Opinion ID: 1637669
Heading Depth: 1
Heading Rank: 13

Heading: response by parenting coordinator

Text: I, { name } ______________________ notify the Court and affirm the following: 1. Acceptance. [Choose only one] a. ____ I accept the appointment as parenting coordinator. b. ____ I decline the appointment as parenting coordinator. 2. Qualifications. [Choose only one] a. ____ I meet the qualifications in section 61.125(4), Florida Statutes. b. ____ I do not meet the qualifications in section 61.125(4), Florida Statutes. However, the parties have chosen me by mutual consent and I believe I can perform the services of a parenting coordinator because: _____________________________________ _________________________________________ _________________________________________ 3. I am not aware of any conflict, circumstance, or reason that renders me unable to serve as the parenting coordinator in this matter and I will immediately inform the court and the parties if such arises. 4. I understand my role, responsibility, and authority under the Order of Referral to Parenting Coordinator, Florida Family Law Rules of Procedure Form 12.998(a) and section 61.125, Florida Statutes. I hereby affirm the truth of the statements in this acceptance and understand that if I make any false representations in this acceptance, I am subject to sanctions by the Court. ____________ Date __________________ Signature Printed Name: __________________ Address: ____________________ City, State, Zip: _______________ Telephone Number: ________________ Professional License # (if applicable) _________ Professional Certification # (if applicable) _______ Copies to: Attorney for Parent # 1 OR Parent # 1 if not represented by Counsel Attorney for Parent #2 OR Parent # 2 if not represented by Counsel IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] I, { full legal name and trade name of nonlawyer } ____________, a nonlawyer, whose address is { street } _______________, { city } ____________, { state } _________, { phone } ________, helped { name } ___________________, who is Florida Family Law Rules of Procedure Form 12.998, Order of Referral to Parenting Coordinator (1/10) IN THE CIRCUIT COURT OF THE ________________ JUDICIAL CIRCUIT, IN AND FOR _________________ COUNTY, FLORIDA Case No: _____________ Division: ___________ ______________________, Petitioner, And ______________________, Respondent.