and the Obligor(s) and, at the option of the IV-D agency, by Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 459 - the IV-D agency in IV-D cases in which there is an assignment of support rights to the state, reviewed and entered into the record by the court. 3. Bonus/one-time payments. {Choose one only} _____ All _____ __________% _____ No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment: _______________________________ _______________________________________________________________________. SECTION VI. ATTORNEY’S FEES, COSTS, AND SUIT MONEY {Choose one only} 1. The ____ Petitioner’s _____Respondents’ request(s) for attorney’s fees, costs, and suit money is (are) denied because ______________________________________________ _______________________________________________________________________. 2. ____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party $___________ in attorney’s fees, and $ ___________ in costs. The Court further finds that the attorney’s fees are awarded based on the reasonable rate of $________________ per hour and _________ reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows: ___________________ _______________________________________________________________________. SECTION VII. OTHER PROVISIONS 1. Other Provisions ________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________. 2. The Court reserves jurisdiction to modify and enforce this Order for Temporary Custody. Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 460 - DONE AND ORDERED in ______________________, Florida on {date} __________________ _____________________________ CIRCUIT JUDGE I certify that a copy of this Order for Temporary Custody was: ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties and any entities listed below on {date} _________________________. by ________________________________ {Clerk of court or designee}. Petitioner (or his or her attorney) Respondents (or his or her attorney) _____State Disbursement Unit _____Central Depository _____Other _________________________________ Florida Supreme Court Approved Family Law Form 12.970(e), Order Granting Petition for Temporary Custody by Extended Family (03/15) - 461 - IN THE CIRCUIT COURT OF THE _________________________ JUDICIAL CIRCUIT IN AND FOR __________________________ COUNTY, FLORIDA Case No: ______________________ Division: ______________________ __________________________________, Petitioner, and __________________________________, Respondent/Father __________________________________, Respondent/Mother. ORDER GRANTING PETITION FOR CONCURRENT CUSTODY BY EXTENDED FAMILY This case came before this Court for a hearing on a Petition for Concurrent Custody by Extended Family. The Court, having reviewed the file and heard the testimony, makes these findings of fact and reaches these conclusions of law: SECTION I. FINDINGS: 1. The Court has jurisdiction over the subject matter and the parties. 2. The minor child(ren) at issue in this matter are: Name Date of Birth ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 3. The Petitioner, {full legal name} _____________________________________ is the {extended family relationship} _________________________________ of the child(ren). 4. The Petitioner currently has physical custody of the child(ren) and has had physical custody of the child(ren) for at least 10 days in any 30-day period within the last 12 months. Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 462 - 5. The Petitioner does not have signed, written documentation from the parent(s) which is sufficient to enable the custodian to do all the things necessary to care for the child(ren) which are available to custodians who have an order for temporary custody by extended family. 6. The Mother {full legal name} _________________________________ of the child(ren): {choose one only} ____ Filed a Waiver and Consent ____ Was served with the petition and failed to file an Answer ____ Is deceased as evidenced by: _______________________________________ 7. The Father {full legal name} _________________________________ of the child(ren): {choose one only} ____ Filed a Waiver and Consent ____ Was served with the petition and failed to file an Answer ____ Is deceased as evidenced by: _______________________________________ 8. It is in the best interest of the child(ren) for the Petitioner to have concurrent custody. SECTION II: CONCURRENT CUSTODY 1. The Petitioner,___________________________________________________, is granted concurrent custody of the minor child(ren). 2. The Petitioner shall have all the concurrent rights and responsibilities of a legal parent. 3. The Petitioner is authorized to make all reasonable and necessary decisions for the minor child(ren), including but not limited to: a) Consent to all necessary and reasonable medical and dental care for the child(ren), including nonemergency surgery and psychiatric care; b) Secure copies of the child(ren)’s records, held by third parties, that are necessary for the care of the child(ren), including, but not limited to: medical, dental, and psychiatric records; birth certificates and other records; and educational records, c) Enroll the child(ren) in school and grant or withhold consent for the child(ren) to be tested or placed in special school programs, including exceptional education; and d) Do all other things necessary for the care of the child(ren). Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 463 - Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 464 - SECTION III. CHILD SUPPORT 1. The Petitioner ____ did ____ did not request the establishment of child support. 2. ____ If child support is requested, the parents have received personal or substituted service of process, the petition requests an order for support of the child(ren), and there is evidence of the parents’ ability to pay the support ordered. The _____ Mother _____ Father has the present ability to pay child support. {Choose one only} a.____ The amounts in the Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e) filed by the ( ) Mother ( ) Father are correct; OR b.____ The Court makes the following findings: The Mother’s net monthly income is $____________, (Child Support Guidelines ____%). The Father’s net monthly income is $_____________, (Child Support Guidelines ____%) Monthly child care costs are $_________________. Monthly health/dental insurance costs are $_____________. OR c.____ The ( ) Mother ( ) Father is currently ordered to pay child support to the other parent in the amount of $_____________ per ________________ as established in the case of (style of case and number} _________________________________________ _____________________________________________________________________. _____ All of the child support or _____ a portion of the child support in the amount of $___________ shall be redirected to the Petitioner. 3. Amount a) Father’s Obligation The Father shall be obligated to pay child support at the rate of $__________ per month for the _____children {total number of parties’ minor or dependent children} commencing ____________ {month, day, year} and terminating _____________ {month, day, year}. Child support shall be paid in the amount of $______________ per _____________ {week, month, other} which is consistent with the Father’s current payroll cycle. Upon the termination of child support for one of the parties’ children, child support in the amount of $_____________ for the remaining _____ children {total number of remaining children} shall be paid commencing __________________ {month, day, year} and terminating _________________________ {month, day, year}. This child support shall be paid in the amount of $___________ per ____________{week, month, other} consistent with the Father’s current payroll cycle. Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 465 - {Insert paragraph for the child support obligation, including the amount, and commencement and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.} The Father shall pay child support until all of the minor or dependent children: reach the age of 18, become emancipated, marry, join the armed services, die, or become selfsupporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any child who is dependent in fact, between the ages of 18 and 19, and is still in high school, performing in good faith with a reasonable expectation of graduation before the age of 19. If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are: ____________________________________ _______________________________________________________________________ _______________________________________________________________________. b) Mother’s Obligation The Mother shall be obligated to pay child support at the rate of $____________ per month for the _______children {total number of parties’ minor or dependent children} commencing__________________________ {month, day, year} and terminating __________________ {month, day, year}. Child support shall be paid in the amount of $__________per ______________ {week, month, other} consistent with the Mother’s current payroll cycle. Upon the termination of the obligation of child support for one of the parties’ children, child support in the amount of $__________ for the remaining ______ children {total number of remaining children} shall be paid commencing _____________________ {month, day, year} and terminating ________________________ month, day, year}. This child support shall be paid in the amount of $______________ per _______________ {week, month, other} consistent with the Mother’s current payroll cycle. {Insert paragraph for the child support obligation, including the amount, and commencement and termination dates, for the remaining minor or dependent children, which shall be payable as the obligation for each child ceases.} The Mother shall pay child support until all of the minor or dependent children: reach the age of 18; become emancipated, marry, join the armed services, die, or become selfsupporting; or until further order of the court or agreement of the parties. The child support obligation shall continue beyond the age of 18 and until high school graduation for any child who is dependent in fact, between the ages of 18 and 19, and is still in high Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 466 - school, performing in good faith with a reasonable expectation of graduation before the age of 19. If the child support ordered deviates from the guidelines more than 5%, the factual findings which support that deviation are:______________________________________ ________________________________________________________________________ _______________________________________________________________________. 4. Arrearages/Retroactive Child Support c) The _____ Mother _____ Father owes child support arrearages in the amount of $__________ as of {date} ________________ to the other parent. The child support arrearages shall be repaid in the amount of $_______ per month, payable _____ in accordance with the employer’s payroll cycle, and in any event at least once per month _____other {explain} ____________________________ __________________________________________________________________ commencing {date} ______________________ , until paid in full including statutory interest. d) The _____ Mother _____ Father owes retroactive child support in the amount of $___________ as of {date} ________________ to the Petitioner. The retroactive child support shall be repaid in the amount of $_______ per month, payable _____in accordance with the employer’s payroll cycle, and in any event at least once per month _____ other {explain} _________________________________ __________________________________________________________________ commencing {date} ______________________, until paid in full including statutory interest. 5. Insurance {Choose all that apply} c) The _____ Mother _____ Father shall be required to maintain _____ health and/or _____ dental insurance for the parties’ minor child(ren), so long as reasonable in cost and accessible to the child(ren). The party providing insurance shall be required to convey insurance cards demonstrating said coverage to the Petitioner and other parent. OR _____ Health and/or _____ dental insurance is either not reasonable in cost or accessible to the child(ren) at this time. d) _____ Reasonable and necessary uninsured medical/dental/prescription drug costs for the minor child(ren) shall be assessed as follows: _____ Shared equally by both parents. Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 467 - _____ Prorated according to the child support guidelines percentages. _____ Other {explain} ____________________________________________ As to these uninsured medical/dental/prescription drug expenses, the party who incurs the expense shall submit a request for reimbursement to the parent or parents within 30 days, and the parent or parents, within 30 days of receipt, shall submit the applicable reimbursement for that expense. SECTION IV. METHOD OF PAYMENT The parent(s) shall pay court-ordered child support and arrearages, if any, as follows: 1. Place of Payment a) _____Parents shall pay court-ordered support directly to either the State Disbursement Unit or the central depository, as required by statute, along with any applicable fee required by statute. OR b) ____ The Petitioner and the Parents have requested and the court finds that it is in the best interest of the child(ren) that support payments need not be directed through either the State Disbursement Unit or the central depository at time; however, any party may subsequently apply, pursuant to 61.13(1)(d)(3), Florida Statutes, to require payment through either the State Disbursement Unit or the central depository. 2. Income Deduction (If applicable) a) _____ Immediate. _____ Mother _____ Father, hereinafter, Obligor(s), shall pay through income deduction, pursuant to a separate Income Deduction Order which shall be effective immediately. Obligor is individually responsible for paying this support obligation until all of said support is deducted from his/her income. Until support payments are deducted, the Obligor is responsible for making timely payments directly to the State Disbursement Unit or the Petitioner as previously set forth in this Order. b) _____ Deferred. Income deduction is ordered this day, but it shall not be effective until a delinquency of $_____________, or, if not specified, an amount equal to one month’s obligation occurs. Income deduction is not being implemented immediately based on the following findings: Income deduction is not in the best interests of the child(ren) because: {explain} _____________________________________________________ Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 468 - _______________________________________________________________ . AND There is proof of timely payment of a previously ordered obligation without an Income Deduction Order, AND _____ there is an agreement by the Obligor(s) to advise the Title IV-D agency, the clerk of court, and the Petitioner of any change in Payor and/or health insurance OR _____ there is a signed, written agreement providing an alternative arrangement between the Petitioner and Obligor(s) and, at the option of the IV-D agency, by the IV-D agency in IV-D cases in which there is an assignment of support rights to the state, reviewed and entered into the record by the court. 3. Bonus/one-time payments. {Choose one only} _____ All _____ __________% _____ No income paid in the form of a bonus or other similar one-time payment, up to the amount of any arrearage or the remaining balance thereof owed pursuant to this order, shall be forwarded to the Petitioner pursuant to the payment method prescribed above. 4. Other provisions relating to method of payment: _______________________________ ________________________________________________________________________ SECTION V. ATTORNEY’S FEES, COSTS, AND SUIT MONEY {Choose one only} 1. The _____ Petitioner’s _____ Respondents’ request(s) for attorney’s fees, costs, and suit money is (are) denied because _____________________________________________ _____________________________________________________________________ . 2. _____ The Court finds there is a need for and ability to pay attorney’s fees, costs, and suit money. _____ Petitioner _____ Respondent(s) is (are) ordered to pay the other party $_____________ in attorney’s fees, and $ ___________ in costs. The Court further finds that the attorney’s fees are awarded based on the reasonable rate of $________________ per hour and ______ reasonable hours. Other provisions relating to attorney’s fees, costs, and suit money are as follows: __________________________ _______________________________________________________________________. SECTION VI. OTHER PROVISIONS Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 469 - 1. Other Provisions _________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. The Court reserves jurisdiction to modify and enforce this Order for Concurrent Custody. 3. The granting of concurrent custody does not affect the ability of the child(ren)’s parent or parents to obtain physical custody of the child(ren) at any time. DONE AND ORDERED in _____________________, Florida on {date} ____________________ _____________________________ CIRCUIT JUDGE I certify that a copy of this Order for Concurrent Custody was: ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the parties and any entities listed below on {date}________________________. by____________________________ {Clerk of court or designee} Petitioner (or his or her attorney) Respondents (or his or her attorney) _____State Disbursement Unit _____Central Depository _____Other _________________________________ Florida Supreme Court Approved Family Law Form 12.970(f), Order Granting Petition for Concurrent Custody by Extended Family (03/15) - 470 - INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(a) PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE (03/15) When should this form be used? If you are a victim of any act of domestic violence or have reasonable cause to believe that you are in imminent danger of becoming a victim of domestic violence, you can use this form to ask the court for a protective order prohibiting domestic violence. Because you are making a request to the court, you are called the petitioner. The person whom you are asking the court to protect you from is called the respondent. Domestic violence includes: assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any other criminal offense resulting in physical injury or death to petitioner by any of petitioner’s family or household members. In determining whether you have reasonable cause to believe you are in imminent danger of becoming a victim of domestic violence, the court must consider all relevant factors alleged in the petition, including, but not limited to the following: 1. The history between the petitioner and the respondent, including threats, harassment, stalking, and physical abuse. 2. Whether the respondent has attempted to harm the petitioner or family members or individuals closely associated with the petitioner. 3. Whether the respondent has threatened to conceal, kidnap, or harm the petitioner’s child or children. 4. Whether the respondent has intentionally injured or killed a family pet. 5. Whether the respondent has used, or has threatened to use, against the petitioner any weapons such as guns or knives. 6. Whether the respondent has physically restrained the petitioner from leaving the home or calling law enforcement. 7. Whether the respondent has a criminal history involving violence or the threat of violence. 8. The existence of a verifiable order of protection issued previously or from another jurisdiction. 9. Whether the respondent has destroyed personal property, including, but not limited to, telephones or other communications equipment, clothing, or other items belonging to the petitioner. 10. Whether the respondent engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe that he or she is in imminent danger of becoming a victim of domestic violence. Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 471 - The domestic violence laws only apply to your situation if the respondent is your spouse, former spouse, related to you by blood or marriage, living with you now or has lived with you in the past (if you are or were living as a family), or the other parent of your child(ren) whether or not you have ever been married or ever lived together. With the exception of persons who have a child in common, the family or household members must be currently residing together or have in the past resided together in the same single dwelling unit. If the respondent is not one of the above, you should look at Petition for Injunction for Protection Against Repeat Violence, Florida Supreme Court Approved Family Law Form 12.980(f), to determine if your situation will qualify for an injunction for protection against repeat violence, or Petition for Injunction for Protection Against Dating Violence, Florida Supreme Court Approved Family Law Form 12.980(n), to determine if your situation will qualify for an injunction for protection against dating violence, or Petition for Injunction for Protection Against Sexual Violence, Florida Supreme Court Approved Family Law Form 12.980(q), to determine if your situation will qualify for an injunction for protection against sexual violence. If you are under the age of eighteen and you have never been married or had the disabilities of nonage removed by a court, then one of your parents, custodians, or your legal guardian must sign this petition with you. This form should be typed or printed in black ink. You should complete this form (giving as much detail as possible) and sign it in front of a notary public or the clerk of the circuit court in the county where you live. The clerk will take your completed petition to a judge. You should keep a copy for your records. If you have any questions or need assistance completing this form, the clerk or family law intake staff will help you. What should I do if the judge grants my petition? If the facts contained in your petition convince the judge that you are a victim of domestic violence or that an imminent danger of domestic violence exists, the judge will sign either an immediate Temporary Injunction for Protection Against Domestic Violence with Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(c)(1) or an immediate Temporary Injunction for Protection Against Domestic Violence without Minor Child(ren), Florida Supreme Court Approved Family Law Form 12.980(c)(2). A temporary injunction is issued without notice to the respondent. The clerk will give your petition, the temporary injunction, and any other papers filed with your petition to the sheriff or other law enforcement officer for personal service on the respondent. The temporary injunction will take effect immediately after the respondent is served with a copy of it. It lasts until a full hearing can be held or for a period of 15 days, whichever comes first. The court may extend the temporary injunction beyond 15 days for a good reason, which may include failure to obtain service on the respondent. Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 472 - The temporary injunction is issued ex parte. This means that the judge has considered only the information presented by one side-- YOU. The temporary injunction gives a date that you must appear in court for a hearing. At that hearing, you will be expected to testify about the facts in your petition. The respondent will be given the opportunity to testify at this hearing, also. At the hearing, the judge will decide whether to issue either a Final Judgment of Injunction for Protection Against Domestic Violence with Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(1), or a Final Judgment of Injunction for Protection Against Domestic Violence without Minor Child(ren)(After Notice), Florida Supreme Court Approved Family Law Form 12.980(d)(2). Either of these final judgments will remain in effect for a specific time period or until modified or dissolved by the court. If either you or the respondent do not appear at the final hearing, the temporary injunction may be continued in force, extended, or dismissed, and/or additional orders may be granted, including entry of a permanent injunction and the imposition of court costs. You and respondent will be bound by the terms of any injunction issued at the final hearing. IF EITHER YOU OR RESPONDENT DO NOT APPEAR AT THE FINAL HEARING, YOU WILL BOTH BE BOUND BY THE TERMS OF ANY INJUNCTION ISSUED IN THIS MATTER. If the judge signs a temporary or final injunction, the clerk will provide you with the necessary copies. Make sure that you keep one certified copy of the injunction with you at all times! What can I do if the judge denies my petition? If your petition is denied solely on the grounds that it appears to the court that no imminent danger of domestic violence exists, the court will set a full hearing, at the earliest possible time, on your petition, unless you request that no hearing be set. The respondent will be notified by personal service of your petition and the hearing. If your petition is denied, you may: amend your petition by filing a Supplemental Affidavit in Support of Petition for Injunction for Protection Against Domestic Violence, Repeat or Dating Violence, Florida Family Law Form 12.980 (g); attend the hearing and present facts that support your petition; and/or dismiss your petition. Where can I look for more information? Before proceeding, you should read General Information for Self-Represented Litigants found at the beginning of these forms. The words that are in bold underline are defined in that section. The clerk of the circuit court or family law intake staff will help you complete any necessary domestic violence forms and can give you information about local domestic violence victim assistance programs, shelters, and other related services. You may also call the Domestic Violence Hotline at 1-800-500-1119. For further information, see Chapter 741, Florida Statutes, and Rule 12.610, Florida Family Law Rules of Procedure. IMPORTANT INFORMATION REGARDING E-FILING Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 473 - The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Special notes... With this form you may also need to file the following:  Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA) Affidavit, Florida Supreme Court Approved Family Law Form 12.902(d), must be completed and filed if you are asking the court to determine issues with regard to your parenting plan or time-sharing for a minor child(ren).  Parenting plan means a document created to govern the relationship between the parents relating to the decisions that must be made regarding the minor child(ren) and must contain a time-sharing schedule for the parents and child(ren). The issues concerning the minor child(ren) may include, but are not limited to, the child(ren)’s education, health care, and physical, social, and emotional well-being. In creating the plan, all circumstances between the parents, including their historic relationship, domestic violence, and other Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 474 - factors must be taken into consideration. The Parenting Plan shall be developed and agreed to by the parents and approved by a court, or, established by the court, with or without the use of a court-ordered parenting plan recommendation. If the parents cannot agree, or if the parents agreed to a plan that is not approved by the court, a Parenting Plan shall established by the court. “Time-sharing schedule” means a timetable that must be included in the Parenting Plan that specifies the time, including overnights and holidays, that a minor child will spend with each parent. If developed and agreed to by the parents of a minor child, it must be approved by the court. If the parents cannot agree, of if their agreed-upon schedule is not approved by the court, the schedule shall be established by the court.  Notice of Social Security Number, Florida Supreme Court Approved Family Law Form 12.902(j), must be completed and filed if you are asking the court to determine issues of temporary child support.  Family Law Financial Affidavit, Florida Family Law Rules of Procedure Form 12.902(b) or (c), must be completed and filed if you are seeking temporary alimony or temporary child support.  Child Support Guidelines Worksheet, Florida Family Law Rules of Procedure Form 12.902(e), MUST be filed with the court at or prior to a hearing to establish or modify child support. Additionally, if you fear that disclosing your address to the respondent would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and file it with the clerk of the circuit court and write confidential in the space provided on the petition. Instructions for Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 475 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA Case No.: Division: , Petitioner, and , Respondent. PETITION FOR INJUNCTION FOR PROTECTION AGAINST DOMESTIC VIOLENCE I, {full legal name} , being sworn, certify that the following statements are true: SECTION I. PETITIONER (This section is about you. It must be completed. However, if you fear that disclosing your address to the respondent would put you in danger, you should complete and file a Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h), and write confidential in the space provided on this form for your address and telephone number.) 1. Petitioner’s current address is: {street address} {city, state and zip code} Telephone Number: {area code and number} Physical description of Petitioner: Race: _____ Sex: Male _____ Female _____ Date of Birth: _________________________ 2. Petitioner’s attorney’s name, address, and telephone number is: . (If you do not have an attorney, write none.) SECTION II. RESPONDENT (This section is about the person you want to be protected from. It must be completed.) 1. Respondent’s current address is: {street address, city, state, and zip code} . Respondent’s Driver’s License number is: {if known} . Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 476 - 2. Respondent is: {Indicate all that apply} a. _____ the spouse of Petitioner. Date of Marriage: b. _____ the former spouse of Petitioner. Date of Marriage: Date of Dissolution of Marriage: c. _____ related by blood or marriage to Petitioner. Specify relationship: d. _____ a person who is or was living in one home with Petitioner, as if a family. e._____ a person with whom Petitioner has a child in common, even if Petitioner and Respondent never were married or living together. 3. Petitioner has known Respondent since {date} . 4. Respondent’s last known place of employment: Employment address: Working hours: 5. Physical description of Respondent: Race: _____ Sex: Male _____ Female _____Date of Birth: _______________________________ Height: Weight: Eye Color: Hair Color: Distinguishing marks or scars: Vehicle: (make/model) Color: Tag Number: 6. Other names Respondent goes by (aliases or nicknames): 7. Respondent’s attorney’s name, address, and telephone number is: (If you do not know whether Respondent has an attorney, write unknown. If Respondent does not have an attorney, write none.) SECTION III. CASE HISTORY AND REASON FOR SEEKING PETITION (This section must be completed.) 1. Has Petitioner ever received or tried to get an injunction for protection against domestic violence against Respondent in this or any other court? _ Yes _ No If yes, what happened in that case? {Include case number, if known} Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 477 - 2. Has Respondent ever received or tried to get an injunction for protection against domestic violence against Petitioner in this or any other court? _ Yes _ No If yes, what happened in that case? {Include case number, if known} . 3. Describe any other court case that is either going on now or that happened in the past, including a dissolution of marriage, paternity action, or child support enforcement action, between Petitioner and Respondent {Include city, state, and case number, if known}: ______________________________________________________________________________. 4. Petitioner is either a victim of domestic violence or has reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence because respondent has: {mark all sections that apply and describe in the spaces below the incidents of violence or threats of violence, specifying when and where they occurred, including, but not limited to, locations such as a home, school, place of employment, or time-sharing exchange} a. _____committed or threatened to commit domestic violence defined in section 741.28, Florida Statutes, as any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another. With the exception of persons who are parents of a child in common, the family or household members must be currently residing or have in the past resided together in the same single dwelling unit. b. _____previously threatened, harassed, stalked, or physically abused the petitioner. c. _____attempted to harm the petitioner or family members or individuals closely associated with the petitioner. d. _____threatened to conceal, kidnap, or harm the petitioner's child or children. e. _____intentionally injured or killed a family pet. f. _____used, or has threatened to use, against the petitioner any weapons such as guns or knives. g. _____physically restrained the petitioner from leaving the home or calling law enforcement. h. _____a criminal history involving violence or the threat of violence (if known). i. _____another order of protection issued against him or her previously or from another jurisdiction (if known). j. _____destroyed personal property, including, but not limited to, telephones or other communication equipment, clothing, or other items belonging to the petitioner. k. _____engaged in any other behavior or conduct that leads the petitioner to have reasonable cause to believe he or she is in imminent danger of becoming a victim of domestic violence. Florida Supreme Court Approved Family Law Form 12.980(a), Petition for Injunction for Protection Against Domestic Violence (03/15) - 478 - Below is a brief description of the latest act of violence or threat of violence that causes Petitioner to honestly fear imminent domestic violence by Respondent. (Use additional sheets if necessary.) On {date} ________, at {location} ___________________________________, Respondent: . _______ Please indicate here if you are attaching additional pages to continue these facts. 5. Additional Information {Indicate all that apply} a.____Other acts or threats of domestic violence as described on attached sheet. b.____This or other acts of domestic violence have been previously reported to {person or agency}:_____________________________________________________________ c.____ Respondent owns, has, and/or is known to have guns or other weapons. Describe weapon(s): d. ____ Respondent has a drug problem.